The influence of blood velocity and vessel geometric parameters on wall shear stress.

Vascular geometry was proposed to be one risk factor of atherosclerosis (AS). When developing this hypothesis, the discussion of geometry-wall shear stress (WSS) has often been included. However, further exploration on how various geometric parameters were affecting WSS was needed. The purpose of this study was to investigate the influence degree of vessel geometric parameters and blood velocity on WSS. A computational fluid dynamics (CFD) analyses of the vertebral and basilar arteries (VA and BA, respectively) was used. Twenty patients with no plaques or vessel wall thickening at the VA and BA were included. CFD analyses using both specific vessel models and flow conditions measured by ultrasound Doppler were performed. Subsequently, CFD results were post-processed with multiple linear regression to investigate numerical correlations between geometrical and flow parameters and WSS. The results of the multiple linear regression analysis further demonstrated that the BA proximal velocity was the most influential factor positively influencing BA WSS. The lower the WSS was, the stronger the influence brought by BA average diameter would be. The regression demonstrated that the contributions brought by average diameter and proximal velocity in lower WSS regions were lower than that in higher WSS regions. Tortuosity was only positively correlated with 97.5th WSS percentile, and vessel length and curvature showed no correlation with WSS. This study quantified the influence degree of BA morphology and flow velocity on WSS, which may have practical implications for predicting hemodynamic risks.

Elongation of the proximal descending thoracic aorta and associated hemodynamics increase the risk of acute type B aortic dissection.

BACKGROUND: Acute type B aortic dissection (ATBAD) is a life-threatening aortic disease. However, little information is available on predicting and understanding of ATBAD. OBJECTIVE: The study sought to explore the underlying mechanism of ATBAD by analyzing the morphological and hemodynamic characteristics related to aortic length. METHODS: The length and tortuosity of the segment and the whole aorta in the ATBAD group (n= 163) and control group (n= 120) were measured. A fixed anatomic landmark from the distal of left subclavian artery (LSA) to the superior border of sixth thoracic vertebra was proposed as the proximal descending thoracic aorta (PDTA), and the dimensionless parameter, length ratio, was introduced to eliminate the individual differences. The significant morphological parameters were filtrated and the associations between parameters were investigated using statistical approaches. Furthermore, how aortic morphology influenced ATBAD was explored based on idealized aortic models and hemodynamic-related metrics. RESULTS: The PDTA length was significantly increased in the ATBAD group compared with the control group and had a strong positive correlation with the whole aortic length (r= 0.89). The length ratio (LR2) and tortuosity (T2) of PDTA in the ATBAD group were significantly increased (0.15 ± 0.02 vs 0.12 ± 0.02 and 1.73 ± 0.48 vs 1.50 ± 0.36; P< 0.001), and LR2 was positive correlation with T2 (r= 0.73). In receiver-operating curve analysis, the area under the curve was 0.835 for LR2 and 0.641 for T2. Low and oscillatory shear (LOS) was positive correlation with LR2, and the elevated LOS occurred in the distal of LSA. CONCLUSION: Elongation of PDTA is associated with ATBAD, and the length ratio is a novel predictor. Elongated PDTA induced more aggressive hemodynamic forces, and high LOS regions may correspond to the entry tear location. The synergy of the morphological variation and aggressive hemodynamics creates contributory conditions for ATBAD.

Physics-informed neural networks (PINNs) for 4D hemodynamics prediction: An investigation of optimal framework based on vascular morphology.

Hemodynamic parameters are of great significance in the clinical diagnosis and treatment of cardiovascular diseases. However, noninvasive, real-time and accurate acquisition of hemodynamics remains a challenge for current invasive detection and simulation algorithms. Here, we integrate computational fluid dynamics with our customized analysis framework based on a multi-attribute point cloud dataset and physics-informed neural networks (PINNs)-aided deep learning modules. This combination is implemented by our workflow that generates flow field datasets within two types of patient personalized models - aorta with fine coronary branches and abdominal aorta. Deep learning modules with or without an antecedent hierarchical structure model the flow field development and complete the mapping from spatial and temporal dimensions to 4D hemodynamics. 88,000 cases on 4 randomized partitions in 16 controlled trials reveal the hemodynamic landscape of spatio-temporal anisotropy within two types of personalized models, which demonstrates the effectiveness of PINN in predicting the space-time behavior of flow fields and gives the optimal deep learning framework for different blood vessels in terms of balancing the training cost and accuracy dimensions. The proposed framework shows intentional performance in computational cost, accuracy and visualization compared to currently prevalent methods, and has the potential for generalization to model flow fields and corresponding clinical metrics within vessels at different locations. We expect our framework to push the 4D hemodynamic predictions to the real-time level, and in statistically significant fashion, applicable to morphologically variable vessels.

