Experimental study of the POP technique: focus on the physical basis of the process

INTRODUCTION

Central or peripheral vascular access devices have been in use for many decades. However, despite adequate care and maintenance, complete occlusion may occur, and its impact cannot be overlooked. A new procedure using a percussion technique has been published and referred as 'the POP technique'.

METHODS

A hydrodynamic bench was used permitting both the recording of the movement of the piston with a fast camera and the pressure variations in the polyurethane and silicone catheters while connected to 2- and 3-piece syringes.

RESULTS

The results are twofold. First the upward movement of the piston leads to the installation of a saturation vapour pressure in the body of the syringe. During this sequence, the clot is submitted to a force of aspiration. Then the release of the plunger leads to a pulse pressure whose dynamics and intensity are dependent of the types of syringes and catheters.

CONCLUSIONS

The experiments bring to light the importance of practical features such as the orientation of the syringe and the nature of the polyurethane or silicone catheters. Then the analysis enables the definition of practical rules for safe practice of the POP technique. This study will impact clinicians as many may be tempted to use the technique in hope to resolve the occlusion safely, in a timely manner.

New method for estimating arterial pulse wave velocity at single site

The clinical importance of measuring local pulse wave velocity (PWV), has encouraged researchers to develop several local methods to estimate it. In this work, we proposed a new method, the sum-of-squares method [Formula: see text], that allows the estimations of PWV by using simultaneous measurements of blood pressure (P) and arterial diameter (D) at single-location. Pulse waveforms generated by: (1) two-dimensional (2D) fluid-structure interaction simulation (FSI) in a compliant tube, (2) one-dimensional (1D) model of 55 larger human systemic arteries and (3) experimental data were used to validate the new formula and evaluate several classical methods. The performance of the proposed method was assessed by comparing its results to theoretical PWV calculated from the parameters of the model and/or to PWV estimated by several classical methods. It was found that values of PWV obtained by the developed method [Formula: see text] are in good agreement with theoretical ones and with those calculated by PA-loop and D²P-loop. The difference between the PWV calculated by [Formula: see text] and PA-loop does not exceed 1% when data from simulations are used, 3% when in vitro data are used and 5% when in vivo data are used. In addition, this study suggests that estimated PWV from arterial pressure and diameter waveforms provide correct values while methods that require flow rate (Q) and velocity (U) overestimate or underestimate PWV.

Mechanical characteristics of plastic base Ports and impact on flushing efficacy

Background

Three types of totally implantable venous access devices, Ports, are currently in use: titanium, plastic (polyoxymethylene, POM), and mixed (titanium base with a POM shell). Physics theory suggests that the interaction between a non-coring needle (NCN, made of stainless steel) and a plastic base would lead to the stronger material (steel) altering the more malleable material (plastic).

Objectives

To investigate whether needle impacts can alter a plastic base’s surface, thus potentially reducing flushing efficacy.

Study design and methods

A Port made of POM was punctured 200 times with a 19-gauge NCN. Following the existing guidelines, the needle tip pricked the base with each puncture. The Port’s base was then examined using a two-dimensional optical instrument, and a bi-dimensional numerical simulation using COMSOL^® was performed to investigate potential surface irregularities and their impact on fluid flow.

Results

Each needle impact created a hole (mean depth, 0.12 mm) with a small bump beside it (mean height, 0.02 mm) the Reynolds number Re_k≈10. A numerical simulation of the one hole/bump set showed that the flushing efficacy was 60% that of flushing along a flat surface.

Discussion

In clinical practice, the number of times a Port is punctured depends on patient and treatment characteristics, but each needle impact on the plastic base may increase the risk of decreased flushing effectiveness. Therefore, the more a plastic Port is accessed, the greater the risk of microorganisms, blood products, and medication accumulation.

Conclusions

Multiple needle impacts created an irregular surface on the Port’s base, which decreased flushing efficacy. Clinical investigation is needed to determine whether plastic base Ports are associated with an increased risk of Port infection and occlusion compared to titanium base Ports.

Bioluminescence-Based Tumor Quantification Method for Monitoring Tumor Progression and Treatment Effects in Mouse Lymphoma Models

Although bioluminescence imaging (BLI) shows promise for monitoring tumor burden in animal models of cancer, these analyses remain mostly qualitative. Here we describe a method for bioluminescence imaging to obtain a semi-quantitative analysis of tumor burden and treatment response. This method is based on the calculation of a luminoscore, a value that allows comparisons of two animals from the same or different experiments. Current BLI instruments enable the calculation of this luminoscore, which relies mainly on the acquisition conditions (back and front acquisitions) and the drawing of the region of interest (manual markup around the mouse). Using two previously described mouse lymphoma models based on cell engraftment, we show that the luminoscore method can serve as a noninvasive way to verify successful tumor cell inoculation, monitor tumor burden, and evaluate the effects of in situ cancer treatment (CpG-DNA). Finally, we show that this method suits different experimental designs. We suggest that this method be used for early estimates of treatment response in preclinical small-animal studies.

