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Xu J, Du X, Zhang S, Zang X, Xiao Z, Su R, Huang X, Liu L. Diagnostic value of uric acid to high-density lipoprotein cholesterol ratio in abdominal aortic aneurysms. Ann Med 2024; 56:2357224. [PMID: 38779715 PMCID: PMC11123539 DOI: 10.1080/07853890.2024.2357224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is highly lethal upon onset of acute aortic diseases (AAD) or rupture. Dyslipidaemia and hyperuricaemia are important risk factors for the development of AAA and AAD as well as aortic disease-related death. The aim of this study was to explore whether uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) can be used as an independent predictor of the presence of AAA or AAD. METHODS Three hundred subjects, including 100 AAA patients (AAA group), 100 AAD patients (AAD group) and 100 controls (CON group), were recruited in this study. UHR and other serum samples were obtained upon the patients' admission before any medical treatment. The optimal cut-off points of UHR were determined using receiver operating characteristic (ROC) curve analysis. RESULTS The UHR in AAA group was significantly higher than that in CON group, but there was no significant difference between AAD group and CON group. The optimal cut-off point of UHR for AAA was 7.78 (sensitivity 84.7%, specificity 62.4%, and AUC 0.811; p < 0.001), and UHR (OR: 1.122, 95%CI: 1.064-1.184; p < 0.001) was found to be an independent factor for predicting AAA after adjusting for traditional AAA risk factor. CONCLUSION UHR can be widely used in clinical practice as an auxiliary tool for screening AAA. The optimal cut-off point for UHR to AAA was determined for the first time in Chinese subjects.
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Affiliation(s)
- Jin Xu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
| | - Xiao Du
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shilan Zhang
- Department of Cardiovascular Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine
| | - Xueyan Zang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
| | - Zixi Xiao
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
| | - Rongkai Su
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
| | - Xiadie Huang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
| | - Ling Liu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, Hunan, China
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Belkacemi D, Tahar Abbes M, Al-Rawi M, Al-Jumaily AM, Bachene S, Laribi B. Intraluminal Thrombus Characteristics in AAA Patients: Non-Invasive Diagnosis Using CFD. Bioengineering (Basel) 2023; 10:bioengineering10050540. [PMID: 37237609 DOI: 10.3390/bioengineering10050540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Abdominal aortic aneurysms (AAA) continue to pose a high mortality risk despite advances in medical imaging and surgery. Intraluminal thrombus (ILT) is detected in most AAAs and may critically impact their development. Therefore, understanding ILT deposition and growth is of practical importance. To assist in managing these patients, the scientific community has been researching the relationship between intraluminal thrombus (ILT) and hemodynamic parameters wall shear stress (WSS) derivatives. This study analyzed three patient-specific AAA models reconstructed from CT scans using computational fluid dynamics (CFD) simulations and a pulsatile non-Newtonian blood flow model. The co-localization and relationship between WSS-based hemodynamic parameters and ILT deposition were examined. The results show that ILT tends to occur in regions of low velocity and time-averaged WSS (TAWSS) and high oscillation shear index (OSI), endothelial cell activation potential (ECAP), and relative residence time (RRT) values. ILT deposition areas were found in regions of low TAWSS and high OSI independently of the nature of flow near the wall characterized by transversal WSS (TransWSS). A new approach is suggested which is based on the estimation of CFD-based WSS indices specifically in the thinnest and thickest ILT areas of AAA patients; this approach is promising and supports the effectiveness of CFD as a decision-making tool for clinicians. Further research with a larger patient cohort and follow-up data are needed to confirm these findings.