Effects of helical centerline stent vs. straight stent placement on blood flow velocity.

As an approach to maintain patency in femoropopliteal stenting, a helical stent configuration was proposed, which showed improved patency in clinical trials. However, the effects of helical stent placement on the flow have not been quantitatively analyzed. The purpose of this study was to estimate flow velocities to quantify the influence of helical stent placement. Helical and straight stents were implanted in three healthy pigs, and the flow velocities were estimated using the time-intensity curve (TIC) in the angiography images. The angiographic images indicated thinning of the leading edge of the contrast medium through the helically deformed artery, which was not observed in the straight stent. The slower rise of the TIC peak in the helical stent indicated faster travel of this thinner edge. Arterial expansion due to stenting was observed in all cases, and the expansion rate varied according to location. All cases of helical stent implantation showed that velocity was maintained (55.0%-71.3% velocity retention), unlike for straight stent implantation (43.0%-68.0% velocity retention); however, no significant difference was observed.

Coupled discrete phase model and Eulerian wall film model for numerical simulation of respiratory droplet generation during coughing.

Computational fluid dynamics is widely used to simulate droplet-spreading behavior due to respiratory events. However, droplet generation inside the body, such as the number, mass, and particle size distribution, has not been quantitatively analyzed. The aim of this study was to identify quantitative characteristics of droplet generation during coughing. Airflow simulations were performed by coupling the discrete phase model and Eulerian wall film model to reproduce shear-induced stripping of airway mucosa. An ideal airway model with symmetric bifurcations was constructed, and the wall domain was covered by a mucous liquid film. The results of the transient airflow simulation indicated that the droplets had a wide particle size distribution of 0.1-400 µm, and smaller droplets were generated in larger numbers. In addition, the total mass and number of droplets generated increased with an increasing airflow. The total mass of the droplets also increased with an increasing mucous viscosity, and the largest number and size of droplets were obtained at a viscosity of 8 mPa s. The simulation methods used in this study can be used to quantify the particle size distribution and maximum particle diameter under various conditions.

A Review of Functional Analysis of Endothelial Cells in Flow Chambers.

The vascular endothelial cells constitute the innermost layer. The cells are exposed to mechanical stress by the flow, causing them to express their functions. To elucidate the functions, methods involving seeding endothelial cells as a layer in a chamber were studied. The chambers are known as parallel plate, T-chamber, step, cone plate, and stretch. The stimulated functions or signals from endothelial cells by flows are extensively connected to other outer layers of arteries or organs. The coculture layer was developed in a chamber to investigate the interaction between smooth muscle cells in the middle layer of the blood vessel wall in vascular physiology and pathology. Additionally, the microfabrication technology used to create a chamber for a microfluidic device involves both mechanical and chemical stimulation of cells to show their dynamics in in vivo microenvironments. The purpose of this study is to summarize the blood flow (flow inducing) for the functions connecting to endothelial cells and blood vessels, and to find directions for future chamber and device developments for further understanding and application of vascular functions. The relationship between chamber design flow, cell layers, and microfluidics was studied.

A Parametric Study of Flushing Conditions for Improvement of Angioscopy Visibility.

During an angioscopy operation, a transparent liquid called dextran is sprayed out from a catheter to flush the blood away from the space between the camera and target. Medical doctors usually inject dextran at a constant flow rate. However, they often cannot obtain clear angioscopy visibility because the flushing out of the blood is insufficient. Good flushing conditions producing clear angioscopy visibility will increase the rate of success of angioscopy operations. This study aimed to determine a way to improve the clarity for angioscopy under different values for the parameters of the injection waveform, endoscope position, and catheter angle. We also determined the effect of a stepwise waveform for injecting the dextran only during systole while synchronizing the waveform to the cardiac cycle. To evaluate the visibility of the blood-vessel walls, we performed a computational fluid dynamics (CFD) simulation and calculated the visible area ratio (VAR), representing the ratio of the visible wall area to the total area of the wall at each point in time. Additionally, the normalized integration of the VAR called the area ratio (ARVAR) represents the ratio of the visible wall area as a function of the dextran injection period. The results demonstrate that the ARVAR with a stepped waveform, bottom endoscope, and three-degree-angle catheter results in the highest visibility, around 25 times larger than that under the control conditions: a constant waveform, a center endoscope, and 0 degrees. This set of conditions can improve angioscopy visibility.