Duality of Iron Oxide Nanoparticles in Cancer Therapy: Amplification of Heating Efficiency by Magnetic Hyperthermia and Photothermal Bimodal Treatment

The pursuit of innovative, multifunctional, more efficient, and safer treatments is a major challenge in preclinical nanoparticle-mediated thermotherapeutic research. Here, we report that iron oxide nanoparticles have the dual capacity to act as both magnetic and photothermal agents. We further explore every key aspect of this magnetophotothermal approach, choosing iron oxide nanocubes for their high efficiency for the magnetic hyperthermia modality itself. In aqueous suspension, the nanocubes' exposure to both: an alternating magnetic field and near-infrared laser irradiation (808 nm), defined as the DUAL-mode, amplifies the heating effect 2- to 5-fold by comparison with magnetic stimulation alone, yielding unprecedented heating powers (specific loss powers) up to 5000 W/g. In cancer cells, the laser excitation restores the optimal efficiency of magnetic hyperthermia, otherwise inhibited by intracellular confinement, resulting in a remarkable heating efficiency in the DUAL-mode (up to 15-fold amplification), with respect to the magnetophotothermal mode. As a consequence, the dual action yielded complete apoptosis-mediated cell death. In solid tumors in vivo, single-mode treatments (magnetic or laser hyperthermia) reduced tumor growth, while DUAL-mode treatment resulted in complete tumor regression, mediated by heat-induced tumoral cell apoptosis and massive denaturation of the collagen fibers, and a long-lasting thermal efficiency over repeated treatments.

Wheezing recognition algorithm using recordings of respiratory sounds at the mouth in a pediatric population

BACKGROUND

Respiratory diseases in children are a common reason for physician visits. A diagnostic difficulty arises when parents hear wheezing that is no longer present during the medical consultation. Thus, an outpatient objective tool for recognition of wheezing is of clinical value.

METHOD

We developed a wheezing recognition algorithm from recorded respiratory sounds with a Smartphone placed near the mouth. A total of 186 recordings were obtained in a pediatric emergency department, mostly in toddlers (mean age 20 months). After exclusion of recordings with artefacts and those with a single clinical operator auscultation, 95 recordings with the agreement of two operators on auscultation diagnosis (27 with wheezing and 68 without) were subjected to a two phase algorithm (signal analysis and pattern classifier using machine learning algorithms) to classify records.

RESULTS

The best performance (71.4% sensitivity and 88.9% specificity) was observed with a Support Vector Machine-based algorithm. We further tested the algorithm over a set of 39 recordings having a single operator and found a fair agreement (kappa=0.28, CI95% [0.12, 0.45]) between the algorithm and the operator.

CONCLUSIONS

The main advantage of such an algorithm is its use in contact-free sound recording, thus valuable in the pediatric population.

Toward the modeling of mucus draining from human lung: role of airways deformation on air-mucus interaction

Chest physiotherapy is an empirical technique used to help secretions to get out of the lung whenever stagnation occurs. Although commonly used, little is known about the inner mechanisms of chest physiotherapy and controversies about its use are coming out regularly. Thus, a scientific validation of chest physiotherapy is needed to evaluate its effects on secretions. We setup a quasi-static numerical model of chest physiotherapy based on thorax and lung physiology and on their respective biophysics. We modeled the lung with an idealized deformable symmetric bifurcating tree. Bronchi and their inner fluids mechanics are assumed axisymmetric. Static data from the literature is used to build a model for the lung's mechanics. Secretions motion is the consequence of the shear constraints apply by the air flow. The input of the model is the pressure on the chest wall at each time, and the output is the bronchi geometry and air and secretions properties. In the limit of our model, we mimicked manual and mechanical chest physiotherapy techniques. We show that for secretions to move, air flow has to be high enough to overcome secretion resistance to motion. Moreover, the higher the pressure or the quicker it is applied, the higher is the air flow and thus the mobilization of secretions. However, pressures too high are efficient up to a point where airways compressions prevents air flow to increase any further. Generally, the first effects of manipulations is a decrease of the airway tree hydrodynamic resistance, thus improving ventilation even if secretions do not get out of the lungs. Also, some secretions might be pushed deeper into the lungs; this effect is stronger for high pressures and for mechanical chest physiotherapy. Finally, we propose and tested two a dimensional numbers that depend on lung properties and that allow to measure the efficiency and comfort of a manipulation.

Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices

Central venous device infections are associated with increased physical and psychological morbidity, mortality, length of stay, and costs. The aim of this study was to prove the efficacy of pulsatile flushing to prevent the bacterial colonization of vascular access devices. One hundred and forty four tests using 576 polyurethane short venous access catheters were performed. Four catheters per test were polluted with a fibronectin-serum albumin solution. Three were filled with a Staphylococcus aureus broth; one served as negative control. One contaminated catheter was not flushed (positive control), and two were flushed (10 mL.sec(-1)) with normal saline solution, either by ten successive boluses of 1 mL each or by one bolus of 10 mL. Each catheter was cultivated. The S. aureus quantity observed after continuous flushing was significantly higher than that observed after pulsative flushing (P<0.001). Unflushed catheters were 20.71 and 6.42 times more polluted than catheters flushed with the pulsative method or the continuous method, respectively. Pulsative flushing was at least twice as effective as continuous flushing in reducing the S. aureus count. Pulsative flushing is more effective than continuous flushing in reducing the endoluminal contamination. Pulsative flushing is a simple, effective, and inexpensive technique to reduce catheter bacterial colonization.

