The number of patients with heart failure in China is large, and the proportion of patients with end-stage heart failure continues to increase. The clinical effect of guideline-directed medications therapy for end-stage heart failure is poor. Heart transplantation is the most effective treatment for end-stage heart failure. But it is faced with many limitations such as the shortage of donors. In recent years, the research and development of artificial heart in China has made great progress. Three devices have been approved by the National Medical Products Administration for marketing, and another one is undergoing pre-marketing clinical trial. Since 2017, more than 200 cases of ventricular assist device implantation have been carried out in more than 34 hospitals in China. Among them, 70 patients in Fuwai Hospital, Chinese Academy of Medical Sciences had a 2-year survival rate of 90%. The first patient has survived more than 5 years with the device. More efforts should be put into the training of standardized technical team and quality control. Further research should be carried out in the aspects of pulsatile blood flow pump, fully implanted cable-free device, and improved biomaterial with better blood compatibility.
Humans ; Heart-Assist Devices ; Heart Failure/surgery* ; Heart, Artificial ; Heart Transplantation ; Pulsatile Flow

PURPOSE: To investigate the effect of cilostazol on ocular hemodynamics and to determine whether the administration of cilostazol increases the ocular blood flow in patients with diabetic retinopathy. METHODS: This prospective observational study investigated the effect of orally administered cilostazol on diabetic retinopathy. Before and after administration for 1 week, pulsatile ocular blood flow (POBF) and retrobulbar hemodynamics were measured using a POBF analyzer and transcranial Doppler imaging, respectively. Visual acuity, intraocular pressure, and blood pressure were also evaluated before and after treatment. RESULTS: Twenty-five eyes of 25 patients were included in this study. POBF increased significantly (16.8 ± 4.6 µL/sec vs. 19.6 ± 6.2 µL/sec, p < 0.001) after administration of cilostazol, while no significant change was identified in visual acuity, intraocular pressure, and blood pressure. Mean flow velocity in the ophthalmic artery as measured with transcranial Doppler imaging also increased significantly after medication (23.5 ± 5.6 cm/sec vs. 26.0 ± 6.9 cm/sec, p = 0.001). The change in POBF directly correlated with the change in mean flow velocity (r = 0.419, p = 0.007). CONCLUSIONS: Cilostazol was effective in increasing ocular blood flow in patients with diabetic retinopathy, possibly by modulating retrobulbar circulation.
Administration, Oral* ; Blood Flow Velocity ; Blood Pressure ; Diabetic Retinopathy* ; Hemodynamics ; Humans ; Intraocular Pressure ; Observational Study ; Ophthalmic Artery ; Prospective Studies ; Pulsatile Flow ; Visual Acuity

Producing accurate pulsatile flow rates is essential for many in vitro experimental studies in biofluid dynamics research. A controller system was developed to control a flow loop to produce easily adjustable pulsatile flow rates with sufficient accuracy. An Arduino board is used as a micro-controller to control a pump to produce various pulsatile flow rates, and an open-source proportional-integral-derivative (PID) control algorithm is developed for this purpose. Four non-trivial pulsatile waveforms were produced by the PID controller, as well as an iterative controller, and the performance of both controllers was evaluated. Both the PID and iterative controllers were able to successfully produce slowly-varying signals (single and multi-harmonic low frequency sine waves), but for high frequency signals where the flow has strong acceleration/deceleration (e.g. for physiological waveforms) the iterative controller exhibited significant undershoot. The comparison of PID and iterative controllers suggests that if the desired flow rate is a low frequency, simple waveform then the iterative controller is preferred due to simplicity of implementation. However, if the desired signal is rapidly changing and more complicated then the PID controller achieves better results. This system can be implemented in many flow loops due to its simplicity and low cost, and does not require a mathematical model of the system.
Carotid Artery, Common ; In Vitro Techniques* ; Models, Theoretical ; Pulsatile Flow*