A machine learning strategy for fast prediction of cardiac function based on peripheral pulse wave.

OBJECTIVE: Pulse wave has been considered as a message carrier in the cardiovascular system (CVS), capable of inferring CVS conditions while diagnosing cardiovascular diseases (CVDs). Clarification and prediction of cardiovascular function by means of powerful feature-abstraction capability of machine learning method based on pulse wave is of great clinical significance in health monitoring and CVDs diagnosis, which remains poorly studied. METHODS: Here we propose a machine learning (ML)-based strategy aiming to achieve a fast and accurate prediction of three cardiovascular function parameters based on a 412-subject database of pulse waves. We proposed and optimized an ML-based model with multi-layered, fully connected network while building up two high-quality pulse wave datasets comprising a healthy-subject group and a CVD-subject group to predict arterial compliance (AC), total peripheral resistance (TPR), and stroke volume (SV), which are essential messengers in monitoring CVS conditions. RESULTS: Our ML model is validated through consistency analysis of the ML-predicted three cardiovascular function parameters with clinical measurements and is proven through error analysis to have capability of achieving a high-accurate prediction on TPR and SV for both healthy-subject group (accuracy: 85.3%, 86.9%) and CVD-subject group (accuracy: 88.3%, 89.2%). DISCUSSION: The independent sample t-test proved that our subject groups could represent the typical physiological characteristics of the corresponding population. While we have more subjects in our datasets rather than previous studies after strict data screening, the proposed ML-based strategy needs to be further improved to achieve a disease-specific prediction of heart failure and other CVDs through training with larger datasets and clinical measurements. CONCLUSION: Our study points to the feasibility and potential of the pulse wave-based prediction of physiological and pathological CVS conditions in clinical application.

Finite element analysis of the mechanical performance of a zinc alloy stent with the tenon-and-mortise structure.

BACKGROUND: Inadequate scaffolding performance hinders the clinical application of the biodegradable zinc alloy stents. OBJECTIVE: In this study we propose a novel stent with the tenon-and-mortise structure to improve its scaffolding performance. METHODS: 3D models of stents were established in Pro/E. Based on the biodegradable zinc alloy material and two numerical simulation experiments were performed in ABAQUS. Firstly, the novel stent could be compressed to a small-closed ring by a crimp shell and can form a tenon-and-mortise structure after expanded by a balloon. Finally, 0.35 MPa was applied to the crimp shell to test the scaffolding performance of the novel stent and meanwhile compare it with an ordinary stent. RESULTS: Results showed that the novel stent decreased the recoiling ratio by 70.7% compared with the ordinary stent, indicating the novel structure improved the scaffolding performance of the biodegradable zinc alloy stent. CONCLUSION: This study proposes a novel design that is expected to improve the scaffolding performance of biodegradable stents.

Flush Flow Behaviour Affected by the Morphology of Intravascular Endoscope: A Numerical Simulation and Experimental Study.