Anisotropic polyvinyl alcohol hydrogel phantom for shear wave elastography in fibrous biological soft tissue: a multimodality characterization

Shear wave elastography imaging techniques provide quantitative measurement of soft tissues elastic properties. Tendons, muscles and cerebral tissues are composed of fibers, which induce a strong anisotropic effect on the mechanical behavior. Currently, these tissues cannot be accurately represented by existing elastography phantoms. Recently, a novel approach for orthotropic hydrogel mimicking soft tissues has been developed (Millon et al 2006 J. Biomed. Mater. Res. B 305-11). The mechanical anisotropy is induced in a polyvinyl alcohol (PVA) cryogel by stretching the physical crosslinks of the polymeric chains while undergoing freeze/thaw cycles. In the present study we propose an original multimodality imaging characterization of this new transverse isotropic (TI) PVA hydrogel. Multiple properties were investigated using a large variety of techniques at different scales compared with an isotropic PVA hydrogel undergoing similar imaging and rheology protocols. The anisotropic mechanical (dynamic and static) properties were studied using supersonic shear wave imaging technique, full-field optical coherence tomography (FFOCT) strain imaging and classical linear rheometry using dynamic mechanical analysis. The anisotropic optical and ultrasonic spatial coherence properties were measured by FFOCT volumetric imaging and backscatter tensor imaging, respectively. Correlation of mechanical and optical properties demonstrates the complementarity of these techniques for the study of anisotropy on a multi-scale range as well as the potential of this TI phantom as fibrous tissue-mimicking phantom for shear wave elastographic applications.

Impact of the shape of the implantable ports on their efficiency of flow (injection and flushing)

Now widely used, totally implantable venous access devices allow mid- and long-term, frequent, repeated, or continuous injection of therapeutic products by vascular, cavitary, or perineural access. The effective flushing of these devices is a key factor that ensures their long-lasting use. We present experimental results and a numerical simulation to demonstrate that the implementation of rounded edge wall cavities improves flushing efficiency. We use the same approaches to suggest that the deposit amount may be reduced by the use of rounded edge wall cavities.

Heat-generating iron oxide nanocubes: subtle "destructurators" of the tumoral microenvironment

Several studies propose nanoparticles for tumor treatment, yet little is known about the fate of nanoparticles and intimate interactions with the heterogeneous and ever-evolving tumor environment. The latter, rich in extracellular matrix, is responsible for poor penetration of therapeutics and represents a paramount issue in cancer therapy. Hence new strategies start aiming to modulate the neoplastic stroma. From this perspective, we assessed the efficacy of 19 nm PEG-coated iron oxide nanocubes with optimized magnetic properties to mediate mild tumor magnetic hyperthermia treatment. After injection of a low dose of nanocubes (700 μg of iron) into epidermoid carcinoma xenografts in mice, we monitored the effect of heating nanocubes on tumor environment. In comparison with the long-term fate after intravenous administration, we investigated spatiotemporal patterns of nanocube distribution, evaluated the evolution of cubes magnetic properties, and examined nanoparticle clearance and degradation processes. While inside tumors nanocubes retained their magnetic properties and heating capacity throughout the treatment due to a mainly interstitial extracellular location, the particles became inefficient heaters after cell internalization and transfer to spleen and liver. Our multiscale analysis reveals that collagen-rich tumor extracellular matrix confines the majority of nanocubes. However, nanocube-mediated hyperthermia has the potential to "destructure" this matrix and improve nanoparticle and drug penetration into neoplastic tissue. This study provides insight into dynamic interactions between nanoparticles and tumor components under physical stimulation and suggests that nanoparticle-mediated hyperthermia could be used to locally modify tumor stroma and thus improve drug penetration.

Correlation between classical rheometry and supersonic shear wave imaging in blood clots

The assessment of coagulating blood elasticity has gained importance as a result of several studies that have correlated it to cardiovascular pathologic conditions. In this study we use supersonic shear wave imaging (SSI) to measure viscoelastic properties of blood clots. At the same time, classical rheometry experiments were carried out on the same blood samples taken within the first few seconds of coagulation. Using SSI, phase velocities of the shear wave indicated increasing dispersion with time. In all cases, the frequency bandwidth of propagating shear waves changed from 20-50 Hz at the first few min of coagulation to around 300 Hz toward the end of experiments. Using the values of G' and G″ from the rheometry studies, the theoretical shear wave velocities were calculated and correlated with SSI measurements. Results of the two techniques were in very good agreement, confirming that SSI provides accurate measurements of viscoelastic properties as corroborated by conventional rheometric measurements.