BACKGROUND: Extracorporeal circulation (ECC) can induce alterations in blood viscoelasticity and cause red blood cell (RBC) aggregation. In this study, the authors evaluated the effects of pump flow pulsatility on blood viscoelasticity and RBC aggregation. METHODS: Mongrel dogs were randomly assigned to two groups: a nonpulsatile pump group (n=6) or a pulsatile pump group (n=6). After ECC was started at a pump flow rate of 80 mL/kg/min, cardiac fibrillation was induced. Blood sampling was performed before and at 1, 2, and 3 hours after ECC commencement. To eliminate bias induced by hematocrit and plasma, all blood samples were adjusted to a hematocrit of 45% using baseline plasma. Blood viscoelasticity, plasma viscosity, hematocrit, arterial blood gas analysis, central venous O2 saturation, and lactate were measured. RESULTS: The blood viscosity and aggregation index decreased abruptly 1 hour after ECC and then remained low during ECC in both groups, but blood elasticity did not change during ECC. Blood viscosity, blood elasticity, plasma viscosity, and the aggregation index were not significantly different in the groups at any time. Hematocrit decreased abruptly 1 hour after ECC in both groups due to dilution by the priming solution used. CONCLUSION: After ECC, blood viscoelasticity and RBC aggregation were not different in the pulsatile and nonpulsatile groups in the adult dog model. Furthermore, pulsatile flow did not have a more harmful effect on blood viscoelasticity or RBC aggregation than nonpulsatile flow.
Adult ; Animals ; Bias (Epidemiology) ; Blood Gas Analysis ; Blood Viscosity ; Cardiopulmonary Bypass ; Dogs ; Elasticity ; Erythrocytes* ; Extracorporeal Circulation* ; Hematocrit ; Hematology ; Humans ; Lactic Acid ; Plasma ; Pulsatile Flow ; Viscosity

PURPOSE: Lacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke. MATERIALS AND METHODS: This study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression. RESULTS: The mean infarct volume and PI were 482.18±406.40 mm3 and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm3 in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022). CONCLUSION: We demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.
Aged ; Cerebral Infarction/*diagnostic imaging/*physiopathology ; *Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Middle Cerebral Artery ; Pulsatile Flow/physiology ; Retrospective Studies ; Stroke, Lacunar/*diagnostic imaging/*physiopathology ; *Ultrasonography, Doppler, Transcranial ; Vascular Resistance/physiology

Aged ; Atherosclerosis ; Case-Control Studies ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Female ; Hemodynamics ; physiology ; Humans ; Male ; Mammary Arteries ; physiology ; transplantation ; Middle Aged ; Pulsatile Flow ; Radial Artery ; physiology ; transplantation ; Rheology ; Saphenous Vein ; physiology ; transplantation ; Shear Strength ; Stress, Mechanical ; Vascular Patency ; physiology

PURPOSE: The goal of this study was to evaluate the effect of vascular compliance, resistance, and pulse rate on the resistive index (RI) by using an electrical circuit model to simulate renal blood flow. METHODS: In order to analyze the renal arterial Doppler waveform, we modeled the renal blood-flow circuit with an equivalent simple electrical circuit containing resistance, inductance, and capacitance. The relationships among the impedance, resistance, and compliance of the circuit were derived from well-known equations, including Kirchhoff's current law for alternating current circuits. Simulated velocity-time profiles for pulsatile flow were generated using Mathematica (Wolfram Research) and the influence of resistance, compliance, and pulse rate on waveforms and the RI was evaluated. RESULTS: Resistance and compliance were found to alter the waveforms independently. The impedance of the circuit increased with increasing proximal compliance, proximal resistance, and distal resistance. The impedance decreased with increasing distal compliance. The RI of the circuit decreased with increasing proximal compliance and resistance. The RI increased with increasing distal compliance and resistance. No positive correlation between impedance and the RI was found. Pulse rate was found to be an extrinsic factor that also influenced the RI. CONCLUSION: This simulation study using an electrical circuit model led to a better understanding of the renal arterial Doppler waveform and the RI, which may be useful for interpreting Doppler findings in various clinical settings.
Compliance ; Computer Simulation ; Electric Impedance ; Heart Rate ; Jurisprudence ; Pulsatile Flow ; Renal Artery ; Renal Circulation ; Ultrasonography, Doppler

