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Watson C, Saaid H, Vedula V, Cardenas JC, Henke PK, Nicoud F, Xu XY, Hunt BJ, Manning KB. Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling. Ann Biomed Eng 2024; 52:467-486. [PMID: 37914979 DOI: 10.1007/s10439-023-03390-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Venous thromboembolism (VTE) is a massive clinical challenge, annually affecting millions of patients globally. VTE is a particularly consequential pathology, as incidence is correlated with extremely common risk factors, and a large cohort of patients experience recurrent VTE after initial intervention. Altered hemodynamics, hypercoagulability, and damaged vascular tissue cause deep-vein thrombosis and pulmonary embolism, the two permutations of VTE. Venous valves have been identified as likely locations for initial blood clot formation, but the exact pathway by which thrombosis occurs in this environment is not entirely clear. Several risk factors are known to increase the likelihood of VTE, particularly those that increase inflammation and coagulability, increase venous resistance, and damage the endothelial lining. While these risk factors are useful as predictive tools, VTE diagnosis prior to presentation of outward symptoms is difficult, chiefly due to challenges in successfully imaging deep-vein thrombi. Clinically, VTE can be managed by anticoagulants or mechanical intervention. Recently, direct oral anticoagulants and catheter-directed thrombolysis have emerged as leading tools in resolution of venous thrombosis. While a satisfactory VTE model has yet to be developed, recent strides have been made in advancing in silico models of venous hemodynamics, hemorheology, fluid-structure interaction, and clot growth. These models are often guided by imaging-informed boundary conditions or inspired by benchtop animal models. These gaps in knowledge are critical targets to address necessary improvements in prediction and diagnosis, clinical management, and VTE experimental and computational models.
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Affiliation(s)
- Connor Watson
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Hicham Saaid
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Jessica C Cardenas
- Department of Surgery and the Center for Translational Injury Research, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Beverley J Hunt
- Department of Thrombosis and Haemostasis, King's College, London, UK
- Thrombosis and Haemophilia Centre, Guy's & St Thomas' NHS Trust, London, UK
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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Stathoulopoulos A, Passos A, Kaliviotis E, Balabani S. Partitioning of dense RBC suspensions in single microfluidic bifurcations: role of cell deformability and bifurcation angle. Sci Rep 2024; 14:535. [PMID: 38177195 PMCID: PMC10767057 DOI: 10.1038/s41598-023-49849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
Red blood cells (RBCs) are a key determinant of human physiology and their behaviour becomes extremely heterogeneous as they navigate in narrow, bifurcating vessels in the microvasculature, affecting local haemodynamics. This is due to partitioning in bifurcations which is dependent on the biomechanical properties of RBCs, especially deformability. We examine the effect of deformability on the haematocrit distributions of dense RBC suspensions flowing in a single, asymmetric Y-shaped bifurcation, experimentally. Human RBC suspensions (healthy and artificially hardened) at 20% haematocrit (Ht) were perfused through the microchannels at different flow ratios between the outlet branches, and negligible inertia, and imaged to infer cell distributions. Notable differences in the shape of the haematocrit distributions were observed between healthy and hardened RBCs near the bifurcation apex. These lead to more asymmetric distributions for healthy RBCs in the daughter and outlet branches with cells accumulating near the inner channel walls, exhibiting distinct hematocrit peaks which are sharper for healthy RBCs. Although the hematocrit distributions differed locally, similar partitioning characteristics were observed for both suspensions. Comparisons with RBC distributions measured in a T-shaped bifurcation showed that the bifurcation angle affects the haematocrit characteristics of the healthy RBCs and not the hardened ones. The extent of RBC partitioning was found similar in both geometries and suspensions. The study highlights the differences between local and global characteristics which impact RBC distribution in more complex, multi-bifurcation networks.
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Affiliation(s)
- Antonios Stathoulopoulos
- FluME, Department of Mechanical Engineering, University College London (UCL), London, WC1E 7JE, UK
| | - Andreas Passos
- FluME, Department of Mechanical Engineering, University College London (UCL), London, WC1E 7JE, UK
- Department of Mechanical Engineering and Material Science Engineering, Cyprus University of Technology, Limassol, Cyprus
| | - Efstathios Kaliviotis
- Department of Mechanical Engineering and Material Science Engineering, Cyprus University of Technology, Limassol, Cyprus
| | - Stavroula Balabani
- FluME, Department of Mechanical Engineering, University College London (UCL), London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London (UCL), London, UK.