Power port contrast medium flushing and trapping: impact of temperature, an in vitro experimental study

Purpose

The use of totally implantable venous access devices (TIVADs) certified as “high pressure resistant” or “power port” has begun to spread worldwide as a safe procedure for power contrast injection. Owing to the thermo-rheological properties of the contrast media, the primary aim of this work is to present an in vitro experimental impact study concerning the impact of the temperature level on flushing efficiency after contrast medium injection. Moreover, we report experimental data that confirms the role of needle bevel orientation. The secondary aim is to answer the following questions: Is there significant device contrast medium trapping after contrast medium injection? Is saline flushing efficient? And, finally, is it safe to inject contrast medium through an indwelled port catheter?

Results

The experimental results show that in addition to hydrodynamics, temperature is a key parameter for the efficiency of device flushing after contrast medium injection. It appears that this is the case when the cavity is incompletely rinsed after three calibrated flushing volumes of 10 mL saline solution, even by using the Huber needle bevel opposite to the port exit. This leads to a potentially important trapped volume of contrast medium in the port, and consequently to the possibility of subsequent salt precipitates and long term trisubstituted benzene nuclei delivery that might impair the solute properties, which may be further injected via the power port later on.

Conclusion

We thus suggest, in TIVADS patients, the use of a temporary supplementary intravenous line rather than the port to perform contrast medium injections in daily radiology routine practice.

Implementing boundary conditions in simulations of arterial flows

Computational hemodynamic models of the cardiovascular system are often limited to finite segments of the system and therefore need well-controlled inlet and outlet boundary conditions. Classical boundary conditions are measured total pressure or flow rate imposed at the inlet and impedances of RLR, RLC, or LR filters at the outlet. We present a new approach based on an unidirectional propagative approach (UPA) to model the inlet/outlet boundary conditions on the axisymmetric Navier-Stokes equations. This condition is equivalent to a nonreflecting boundary condition in a fluid-structure interaction model of an axisymmetric artery. First we compare the UPA to the best impedance filter (RLC). Second, we apply this approach to a physiological situation, i.e., the presence of a stented segment into a coronary artery. In that case a reflection index is defined which quantifies the amount of pressure waves reflected upon the singularity.

Shear wave elastography quantification of blood elasticity during clotting

Deep venous thrombosis (DVT) affects millions of people worldwide. A fatal complication occurs when the thrombi detach and create a pulmonary embolism. The diagnosis and treatment of DVT depends on clot's age. The elasticity of thrombi is closely related to its age. Blood was collected from pigs and anticoagulated using ethylenediaminetetraacetic acid (EDTA). Coagulation was initiated using calcium ions. Supersonic shear wave imaging was used to generate shear waves using 100 μs tone bursts of 8 MHz. Tracking of the shear waves was done by ultrafast imaging. Postprocessing of the data was done using Matlab(®). Two-dimensional (2-D) maps of elasticity were obtained by calculating the speed of shear wave propagation. Elasticity varied with time from around 50 Pa at coagulation to 1600 Pa at 120 min after which the elasticity showed a natural decreased (17%) because of thrombolytic action of plasmin. Ejection of the serum from the clot showed a significant decrease in the elasticity of the clot next to the liquid pool (65% decrease), corresponding to the detachment of the clot from the beaker wall. The use of a thrombolytic agent (Urokinase) on the coagulated blood decreased the shear elasticity close to the point of injection, which varied with time and distance. Supersonic imaging proved to be useful mapping the 2-D clot's elasticity. It allowed the visualization of the heterogeneity of mechanical properties of thrombi and has potential use in predicting thrombi breakage as well as in monitoring thrombolytic therapy.

Carotid circumferential wall stress homeostasis in early remodeling: theoretical approach and clinical application

PURPOSE

To assess the influence of cardiovascular risk factors on arterial wall growth and the remodeling process.

METHODS

In a theoretical part, we used a well-established relationship linking the rate of thickening of the arterial wall to the circumferential wall stress (CWS) increase. In a clinical part, we measured the intima-media thickness (IMT) in 166 subjects with increased cardiovascular risk score but no treatment for hypertension or hypercholesterolemia, no diabetes, and no cardiovascular disease. Far wall IMT and lumen diameter were measured along the right carotid artery by high-resolution ultrasonography and computerized image analysis.

RESULTS

A decreasing linear relationship between IMT and CWS was deduced from the theoretical model, implying that an increase in CWS would result in an IMT increase, and that the higher the IMT-CWS slope, the higher the thickening response. Subjects with advanced age, renal insufficiency, high 10-year Framingham risk, carotid atherosclerosis, and advanced atherosclerosis at other sites had sharper IMT-CWS slope (p < 0.05), in agreement with the homeostasis of CWS hypothesis.

CONCLUSIONS

The IMT increase responding to a CWS increase was greater in high-risk patients.

Flushing ports of totally implantable venous access devices, and impact of the Huber point needle bevel orientation: experimental tests and numerical computation

The use of totally implantable venous access devices developed as a medical device allowing mid- and long-term, frequent, repeated, or continuous injection of therapeutic products, by vascular, cavitary, or perineural access. The effective flushing of these devices is a central element to assure long-lasting use. Our experimental work demonstrates that directing the Huber point needle opening in the diametrically opposite direction of the implantable port exit channel increases the flushing efficiency. These results are consolidated by numerical computations, which support recommendations not only for their maintenance, but also for their use.