Background: Whilst intravascular endoscopy can be used to identify lesions and assess the deployment of endovascular devices, it requires temporary blockage of the local blood flow during observation, posing a serious risk of ischaemia. Objective: To aid the design of a novel flow-blockage-free intravascular endoscope, we explored changes in the haemodynamic behaviour of the flush flow with respect to the flow injection speed and the system design. Methods: We first constructed the computational models for three candidate endoscope designs (i.e., Model A, B, and C). Using each of the three endoscopes, flow patterns in the target vessels (straight, bent, and twisted) under three different sets of boundary conditions (i.e., injection speed of the flush flow and the background blood flowrate) were then resolved through use of computational fluid dynamics and in vitro flow experiments. The design of endoscope and its optimal operating condition were evaluated in terms of the volume fraction within the vascular segment of interest, as well as the percentage of high-volume-fraction area (PHVFA) corresponding to three cross-sectional planes distal to the microcatheter tip. Results: With a mild narrowing at the endoscope neck, Model B exhibited the highest PHVFA, irrespective of location of the cross-sectional plane, compared with Models A and C which, respectively, had no narrowing and a moderate narrowing. The greatest difference in the PHVFA between the three models was observed on the cross-sectional plane 2 mm distal to the tip of the microcatheter (Model B: 33% vs. Model A: 18%). The background blood flowrate was found to have a strong impact on the resulting volume fraction of the flush flow close to the vascular wall, with the greatest difference being 44% (Model A). Conclusion: We found that the haemodynamic performance of endoscope Model B outperformed that of Models A and C, as it generated a flush flow that occupied the largest volume within the vascular segment of interest, suggesting that the endoscope design with a diameter narrowing of 30% at the endoscope neck might yield images of a better quality.

Incomplete stent expansion in flow-diversion treatment affects aneurysmal haemodynamics: a quantitative comparison of treatments affected by different severities of malapposition occurring in different segments of the parent artery.

Incomplete stent expansion (IncSE) is occasionally seen in flow-diversion (FD) treatment of intracranial aneurysms; however, its haemodynamic consequences remain inconclusive. Through a parametric study, we quantify the aneurysmal haemodynamics subject to different severities of IncSE occurring in different portions of the stent. Two patient cases with IncSE confirmed in vivo were studied. To investigate a wider variety of IncSE scenarios, we modelled IncSE at two severity levels respectively located in the proximal, central, or distal segment of a stent, yielding a total of 14 treatment scenarios (including the ideal deployment). We examined stent wire configurations in 14 scenarios and resolved aneurysm haemodynamics through computational fluid dynamics (CFD). A considerable degradation of aneurysm flow-reduction performance was observed when central or distal IncSE occurred, with the maximal elevations of the inflow rate (IR) and energy loss (EL) being 10% and 15%. The underlying mechanism might be the increased resistance for flow to remain within the FD stent, which forces more blood to leak into the aneurysm sac. Counter-intuitively, a slight reduction of aneurysm inflow was associated with proximal IncSE, with the maximal further reduction of the IR and EL being 5% and 8%. This may be due to the disruption of the predominant parent-artery flow by the collapsed wires, which decreased the strength and altered the direction of aneurysmal inflow. The effects of IncSE vary greatly with the location of occurrence, revealing the importance of performing individualised, patient-specific risk assessment before treatment.

Prediction of 3D Cardiovascular hemodynamics before and after coronary artery bypass surgery via deep learning.

The clinical treatment planning of coronary heart disease requires hemodynamic parameters to provide proper guidance. Computational fluid dynamics (CFD) is gradually used in the simulation of cardiovascular hemodynamics. However, for the patient-specific model, the complex operation and high computational cost of CFD hinder its clinical application. To deal with these problems, we develop cardiovascular hemodynamic point datasets and a dual sampling channel deep learning network, which can analyze and reproduce the relationship between the cardiovascular geometry and internal hemodynamics. The statistical analysis shows that the hemodynamic prediction results of deep learning are in agreement with the conventional CFD method, but the calculation time is reduced 600-fold. In terms of over 2 million nodes, prediction accuracy of around 90%, computational efficiency to predict cardiovascular hemodynamics within 1 second, and universality for evaluating complex arterial system, our deep learning method can meet the needs of most situations.

Implementation of computer simulation to assess flow diversion treatment outcomes: systematic review and meta-analysis.