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Affiliation(s)
- Djelloul Belkacemi
- Mechanics and Energetics Laboratory, Hassiba Ben Bouali University, Chlef 02000, Algeria
- Unité de Développement des Equipements Solaires UDES, CDER, Bousmail, Tipaza 42415, Algeria
| | - Miloud Tahar Abbes
- Mechanics and Energetics Laboratory, Hassiba Ben Bouali University, Chlef 02000, Algeria
| | - Mohammad Al-Rawi
- Center for Engineering and Industrial Design, Waikato Institute of Technology, Hamilton 3240, New Zealand
| | - Ahmed M Al-Jumaily
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland 1010, New Zealand
| | - Sofiane Bachene
- Radiologie, Centre d'Imagerie Médicale, Cheraga, Algiers 16000, Algeria
| | - Boualem Laribi
- FIMA Laboratory, Department of Technology, Djilali Bounaama University, Khemis Miliana 44225, Algeria
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Wang Y, Luan J, Luo K, Fan J, Zhu T. Model reduction of coagulation cascade based on genetic algorithm. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3652. [PMID: 36167948 DOI: 10.1002/cnm.3652] [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: 03/31/2022] [Revised: 08/18/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Fibrin is an important product of the coagulation cascade, and plays an eminent role in platelet stabilization. Since coagulation cascade models typically involve the reaction kinetics of dozens of proteins, which will incur burdensome computational costs when coupled to blood flow in complex geometries, researchers often ignore this process when constructing thrombosis models. However, previous studies have shown that fundamental aspects of coagulation can be reproduced with simpler models, which motivated us to obtain a reduced-order model of fibrin generation through a systematic approach. Therefore, we introduced a semi-automatic framework to perform model-reduction of cascade reactions in this study, which consisted of two processes. Specifically, the retained protein species and cascade reactions were determined based on published studies and simulation results from the full cascade model, while the optimal reaction rates for the new cascade network were determined using a genetic algorithm. The framework has been applied to a 19-species coagulation model that triggers fibrin generation in internal fields via reactive boundaries, and a 10-species reduced-order model was obtained to reproduce the kinetics of fibrinogenesis in the full cascade model at different boundary tissue factor concentrations. This reduced-order model of fibrinogenesis would be valuable for thrombosis modeling that considers both the coagulation cascade and platelet activity. Furthermore, the framework proposed herein can also be applied to the reductions of other cascade reaction models.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Méndez Rojano R, Lai A, Zhussupbekov M, Burgreen GW, Cook K, Antaki JF. A fibrin enhanced thrombosis model for medical devices operating at low shear regimes or large surface areas. PLoS Comput Biol 2022; 18:e1010277. [PMID: 36190991 PMCID: PMC9560616 DOI: 10.1371/journal.pcbi.1010277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Over the past decade, much of the development of computational models of device-related thrombosis has focused on platelet activity. While those models have been successful in predicting thrombus formation in medical devices operating at high shear rates (> 5000 s−1), they cannot be directly applied to low-shear devices, such as blood oxygenators and catheters, where emerging information suggest that fibrin formation is the predominant mechanism of clotting and platelet activity plays a secondary role. In the current work, we augment an existing platelet-based model of thrombosis with a partial model of the coagulation cascade that includes contact activation of factor XII and fibrin production. To calibrate the model, we simulate a backward-facing-step flow channel that has been extensively characterized in-vitro. Next, we perform blood perfusion experiments through a microfluidic chamber mimicking a hollow fiber membrane oxygenator and validate the model against these observations. The simulation results closely match the time evolution of the thrombus height and length in the backward-facing-step experiment. Application of the model to the microfluidic hollow fiber bundle chamber capture both gross features such as the increasing clotting trend towards the outlet of the chamber, as well as finer local features such as the structure of fibrin around individual hollow fibers. Our results are in line with recent findings that suggest fibrin production, through contact activation of factor XII, drives the thrombus formation in medical devices operating at low shear rates with large surface area to volume ratios. Patients treated with blood-contacting medical devices suffer from clotting complications. Over the past decades, a great effort has been made to develop computational tools to predict and prevent clot formation in these devices. However, most models have focused on platelet activity and neglected other important parts of the problem such as the coagulation cascade reactions that lead to fibrin formation. In the current work, we incorporate this missing element into a well-established and validated model for platelet activity. We then use this novel approach to predict thrombus formation in two experimental configurations. Our results confirm that to accurately predict the clotting process in devices where surface area to volume ratios are large and flow velocity and shear stresses remain low, coagulation reactions and subsequent fibrin formation must be considered. This new model could have great implications for the design and optimization of medical devices such as blood oxygenators. In the long term, the model could evolve into a functional tool to inform anticoagulation therapies for these patients.