Toward the modeling of mucus draining from the human lung: role of the geometry of the airway tree

Mucociliary clearance and cough are the two main natural mucus draining methods in the bronchial tree. If they are affected by a pathology, they can become insufficient or even ineffective, then therapeutic draining of mucus plays a critical role to keep mucus levels in the lungs acceptable. The manipulations of physical therapists are known to be very efficient clinically but they are mostly empirical since the biophysical mechanisms involved in these manipulations have never been studied. We develop in this work a model of mucus clearance in idealized rigid human bronchial trees and focus our study on the interaction between (1) tree geometry, (2) mucus physical properties and (3) amplitude of flow rate in the tree. The mucus is considered as a Bingham fluid (gel-like) which is moved upward in the tree thanks to its viscous interaction with air flow. Our studies point out the important roles played both by the geometry and by the physical properties of mucus (yield stress and viscosity). More particularly, the yield stress has to be overcome to make mucus flow. Air flow rate and yield stress determine the maximal possible mucus thickness in each branch of the tree at equilibrium. This forms a specific distribution of mucus in the tree whose characteristics are strongly related to the multi-scaled structure of the tree. The behavior of any mucus distribution is then dependent on this distribution. Finally, our results indicate that increasing air flow rates ought to be more efficient to drain mucus out of the bronchial tree while minimizing patient discomfort.

Accurate modelling of unsteady flows in collapsible tubes

The context of this paper is the development of a general and efficient numerical haemodynamic tool to help clinicians and researchers in understanding of physiological flow phenomena. We propose an accurate one-dimensional Runge-Kutta discontinuous Galerkin (RK-DG) method coupled with lumped parameter models for the boundary conditions. The suggested model has already been successfully applied to haemodynamics in arteries and is now extended for the flow in collapsible tubes such as veins. The main difference with cardiovascular simulations is that the flow may become supercritical and elastic jumps may appear with the numerical consequence that scheme may not remain monotone if no limiting procedure is introduced. We show that our second-order RK-DG method equipped with an approximate Roe's Riemann solver and a slope-limiting procedure allows us to capture elastic jumps accurately. Moreover, this paper demonstrates that the complex physics associated with such flows is more accurately modelled than with traditional methods such as finite difference methods or finite volumes. We present various benchmark problems that show the flexibility and applicability of the numerical method. Our solutions are compared with analytical solutions when they are available and with solutions obtained using other numerical methods. Finally, to illustrate the clinical interest, we study the emptying process in a calf vein squeezed by contracting skeletal muscle in a normal and pathological subject. We compare our results with experimental simulations and discuss the sensitivity to parameters of our model.

Mechanical performances of elastomers used in diffusers

The use of elastomeric diffusers (EDs) has grown together with the expansion of home care. In these devices, the fill volume of the drug reservoir and the flow rate are preset and cannot be modified. The elastomer, which makes up the reservoir walls, is what makes the infusate flow due to the pressure it exerts. The purpose of this work was to quantify, under standardized experimental conditions and following recommended conditions of use, the mechanical performances of the 2 commonly used elastomers (silicone and polyisoprene) and their impact on infusion flow rate consistency. Results show that they exhibit different mechanical performances which leads to concerns regarding the use of these devices for some intravenous (IV) therapies.

Active Catheters for Neuroradiology

Surgeons performing endovascular interventions have high expectations with regard to the improvement of their operating tools and, more specifically, of their catheters. Active catheters, in which the tip moves actively using Shape Memory Alloy (SMA) actuators, constitute a promising approach. In this article, we review existing SMA-based active catheters present in the literature. We analyze their performances regarding the requirements imparted to neuroradiology. Then, we propose a new analytical model for predicting the thermo-mechanical behavior of steerable catheters actuated through SMA wires. Particularly, we give an expression for the maximal achievable bending angle of the catheter tip. These results are finally applied to the design of single-use small-diameter active catheters especially devoted to neuroradiology. In particular, we present a 3.3-Fr catheter suited for navigating into the Willis’ polygon and for accurate positioning into aneurysmal cavities.

Comparative in vitro study of three interface pressure sensors used to evaluate medical compression hosiery

BACKGROUND

Compressive treatment is recognized as therapy to prevent and treat chronic venous insufficiency. Measurement of the pressure exerted by compression hosiery is important within the context of clinical trials. Different pressure sensors are available, with different performance.

OBJECTIVE

This study is a metrological characterization of three interface pressure sensors (Salzmann, Talley, and Kikuhime). We compare their performance in terms of accuracy, repeatability, and sensitivity to flexion on a curved surface.

METHOD

The measuring devices were first tested in a pressurized chamber and then compared by placing the probes on a wooden leg model using compression stockings of known pressure.

RESULTS

In a pressurized chamber, the three systems gave linear responses and an overall error of 15.4%, 3.1%, and 4.3% for Salzmann, Talley, and Kikuhime, respectively. The repeatability error was less than 0.6 mmHg. On the leg model, the overall errors differ between the systems. Repeatability was comparable between the sensors.

CONCLUSION

The three sensors displayed interesting performances for measuring in situ interface pressure, but they had different advantages and limitations. Performance and practical factors will determine the choice of a sensor for specific experiments.

