Proposed methods for the measurement of regional renal blood flow using heat transfer analysis

The Flow of Blood-Based Hybrid Nanofluids with Couple Stresses by the Convergent and Divergent Channel for the Applications of Drug Delivery

This research work aims to scrutinize the mathematical model for the hybrid nanofluid flow in a converging and diverging channel. Titanium dioxide and silver TiO2 and Ag are considered as solid nanoparticles while blood is considered a base solvent. The couple-stress fluid model is essentially use to describe the blood flow. Therefore, the couple-stress term was used in the recent study with the existence of a magnetic field and a Darcy–Forchheiner porous medium. The heat absorption/omission and radiation terms were also included in the energy equation for the sustainability of drug delivery. An endeavor was made to link the recent study with the applications of drug delivery. It has already been revealed by the available literature that the combination of TiO2 with any other metal can destroy cancer cells more effectively than TiO2 separately. Both the walls are stretchable/shrinkable, whereas flow is caused by a source or sink with α as a converging/diverging parameter. Governing equations were altered into the system of non-linear coupled equations by using the similarity variables. The homotopy analysis method (HAM) was applied to obtain the preferred solution. The influences of the modeled parameters have been calculated and displayed. The confrontation of wall shear stress and hybrid nanofluid flow increased as the couple stress parameter rose, which indicates an improvement in the stability of the base fluid (blood). The percentage (%) increase in the heat transfer rate with the variation of nanoparticle volume fraction was also calculated numerically and discussed theoretically.

Objective, real-time, intraoperative assessment of renal perfusion using infrared imaging

Allograft ischemia induces delayed graft function and is correlated with increasing rates of rejection. There is not currently a way to objectively measure the effects of ischemia in real-time, nor to relate therapies combating reperfusion injury with their intended effects. An infrared (IR) method utilizing a focal plane array detector camera was developed for real-time intraoperative IR imaging of renal allografts, and evaluated in a pilot trial to quantify perfusion in recipients of live (n = 8) and cadaveric donor (n = 5) allografts. Digital images were taken for 3-8 min postreperfusion. Image data were compared to ischemic time and allograft function to assess potential clinical relevance. Cold ischemic time ranged from 0.5 to 29 h and was bimodally distributed between living and cadaveric donors. Renal rewarming time (RT) as determined by IR imaging correlated with cold ischemic time (p < 0.001, R 2 = 0.81), and predicted the subsequent return of renal function with RT negatively correlated to the regression slopes of creatinine (p = 0.02, R 2 = 0.38) and BUN (p = 0.07, R 2 = 0.26). Intraoperative IR imaging noninvasively provides clinically relevant real-time whole kidney assessment of reperfusion. This technology may aide in the objective assessment of therapies designed to limit reperfusion injury, and allow for quantitative assessment of allograft ischemic damage.

Assessment of renal graft function by perioperative monitoring of cortical microcirculation in kidney transplantation

BACKGROUND

We evaluated the significance of perioperative cortical microperfusion for graft function and long-term prognosis after renal allotransplantation. Thermodiffusion technology was clinically applied for the first time, after previous validation for perfusion monitoring of the renal cortex in pigs.

METHODS

A thermodiffusion probe was inserted into the renal cortex in 30 transplant recipients after graft reperfusion. Real-time measurements were recorded until the end of the operation. In 14 patients perfusion was measured daily until postoperative day 7. Microcirculation was correlated to serum creatinine level, scintigraphic findings, and long-term outcome.

RESULTS

In primary graft function, intraoperative perfusion was 85+/-7 mL/100 g per min compared with significantly lower values in cases with subsequent graft dysfunction. The best discrimination was defined for a level of 70 mL/100 g per min with a positive predictive value of 88% for detection of good graft function and 86% for nonfunction. Intraoperative perfusion was significantly different in patients with normal grafts, delayed function, and graft loss. Postoperatively, lower perfusion was found in acute tubular necrosis; a significant correlation could be noted between microcirculation and perfusion index measured by nuclear scanning (r=0.78, P<0.01). Living-related grafts were characterized by higher intraoperative perfusion and superior graft quality.

CONCLUSION

Thermodiffusion could be clinically applicable for the perioperative monitoring of renal graft perfusion. Intraoperative reduction of cortical microcirculation has a high predictive value with respect to detection of delayed renal function. Postoperatively, impaired renal microperfusion is associated with acute tubular necrosis. Living-related donor grafts show less microcirculatory alteration than cadaveric kidneys.

Characterization of hepatic parenchymous perfusion heterogeneity and regional flow kinetics after porcine liver transplantation

BACKGROUND

In clinical practice, a heterogeneous hepatic tissue microperfusion (MC) is often observed after liver resection or transplantation (LTx). Nevertheless this hepatic perfusion phenomenon has never been really quantified with respect to its anatomic distribution and time course in detail. The aim of the study was to characterize liver perfusion heterogeneity and local flow kinetics both in the physiological situation and after standardized ischemia and reperfusion using an established model of porcine LTx.