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Affiliation(s)
- Rodrigo Méndez Rojano
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
- * E-mail:
| | - Angela Lai
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Mansur Zhussupbekov
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
| | - Greg W. Burgreen
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, Mississippi, United States of America
| | - Keith Cook
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - James F. Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, United States of America
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Qiao Y, Luo K, Fan J. Computational Prediction of Thrombosis in Food and Drug Administration's Benchmark Nozzle. Front Physiol 2022; 13:867613. [PMID: 35547578 PMCID: PMC9081348 DOI: 10.3389/fphys.2022.867613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Thrombosis seriously threatens human cardiovascular health and the safe operation of medical devices. The Food and Drug Administration’s (FDA) benchmark nozzle model was designed to include the typical structure of medical devices. However, the thrombosis in the FDA nozzle has yet not been investigated. The objective of this study is to predict the thrombus formation process in the idealized medical device by coupling computational fluid dynamics and a macroscopic hemodynamic-based thrombus model. We developed the hemodynamic-based thrombus model by considering the effect of platelet consumption. The thrombus model was quantitatively validated by referring to the latest thrombosis experiment, which was performed in a backward-facing step with human blood flow. The same setup was applied in the FDA nozzle to simulate the thrombus formation process. The thrombus shaped like a ring was firstly observed in the FDA benchmark nozzle. Subsequently, the accuracy of the shear-stress transport turbulence model was confirmed in different turbulent flow conditions. Five scenarios with different Reynolds numbers were carried out. We found that turbulence could change the shape of centrosymmetric thrombus to axisymmetric and high Reynolds number blood flow would delay or even prevent thrombosis. Overall, the present study reports the thrombosis process in the FDA benchmark nozzle using the numerical simulation method, and the primary findings may shed light on the effect of turbulence on thrombosis.
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Affiliation(s)
- Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
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An integrated fluid-structure interaction and thrombosis model for type B aortic dissection. Biomech Model Mechanobiol 2022; 21:261-275. [PMID: 35079931 PMCID: PMC8807468 DOI: 10.1007/s10237-021-01534-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
False lumen thrombosis (FLT) in type B aortic dissection has been associated with the progression of dissection and treatment outcome. Existing computational models mostly assume rigid wall behavior which ignores the effect of flap motion on flow and thrombus formation within the FL. In this study, we have combined a fully coupled fluid–structure interaction (FSI) approach with a shear-driven thrombosis model described by a series of convection–diffusion reaction equations. The integrated FSI-thrombosis model has been applied to an idealized dissection geometry to investigate the interaction between vessel wall motion and growing thrombus. Our simulation results show that wall compliance and flap motion can influence the progression of FLT. The main difference between the rigid and FSI models is the continuous development of vortices near the tears caused by drastic flap motion up to 4.45 mm. Flap-induced high shear stress and shear rates around tears help to transport activated platelets further to the neighboring region, thus speeding up thrombus formation during the accelerated phase in the FSI models. Reducing flap mobility by increasing the Young’s modulus of the flap slows down the thrombus growth. Compared to the rigid model, the predicted thrombus volume is 25% larger using the FSI-thrombosis model with a relatively mobile flap. Furthermore, our FSI-thrombosis model can capture the gradual effect of thrombus growth on the flow field, leading to flow obstruction in the FL, increased blood viscosity and reduced flap motion. This model is a step closer toward simulating realistic thrombus growth in aortic dissection, by taking into account the effect of intimal flap and vessel wall motion.
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