Incoherent light transport in an anisotropic random medium: a probe of human erythrocyte aggregation and deformation

This paper investigates the flow induced disaggregation, deformation and orientation of several modified human red blood cells suspended in concentrated, physiological like conditions (volume fraction in erythrocytes of 0.4). The aim is to determine simultaneously, and under flow, the aggregate sizes as well as the deformation and orientation of the cells. The measurement method uses steady, incoherent, unpolarized light transport while the sample is sheared in a flow cell controlled by a rheometer. Several blood samples were prepared to alter the erythrocyte's aggregating, deformability and shape properties. The measurements using these samples show a clear relationship between the intrinsic properties of the cells and the evolution of aggregate sizes, average cell orientation and anisotropy as a function of the applied shear, which may lead to clinical applications. In other words, the careful analysis of the incoherent light transport in concentrated media provides quantitative insight into their microscopic details. In particular, the topological properties (average anisotropy and orientation) and size of the suspended objects can be determined.

Rheological changes after stenting of a cerebral aneurysm: a finite element modeling approach

Hemodynamic changes in intracranial aneurysms after stent placement include the appearance of areas with stagnant flow and low shear rates. We investigated the influence of stent placement on blood flow velocity and wall shear stress of an intracranial aneurysm using a finite element modeling approach. To assess viscosity changes induced by stent placement, the rheology of blood as non-Newtonian fluid was taken into account in this model. A two-dimensional model with a parent artery, a smaller branching artery, and an aneurysm located at the bifurcation, before and after stent placement, was used for simulation. Flow velocity plots and wall shear stress before and after stent placement was calculated over the entire cardiac circle. Values for dynamic viscosity were calculated with a constitutive equation that was based on experimental studies and yielded a viscosity, which decreases as the shear rate increases. Stent placement lowered peak velocities in the main vortex of the aneurysm by a factor of at least 4 compared to peak velocities in the main artery, and it considerably decreased the wall shear stress of the aneurysm. Dynamic viscosity increases after stent placement persisted over a major part of the cardiac cycle, with a factor of up to 10, most pronounced near the dome of the aneurysm. Finite element modeling can offer insight into rheological changes induced by stent treatment of aneurysms and allows visualizing dynamic viscosity changes induced by stent placement.

Intramuscular pressure and surface EMG in voluntary ankle dorsal flexion: Influence of elastic compressive stockings

Intramuscular pressure (IMP) is of major importance in blood flow and is often taken as a good estimate of muscular tension. However, its measurement remains invasive. The aims of the present work were: (1) to re-examine the possibility of evaluating IMP and muscular tension changes by means of surface electromyographic recordings, and (2) to clarify the influence of elastic compressive stockings (ECS). Surface EMG of muscles tibialis anterior (TA), soleus, gastrocnemius, and IMP from the anterior tibial compartment (ATC), deep posterior compartment (DPC), superficial posterior compartment (SPC) of the right leg, were simultaneously recorded in nine healthy subjects. Subjects performed series of voluntary concentric TA contractions (right ankle dorsal flexions) and TA isometric contractions, with or without elastic ECS, in a decubitus posture. Rest IMP mean values, measured over 60 s, ranged between 12.3 and 26.6 mmHg, i.e. in the range or slightly higher than those reported in the literature. When ECS were applied, mean IMP increase was 6.4 mmHg in ATC, 8.7 mmHg in DPC and 21.0 mmHg in SPC, while the corresponding EMG amplitude decreased. In ankle dorsal flexion movements, instantaneous values of TA-EMG amplitudes were linearly correlated to ATC-IMP instantaneous values, over the whole of the EMG rising part of every movement. When ECS were applied, the relationships between TA-EMG amplitude and ATC-IMP amplitude remained linear but where shifted towards higher IMP, in agreement with the increase in rest IMP. Because of antagonist co-contractions, IMP from DPC and SPC were also linearly correlated with ATC-IMP but with low coefficients of proportionality. As in TA concentric contractions, TA-EMG amplitudes were linearly correlated to ATC-IMP instantaneous values in isometric contractions, but the slopes of the latter were always greater. This result is explained by the relationship between muscle tension and shortening velocity. Al the results showed that: (1) instantaneous changes in surface EMG amplitude may provide a good estimate of IMP changes during the rising part of isometric, but also of concentric voluntary contractions; (2) elastic compressive stockings do not impair subjects relaxation capacity but actually increase the ratio IMP/muscle activation. As a consequence, ECS may actually increase the venous return during voluntary contractions.

Experimental evidence of a potentially increased thrombo-embolic disease risk by domestic electromagnetic field exposure

We have used the EaHy926 endothelial cell line, able to secrete both pro and anti-aggregant platelet agents, as a model for thrombo-embolic diseases. We experimentally established, by comparing these two secretions with or without a Faraday cage, that the environmental electromagnetic field significantly increases the thrombo-embolic risks in this endothelial cell line.