METHODS

Regional distribution of hepatic MC in healthy native porcine livers (control group; n = 8) was analyzed in comparison with data derived 60 min, 24 h, and 72 h after porcine LTx (transplantation group; n = 8 each subgroup; cold ischemia time: 5.7 +/- 1.2 h). MC was measured with implanted thermal diffusion electrodes (TD). Flow in hepatic artery and portal vein was continuously detected by ultrasonic probes. For standardization of measurement localizations, porcine liver lobes were divided anatomically into three horizontal layers (cranial, medial, caudal), defining 12 distinct hepatic measurement regions.

RESULTS

In the control group, a homogenous liver MC with a mean flow of 81.6 +/- 13.9 ml/100 g/min was detected in all regions. After LTx, a marked MC heterogeneity was noted 60 min after reperfusion. MC rehomogenization was first documented within horizontal liver planes 24 h later. Comparison of MC between planes showed persisting heterogeneity with a significant intralober drop of mean MC in the cranio-caudal direction. Complete MC rehomogenization (both between horizontal and vertical liver planes) was detected 72 h after reperfusion. Still, an overall reduction of mean liver perfusion by about 15% was existent.

CONCLUSIONS

A homogenous tissue perfusion was observed in healthy porcine livers. In contrast, marked heterogeneity of hepatic MC was detected after LTx. Heterogeneity presents as a very dynamic and temporary phenomenon. Early horizontal flow rehomogenization and reconstitution of normal blood flow, particularly primarily in the cranial liver layers, appear to be characteristic features during early flow reconstitution after postischemic reperfusion. Due to heterogeneity and time-dependent flow dynamics, measurement of MC volumes at single hepatic regions may not always allow a valid characterization of liver perfusion quality during the first 24 h after postischemic reperfusion.

Characterization of renal parenchymal perfusion during experimental infrarenal aortic clamping and declamping with enhanced thermodiffusion electrodes

Despite multiple previous experimental and clinical investigations, it has not been fully clarified until now whether infrarenal aortic cross-clamping (IRAC) induces a significant disturbance of renal parenchymal perfusion. Most renal cortical flow data collected thus far have been heterogenous because of inherent limitations of available measurement technology. The enhanced thermal diffusion (TD) electrode is a newly developed and previously validated prototype device that allows continuous quantification of parenchymal kidney perfusion after local probe implantation. We monitored renal perfusion during experimental IRAC with TD for the first time, thereby also evaluating the potential applicability of the method in clinical aortic surgery. IRAC (20 min) followed by sudden declamping was performed in pigs under general anesthesia (n = 14). Renal cortical blood flow (RCBF) was continuously quantified by TD, total aortic flow (TABF) and renal artery flow (RABF) were measured by ultrasonic flow probes, and parameters of systemic circulation were determined by Swan-Ganz catheter. Our results showed that kidney perfusion can be continuously quantified using TD electrodes during experimental aortic surgery in a porcine model. IRAC does not lead to a significant impairment of RCBF in young pigs as measured by TD. Renal perfusion appears to be predominantly pressure driven. Consequently, abrubt aortic declamping can bring about prolonged renal ischemia. Transfer of the TD method to RCBF monitoring during clinical aortic surgery appears to be feasible and should be investigated in selected cases.

Application of missing pulse steady state free precession to the study of renal microcirculation

Missing pulse steady state free precession (MP-SSFP), an extension of steady state free precession (SSFP), was evaluated for its ability to measure slow fluid flows. In experiments using flow phantoms, the MP-SSFP signal was sensitive to fluid velocities in the millimeters per second range. Isolated perfused rabbit kidneys were then used to determine if MP-SSFP could measure perfusion in a biological tissue. The signal intensities in the different anatomical regions of the kidney were observed to be related to the total flow to the organ. Furthermore, increasing the flow sensitivity of the pulse sequence by increasing the gradient strength resulted in decreases in the image signal intensity. The MP-SSFP signal was more sensitive to flow in the medulla than in the cortex. This can be related to slow flow sensitivity of MP-SSFP and the known differences in velocity profiles between these two regions. These results suggest that MP-SSFP may be a powerful tool for the noninvasive measurement of slow fluid flows in different regions of the kidney.

The transient thermal clearance method for regional blood flow measurement--the influence of tissue heat conduction

When heat is supplied to or retrieved from living tissue, the heat in or out is either conducted by means of the tissue or convected by blood. In order quantitatively to assess blood flow by thermal clearance the contributions of conduction and convection have to be separated, and various methods have been developed for this purpose. The various methods are reviewed and it is shown that the adequacy of each depends on the specific thermal clearance method used. The review concentrates on aspects of the role of thermal conduction in the non-invasive transient thermal clearance method. It is shown that by applying correct methodology, for regional blood flow of around 0.0025 ml blood per ml tissue per second the predominant contribution to the heat transfer is by convection. However, if the regional blood flow is much lower, the effect of heat conduction cannot be ignored.