Quantitative measurement of strain distribution of arterial vessel walls due to pulsatile blood flow within the vascular lumen is valuable for evaluating the elasticity of arterial wall and predicting the evolution of plaques. The present paper shows that the three-dimensional (3D) strain distribution are estimated through uni-directional coupling for 3D vessel and blood models reconstructed from intravascular ultrasound (IVUS) images with the computational. fluid dynamics (CFD) numerical simulation technique. The morphology of vessel wall and plaques as well as strain distribution can be visually displayed with pseudo-color coding.
Arteries ; diagnostic imaging ; physiology ; Elasticity ; Hemodynamics ; Humans ; Imaging, Three-Dimensional ; Pulsatile Flow ; Ultrasonography

OBJECTIVETo explore the predictive value of high-sensitivity C reactive protein (hsCRP) in middle-aged population during the peripheral arteriosclerosis.

METHODSRandom sampling method was used in the study. In 2006-2007 Kailuan Group health examination of 101,510 employees, using stratified random sampling method to select 5,852 as observational cohort included, in the final with a standard queue 5,440 in December 2009. This study selected to participate in the 2012-2013 health examination cohort as the research object, in accordance with the inclusion criteria ultimately selected survey 3,978, select the epidemiological investigation, physical examination, laboratory testing data analysis. Of the 3 978 subjects, 2,282 were male and 1,696 were female, and the baseline age was (53.80±11.14) years. According to the baseline hsCRP quartile level was divided into four groups for comparison of baseline data, using multiple linear regression analysis between hsCRP and brachial-ankle pulse wave velocity (baPWV). Area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the prediction of hsCRP levels in peripheral arteriosclerosis.

RESULTSWith increase of hsCRP levels, the survey of baseline levels of baPWV showed increasing trend, (1,445.49±300.55), (1,494.46±307.94), (1,547.67±320.34), (1,621.32±342.53) cm/s, respectively. Multiple linear regression results showed that age, by logarithmic transformation of hsCRP (lghsCRP) level, systolic blood pressure and fasting blood glucose for each additional unit, baPWV levels were increased 266.47, 58.00, 5.02, 39.79 cm/s (P<0.001), and BMI for each additional unit, baPWV level decreased 9.52 cm/s (P=0.030). The prediction of hsCRP in peripheral artery showed that lghsCRP level of AUC to 0.59 (95% CI: 0.57-0.61), lower than the age and systolic blood pressure predicted value AUC (95% CI) of 0.69 (0.67-0.71), 0.75 (0.73-0.77), respectively.

CONCLUSIONThe hsCRP level could not predict the peripheral arteriosclerosis alone, and the combined age and systolic blood pressure level could have better predictive value.

Ankle ; Ankle Brachial Index ; Biomarkers ; Blood Flow Velocity ; Blood Pressure ; C-Reactive Protein ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease ; Pulsatile Flow

Computational fluid dynamics (CFD) technology has the potential to simulate normal or pathologic aortic blood flow changes of mechanical properties and flow field, thereby helping researchers understand and reveal the occurrence, development and prognosis of aortic disease. In aortic diseases research, the initial conditions of CFD numerical simulation has experienced a developed process from idealization (forward engineering), rigid vessel wall, uniform cross-sections, laminar flow and stable blood flow towards personalization (reverse engineering), elastic vessel wall (fluid-solid coupling technique), cone-shaped diminishing cross-sections, turbulent flow, pulsatile blood flow. In this review, the research status, the technical superiority and application prospect of CFD technology were discussed with examples in following three major application areas: (1) dynamics characteristic and mechanical properties in normal thoracic aorta; (2) occurrence, advance and disruptive risk predicting in thoracic aortic aneurysm; (3) therapeutic effect and aneurysmal dilatation simulation in thoracic aortic dissection. For the future, the CFD technology may profoundly put an influence on the awareness to aortic diseases and treatment strategies.
Aorta ; pathology ; physiology ; Aortic Aneurysm, Thoracic ; physiopathology ; Computer Simulation ; Dilatation ; Hemodynamics ; Humans ; Pulsatile Flow ; Regional Blood Flow