A digital model for the venous junctions

The venous network in the lower limbs is composed of a considerable number of confluent junctions. Each of these singularities introduces some blood flow disturbances. Each physiological junction is unique, in terms of its geometry as well as the blood flow rate. In order to account for this great variability, we developed a numerical model based on the use of the N3S code (a software package for solving Navier-Stokes equations). To test the validity of the model, one of the numerical simulations is compared with the data obtained in the corresponding experimental configuration. The velocity measurements were carried out with an ultrasonic pulsed Doppler velocimeter. We also measured pressure differences using differential sensors. The numerical computations were then used to obtain the values of the flow variables at any point, with various geometrical and flow configurations. As far as the velocity field is concerned, a very marked three-dimensional pattern with swirls was observed. The pressure evolution was also strongly disturbed, with a non-linear decrease. All these data indicate that confluence effects cannot be neglected when evaluating pressure decreases. With a tool of this kind, it is possible to accurately predict the disturbances associated with any geometrical configuration or any flow rate.

Uterine artery embolization in sheep: comparison of acute effects with polyvinyl alcohol particles and calibrated microspheres

PURPOSE

To compare the effects on the myometrium of polyvinyl alcohol (PVA) particles and calibrated microspheres (MS) in embolization of the uterine arteries in sheep.

MATERIALS AND METHODS

Superselective and bilateral embolization of the uterine arteries was performed with PVA particles and calibrated MS within 24 hours after artificial ovulation in 26 adult nonpregnant sheep. PVA particles of four diameters, 150-250, 250-400, 400-600, and 600-1,000 microm, were compared with calibrated MS of similar diameters, 100-300, 300-500, 500-700, and 700-900 microm, in eight groups of sheep. Evaluation was based on histopathologic study of uterus, ovaries, and vascular pedicles after sacrifice 5 days after embolization. The scores of necrosis, the diameter of occluded arteries, and the number of particles were determined. The scores of uterine necrosis were compared by using nonparametric tests (Mann-Whitney U and Kruskal-Wallis). Spearman rank test was used for correlations.

RESULTS

PVA particles clumped more readily than did MS. Small particles had a higher score (P =.02) of uterine necrosis than did large particles. PVA particles produced more necrosis than did MS. Size of MS and diameter of occluded arteries showed significant correlation (rho = 0.762, P <.001). Size of PVA particles and diameter of occluded arteries showed no correlation. PVA particles occluded vessels of a wider range of size than did calibrated MS.

CONCLUSION

PVA particles are associated with intense uterine necrosis and extensive arterial occlusion regardless of size. Calibrated MS, which are associated with less uterine necrosis, permit a segmental arterial occlusion correlated with size.

Hemorheology in asymptomatic HIV-infected patients

Although cardiac and vascular complications have been recognized among patients infected with the Human Immunodeficiency Virus-1 (HIV-1), their vascular biology and rheology have not been studied. Rheology of red blood cells (RBC) was assessed with an erythroaggregometer in 22 HIV-1 infected asymptomatic patients (pts) and 17 healthy HIV negative controls (C). All participants were normotensive, nondiabetics, had normal lipid levels and had an hematocrit ranging from 37 to 44% and hemoglobin levels > or = 12 g/100 ml. Patients had a shorter RBC aggregation characteristic time than controls (1.49 +/- 0.17 vs. 2.04 +/- 0.41 s, p = 0.001) and an increased disaggregation shear rate (166 +/- 34.9 vs. 122 +/- 25.4 s(-1), p = 0.001). This hyperaggregation tendancy was associated with increased gamma-globulin (18.3 +/- 3.3 vs. 13.7 +/- 1.9 g/l, p = 0.01) and fibrinogen (3.52 +/- 0.57 vs 3.03 +/- 0.48 g/l, p = 0.003) levels and with an increased erythrocyte sedimentation rate (ESR) (25 +/- 14.3 vs. 12.3 +/- 7.5 mm, p = 0.02). Even in patients with ESRs ranging within normal values (< or = 20 mm), the aggregation characteristic time was found lower in patients than in controls (p = 0.004). There was no correlation between these rheological changes and the CD4+ T-cell count. The 17 patients receiving an antiviral therapy had lower CD4+ T-cell counts than their 5 untreated counterparts (244.7 +/- 167 vs. 410 +/- 106/mm3, p = 0.025), and a higher disaggregation shear rate (177.4 +/- 38.2 vs. 127 +/- 25.4, p = 0.01). Thus, an impairment of rheological characteristics is observed in asymptomatic HIV-I infected patients in association with changes in plasma proteins.

Non-linear analysis of the arterial pulsatile flow: assessment of a model allowing a non-invasive ultrasonic functional exploration

Ultrasonic measurements and modelling of blood flow in large vessels allows non-invasive evaluation of clinically interesting hemodynamic variables. To this aim, a non-linear mathematical model for the pulsatile arterial flow is proposed using the approximation of "local flow" theory. The model requires only measurements of instantaneous radius and centre-line blood velocity, and the knowledge of the tube distensibility to calculate blood velocity profiles, pressure gradient and wall shear stress. Evaluation of the proposed model using experimental data obtained from the literature proved that it can provide reliable results. In addition, as shown by assessing significance of various non-linear terms, results did not significantly change when a linear pressure-radius relationship was used instead of a non-linear relationship. Also, the model was found to be moderately sensitive to arterial tapering. Thus, the proposed model is suitable for a non-invasive clinical arterial exploration since it only requires three measurements which can be easily and precisely obtained in vivo using ultrasonic methods: the instantaneous radius, the centre-line velocity and the mean pulse wave velocity, this last variable characterizing the tube distensibility when assuming a linear pressure-radius relationship.