INTRODUCTION: Despite a decade of research into virtual stent deployment and the post-stenting aneurysmal hemodynamics, the hemodynamic factors which correlate with successful treatment remain inconclusive. We aimed to examine the differences in various post-treatment hemodynamic parameters between successfully and unsuccessfully treated cases, and to quantify the additional flow diversion achievable through stent compaction or insertion of a second stent. METHODS: A systematic review and meta-analysis were performed on eligible studies published from 2000 to 2019. We first classified cases according to treatment success (aneurysm occlusion) and then calculated the pooled standardized mean differences (SMD) of each available parameter to examine their association with clinical outcomes. Any additional flow diversion arising from the two common strategies for improving the stent wire density was quantified by pooling the results of such studies. RESULTS: We found that differences in the aneurysmal inflow rate (SMD -6.05, 95% CI -10.87 to -1.23, p=0.01) and energy loss (SMD -5.28, 95% CI -7.09 to -3.46, p<0.001) between the successfully and unsuccessfully treated groups were indicative of statistical significance, in contrast to wall shear stress (p=0.37), intra-aneurysmal average velocity (p=0.09), vortex core-line length (p=0.46), and shear rate (p=0.09). Compacting a single stent could achieve additional flow diversion comparable to that by dual-stent implantation. CONCLUSIONS: Inflow rate and energy loss have shown promise as identifiers to discriminate between successful and unsuccessful treatment, pending future research into their diagnostic performance to establish optimal cut-off values.

Endothelial Cell Distribution After Flow Exposure With Two Stent Struts Placed in Different Angles.

Stent implantation has been a primary treatment for stenosis and other intravascular diseases. However, the struts expansion procedure might cause endothelium lesion and the structure of the struts could disturb the blood flow environment near the wall of the blood vessel. These changes could damage the vascular innermost endothelial cell (EC) layer and pose risks of restenosis and post-deployment thrombosis. This research aims to investigate the effect of flow alterations on EC distribution in the presence of gap between two struts within the parallel flow chamber. To study how the gap presence impacts EC migration and the endothelialization effect on the surface of the struts, two struts were placed with specific orientations and positions on the EC layer in the flow chamber. After a 24-h exposure under wall shear stress (WSS), we observed the EC distribution conditons especially in the gap area. We also conducted computational fluid dynamics (CFD) simulations to calculate the WSS distribution. High EC-concentration areas on the bottom plate corresponded to the high WSS by the presence of gap between the two struts. To find the relation between the WSS and EC distributions on the fluorescence images, WSS condition by CFD simulation could be helpful for the EC distribution. The endothelialization rate, represented by EC density, on the downstream sides of both struts was higher than that on the upstream sides. These observations were made in the flow recirculation at the gap area between two struts. On two side surfaces between the gaps, meaning the downstream at the first and the upstream at the second struts, EC density differences on the downstream surfaces of the first strut were higher than on the upstream surfaces of the second strut. Finally, EC density varied along the struts when the struts were placed at tilted angles. These results indicate that, by the presence of gap between the struts, ECs distribution could be predicted in both perpendicular and tiled positions. And tiled placement affect ECs distribution on the strut side surfaces.

[Elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role].

Objectives　The purpose of this study was to identify elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role.Methods　A qualitative inductive research was conducted. Introductions to potential participants were obtained from a patient association that agreed to help with the study. Interviews were conducted from July through October 2014, using an interview guide, with cancer peer supporters who consented to participate in the study. Elements they perceived as important to the performance of their role were inductively identified from interview transcripts. The analysis consisted of coding phrases in the text and organizing the codes generated into categories and subcategories.Results　The study participants consisted of 10 cancer peer supporters (2 men, 8 women), in the age range of 40 to 70 years, who provided private counseling and worked in cancer support groups in hospitals. The analysis generated 129 codes, 11 subcategories, and 5 categories. These 5 categories were: [1.Help service users determine their own paths by listening to and accepting what they say with a non-judgmental attitude]; [2.Offer a perspective distinct from that of the medical staff]; [3.Think of ways to achieve a good balance between one's personal life and cancer peer support work while maintaining a stable state of mind]; [4.Ensure that one maintains the necessary knowledge and skills, and continually improve oneself]; and [5.Build relationships of trust with medical staff and the hospital].Conclusion　Category [1] and category [2] were behaviors regarded as important when interacting with users. They were "matters regarded as important during the practice of cancer peer support working for users," and comprised the core of matters that were regarded as important. Next, as for matters regarded as important in relation to the supporters themselves, the categories were [3] and [4]. These were "matters regarded as important for continuity and qualitative improvement of cancer peer support working." Areas that call for improvement in relation to this are preparation of support systems and learning environments. Another matter regarded as important was category [5]. This was a "matter regarded as important to smoothen and facilitate cancer peer support working." Placing importance on relationships of trust with medical staff and hospitals could be considered a distinctive characteristic of cancer peer supporters working at hospitals.