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Hashuro MSS, Tupin S, Putra NK, Daibo K, Inoue K, Ishii T, Kosukegawa H, Funamoto K, Hayase T, Ohta M. Development of Ultrasound Phantom Made of Transparent Material: Feasibility of Optical Particle Image Velocimetry. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1385-1394. [PMID: 36878829 DOI: 10.1016/j.ultrasmedbio.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/19/2022] [Accepted: 12/31/2022] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The need for ultrasound flow phantoms to validate ultrasound systems requires the development of materials that can clearly visualize the flow inside for measurement purposes. METHODS A transparent ultrasound flow phantom material composed of poly(vinyl alcohol) hydrogel (PVA-H) with dimethyl sulfoxide (DMSO) and water solution manufactured using the freezing method and mixed with quartz glass powder to exhibit scattering effects is proposed. To achieve transparency of the hydrogel phantom, the refractive index (RI) was changed to match that of the glass by modifying the PVA concentration and the ratio of DMSO to water in the solvent. The feasibility of optical particle image velocimetry (PIV) was verified by comparing an acrylic rectangular cross-section channel with a rigid wall. After the feasibility tests, an ultrasound flow phantom was fabricated to conduct ultrasound B-mode visualization and Doppler-PIV comparison. DISCUSSION The results revealed that the PIV measured through PVA-H material exhibited 0.8% error in the measured maximum velocity compared with PIV through the acrylic material. B-mode images are similar to real tissue visualization with a limitation of a higher sound velocity, when compared with human tissue, of 1792 m/s. Doppler measurement of the phantom revealed approximately 120% and 19% overestimation of maximum and mean velocities, respectively, compared with those from PIV. CONCLUSION The proposed material possesses the advantage of the single-phantom ability to improve the ultrasound flow phantom for validation of flow.
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Affiliation(s)
- Muhammad Shiddiq Sayyid Hashuro
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan; Graduate School of Engineering, Tohoku University, Sendai, Miyagi, Japan; Biomedical Engineering Department, School of Electrical Engineering and Informatics, Institut Teknologi Bandung, Jawa Barat, Indonesia
| | - Simon Tupin
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Narendra Kurnia Putra
- Instrumentation and Control Research Group, Faculty of Industrial Technology, Institut Teknologi Bandung, Jawa Barat, Indonesia
| | - Kotaro Daibo
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-12 Aramaki Aza Aoba, Aoba-ku, Sendai, Miyagi 980-8579, Japan
| | - Kosuke Inoue
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Takuro Ishii
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | | | - Kenichi Funamoto
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Toshiyuki Hayase
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.
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Farina A, Fasano A, Rosso F. A theoretical model for the Fåhræus effect in medium-large microvessels. J Theor Biol 2023; 558:111355. [PMID: 36402201 DOI: 10.1016/j.jtbi.2022.111355] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
This paper presents a mathematical model capable to reproduce a celebrated phenomenon in blood microcirculation known as Fåhræus effect, since its discovery by Robin Fåhræus (1929). This consists in a decaying of the relative hematocrit in small vessels as the vessel diameter decreases. The key point of the model is a formula, direct consequence of the basic principles of fluid dynamics, that links the relative hematocrit to the reservoir hematocrit and the vessel diameter, which confirms the observed behavior. To test the model we selected, among the few experiments carried on since then, those performed by Barbee and Cokelet (1971). The agreement is remarkable. An extended comparison is also carried out with a celebrated empirical formula proposed by Pries et al. (1992) to describe the same phenomenon.
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Affiliation(s)
- Angiolo Farina
- Dipartimento di Matematica e Informatica "Ulisse Dini", Università degli Studi di Firenze, Viale Morgagni 67/a, 50134 Firenze, Italy.
| | - Antonio Fasano
- Dipartimento di Matematica e Informatica "Ulisse Dini", Università degli Studi di Firenze, Viale Morgagni 67/a, 50134 Firenze, Italy; FIAB S.p.A., Vicchio, Firenze, Italy; I.A.S.I. - C.N.R., Via dei Taurini, Roma, Italy.
| | - Fabio Rosso
- Dipartimento di Matematica e Informatica "Ulisse Dini", Università degli Studi di Firenze, Viale Morgagni 67/a, 50134 Firenze, Italy.
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