Modeling of the deformation of flexible tubes using a single law: application to veins of the lower limb in man

The topic of this study mainly concerns a representative model of the behavior of flexible ducts such as elastic tubes or veins. This model is based on a phenomenological approach of the inflation and collapse of the tube. It leads to a single "universal" analytical expression of the tube law, valid fir a wide range of' positive and negative transmural pressures, which presents a significant improvement compared to previous theoretical studies defined with different expressions on restricted ranges of pressure. Moreover, the theoretical approaches most often require simplif'ing hypotheses--no longitudinal tension, no surrounding tissues--which are quite unrealistic both in the physiological case and in the experimental setup. These theoretical models can therefore be expected only roughly to describe the actual behavior of such vessels. The representative model, on the contrary, allows one to account for the deformation--inflating as well as collapse--of elastic tubes or veins with better accuracy. The tube law is a function of six parameters chosen in order to fit the experimental data. A comparison between results obtained in our laboratory using silicone tubes and representative models is presented. The model is then applied to physiological data obtained in vivo on human leg veins.

Deconvolution process in measurement of arterial velocity profiles via an ultrasonic pulsed Doppler velocimeter for evaluation of the wall shear rate

A numerically based simulation of pulsed Doppler ultrasound convolution and deconvolution of theoretical hemodynamic velocity profiles yields two major conclusions on performing a deconvolution process. First, the most important parameter to be accounted for is the size of the sample volume. Second, a deconvolution process with an overestimated sample volume size is revealed by high-frequency noise on the resulting profile. A deconvolution process is presented for in vivo arterial velocity profiles, which has the advantage of being systematic and not needing experimental testing for determining the size or the shape of the sample volume. It is also independent of the observation angle. Finally, an example of an application to in vivo human velocity profiles is given. Evaluation of the wall shear rate from the corrected deconvolved profiles shows a noticeable improvement with respect to that using the directly convolved Doppler profiles.

In vitro study of haemodynamics in a giant saccular aneurysm model: influence of flow dynamics in the parent vessel and effects of coil embolisation

The purpose of this study was to investigate the influence of flow dynamics in the parent vessel and of intra-aneurysmal coil embolisation on flow pattern and pressure in an in vitro model of giant aneurysm. A pulsatile perfusion with a glycerol aqueous solution was installed in a silicone model of a lateral giant aneurysm. Flow visualization and pressure measurements were performed while modifying the flow rate, the pulsatility and the pulse rate in the parent vessel, and after partial coil embolisation. Vortices were formed during systole at the downstream lip of the aneurysm and circulated around the aneurysm. The centre and dome of the aneurysm were areas of fluid stagnation. Flow rate and pulsatility were the main factors which varied the pattern of flow within the aneurysm. Partial coil embolisation induced major flow disturbances in the aneurysm, in particular fluid stagnation at the dome. Pressure measurements were similar in the aneurysm and in the parent vessel. It was concluded that the pulsatility of flow is an important as the flow rate when considering the haemodynamics in a giant aneurysm. In the clinical context, this could explain the efficacy of vertebral artery occlusion in thrombosing giant vertebrobasilar aneurysms. Studies with intra-aneurysmal coil embolisation showed early fluid stagnation at the dome. This could result in embolic migration during endovascular treatment. Partial coil embolisation may prevent early rebleeding; however, it may induce additional mural stresses resulting from new haemodynamic forces and compliance mismatch.

[In vitro evaluation of Dibie-Musset vena caval filter]

The Dibie-Musset (DM) vena caval filter was evaluated on a hydraulic test bench reproducing flow conditions in the inferior vena cava: pressure, flow, viscosity, diameter and elasticity of the conduit. The results were compared with those obtained with the Greenfield filter (GF). In addition to classical measurements (captation and loss of load) we measured the velocity profile with a Doppler ultrasonic probe proximal and distal to the filter to study flow conditions before and after embolisation of clots. In order to circumvent the difficulties encountered with the use of real thrombi, chemical gels with visco-elastic properties, evaluated by viscosimetry, similar to those of blood clots, were used. Clots 45 mm long and 4 mm diameter were injected in several series of measurements. The DM filter was stable and did not migrate. In the horizontal position (flexible conduit) the DM filter was significantly more effective than the GF for less than 5 clots injected successively. The filtration capacity of both filters decreased with the number of clots captured. In the vertical position (rigid conduit), when there are less than 5 clots injected the two devices were perfectly effective. There was no significant difference between the two filters when 10 clots were injected. The loss of load resulting from the presence of the filter and clots was greater with the DM filter because of the greater captation capacity. However, the velocity profile distal to the filter was less disturbed with the DM filter because there was a more uniform distribution of the clots captured over the surface of the filter.(ABSTRACT TRUNCATED AT 250 WORDS)