Endothelial cell distributions and migration under conditions of flow shear stress around a stent wire.

BACKGROUND: Blood vessels are constantly exposed to flow-induced stresses, and endothelial cells (ECs) respond to these stresses in various ways. OBJECTIVE: In order to facilitate endothelialization after endovascular implantation, cell behaviors around a metallic wire using a flow circulation system are observed. METHODS: A parallel flow chamber was designed to reproduce constant shear stresses (SSs) on cell surfaces and to examine the effects of a straight bare metal wire on cell monolayers. Cells were then exposed to flow for 24 h under SS conditions of 1, 2, and 3 Pa. Subsequently, cell distributions were observed on the plate of the flow chamber and on the surface of the bare metal wire. Flow fields inside the flow chamber were analyzed using computational fluid dynamics under each SS condition. RESULTS: After 24 h, ECs on the bottom plate were concentrated toward the area of flow reattachment. The matching of higher cell density and CFD result suggests that flow-induced stimuli have an influence on EC distributions. CONCLUSION: Typical cell concentration occurs on dish plate along the vortexes, which produces large changes in SSs on cell layer.

Pulse-Wave-Pattern Classification with a Convolutional Neural Network.

Owing to the diversity of pulse-wave morphology, pulse-based diagnosis is difficult, especially pulse-wave-pattern classification (PWPC). A powerful method for PWPC is a convolutional neural network (CNN). It outperforms conventional methods in pattern classification due to extracting informative abstraction and features. For previous PWPC criteria, the relationship between pulse and disease types is not clear. In order to improve the clinical practicability, there is a need for a CNN model to find the one-to-one correspondence between pulse pattern and disease categories. In this study, five cardiovascular diseases (CVD) and complications were extracted from medical records as classification criteria to build pulse data set 1. Four physiological parameters closely related to the selected diseases were also extracted as classification criteria to build data set 2. An optimized CNN model with stronger feature extraction capability for pulse signals was proposed, which achieved PWPC with 95% accuracy in data set 1 and 89% accuracy in data set 2. It demonstrated that pulse waves are the result of multiple physiological parameters. There are limitations when using a single physiological parameter to characterise the overall pulse pattern. The proposed CNN model can achieve high accuracy of PWPC while using CVD and complication categories as classification criteria.

Multiobjective design optimization of stent geometry with wall deformation for triangular and rectangular struts.

The stent geometrical design (e.g., inter-strut gap, length, and strut cross-section) is responsible for stent-vessel contact problems and changes in the blood flow. These changes are crucial for causing some intravascular abnormalities such as vessel wall injury and restenosis. Therefore, structural optimization of stent design is necessary to find the optimal stent geometry design. In this study, we performed a multiobjective stent optimization for minimization of average stress and low wall shear stress ratio while considering the wall deformation in 3D flow simulations of triangular and rectangular struts. Surrogate-based optimization with Kriging method and expected hypervolume improvement (EHVI) are performed to construct the surrogate model map and find the best configuration of inter-strut gap (G) and side length (SL). In light of the results, G-SL configurations of 2.81-0.39 and 3.00-0.43 mm are suggested as the best configuration for rectangular and triangular struts, respectively. Moreover, considering the surrogate model and flow pattern conditions, we concluded that triangular struts work better to improve the intravascular hemodynamics. ᅟ Graphical abstract.

Computational Fluid Dynamics Analysis to Predict Endothelial Cells Migration During Flow Exposure Experiment With Placement of Two Stent Wires.

Stent deployment is currently used for many cardiovascular treatments. During its application, the presence of the stent inside the blood vessel will indeed cause some change in both flow environment and also vessel wall's cellular conditions. This research intends to learn about the flow phenomenon of how vessel wall endothelial cells (ECs) react to the presence of stent wires within a microfluidic flow chamber environment. Computational fluid dynamics (CFD) simulation analysis of the microfluidic flow chamber system has been performed for observing the hemodynamics phenomena in the chamber. Moreover, CFD method also can be beneficial as a planning step for a successful experimental study. We found that under the two wires configurations, high wall shear stress (WSS) area is developed on the downstream side of the wires. Based on the analysis of WSS and WSS gradients (WSSG) conditions, ECs morphological change and migration are likely to occur some specific area.