重力对锥形血管中血流压力的影响——基于考虑体位改变的三维流固耦合数学模型

重力是体位改变过程中最基本的生物力学刺激因素．血流压力是表征心血管功能状态的一个基本指标．目前,体位改变影响心血管系统的确切内部机制尚不清楚．为此,采用在流体和固体方程中分别引入体力项的方法,建立一个基于血流动力学概念的三维流固耦合数学模型,用以研究体位改变,确切量化重力对血流压力的影响．通过数值计算,得到以下结果．水平卧位条件下：a．单一血管中血流压力由无重力影响的轴对称二维分布变为重力影响下的三维不对称分布;b．随着进出口压差由小变大,重力对压力分布和极值的影响由大变小,当压差值分别达到10 665.6 Pa(80 mmHg)和2 666.4 Pa(20 mmHg)时,重力的影响就不再随进出口压差增大而变化;对三维单一流体,重力影响的总体趋势类似．对正、倒直立位,压力均为二维轴对称分布,其重力影响强度约为水平卧位的2倍以上．结果表明：基于血流动力学概念,引入体力项,建立三维流固耦合模型为研究体位改变提供了一种新思路,重力对单一血管中血流压力分布和大小的影响因体位不同而不同,并与进出口压差密切相关,提示,若血管进出口压差较小,忽略重力影响,不考虑体位改变,以二维轴对称模型来研究血管中血流状态,须谨慎解释所得结果．     

Hemodynamics for medical students

The flow of blood through the cardiovascular system depends on basic principles of liquid flow in tubes elucidated by Bernoulli and Poiseuille. The elementary equations are described involving pressures related to velocity, acceleration/deceleration, gravity, and viscous resistance to flow (Bernoulli-Poiseuille equation). The roles of vascular diameter and number of branches are emphasized. In the closed vascular system, the importance of gravity is deemphasized, and the occurrence of turbulence in large vessels is pointed out.     

Determination of the activities of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase in a microfluidic system

A microfluidic system for the analysis of the activities of glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transaminase (GPT) was fabricated. The device consists of a glass chip with a micro-electrochemical L-glutamate sensor and a polydimethylsiloxane (PDMS) sheet with a Y-shaped micro-flow channel. A sample solution and a substrate solution for the enzymes were introduced from two injection ports at the end of the flow channel. When the flows were stopped, substrates in a solution mixed immediately with either of the enzymes by diffusion in a mixing channel. L-glutamate produced by the enzymatic reaction of GOT or GPT in the flow channel was detected by using the L-glutamate sensor. A distinct current increase was observed immediately after mixing, and the initial slope of the response curve varied in proportion to the activity of GOT or GPT. The relation between the slope of the response curve and the enzyme activity was linear between 7 and 228 U l-1 for GOT and 9 and 250 U l-1 for GPT. The quality of the response curve was improved with an increase in the channel height. The measurement based on the rate analysis in the micro-flow channel facilitated the reduction of the influence of interferents. The influence of the viscosity of the sample solution was also checked for the analysis of real samples. The determination of the enzyme activities was also conducted in a system with micropumps fabricated for a sample injection. Two solutions could be mixed in the mixing channel, and the activity of the enzymes could be measured as in the experiments using microsyringe pumps.     

Quantitative description of blood oxygenation process in oxygenator for extracorporal circulation

Based on conceptions and assumptions concerning the blood oxygenation process, some fundamental quantitative relations for red blood corpuscle oxygenation and blood oxygenation kinetics are presented. A distribution function is introduced expressing the probability density for the occurrence of a red blood cell with a specific oxygen content. By means of a kinetic equation deduced the distribution function is connected with spatial distribution of oxygen pressure and with blood flow rate. For the given initial conditions the kinetic equation is solved for a one-dimensional case, and this solution is applied to a generalized oxygenator in a stationary case. The generalized oxygenator presents a system of through-flow elements in which blood flows and contacts oxygen. Each of the through-flow elements is characterized by length, blood flow rate, probability of red blood corpuscle entry and by a quantity depending on oxygen pressure. Results obtained for the generalized oxygenator are then applied to a disc oxygenator with certain presumptions concerning blood oxygen saturation at the system's output expressed in dependence on geometry and performance conditions. Stress is laid upon the influence of blood flow in the oxygenator, on oxygenation; and two extreme cases are compared—series and parallel types of disc oxygenator.     

Doppler Optical Coherence Tomography of Retinal Circulation

Noncontact retinal blood flow measurements are performed with a Fourier domain optical coherence tomography (OCT) system using a circumpapillary double circular scan (CDCS) that scans around the optic nerve head at 3.40 mm and 3.75 mm diameters. The double concentric circles are performed 6 times consecutively over 2 sec. The CDCS scan is saved with Doppler shift information from which flow can be calculated. The standard clinical protocol calls for 3 CDCS scans made with the OCT beam passing through the superonasal edge of the pupil and 3 CDCS scan through the inferonal pupil. This double-angle protocol ensures that acceptable Doppler angle is obtained on each retinal branch vessel in at least 1 scan. The CDCS scan data, a 3-dimensional volumetric OCT scan of the optic disc scan, and a color photograph of the optic disc are used together to obtain retinal blood flow measurement on an eye. We have developed a blood flow measurement software called "Doppler optical coherence tomography of retinal circulation" (DOCTORC). This semi-automated software is used to measure total retinal blood flow, vessel cross section area, and average blood velocity. The flow of each vessel is calculated from the Doppler shift in the vessel cross-sectional area and the Doppler angle between the vessel and the OCT beam. Total retinal blood flow measurement is summed from the veins around the optic disc. The results obtained at our Doppler OCT reading center showed good reproducibility between graders and methods (<10%). Total retinal blood flow could be useful in the management of glaucoma, other retinal diseases, and retinal diseases. In glaucoma patients, OCT retinal blood flow measurement was highly correlated with visual field loss (R²>0.57 with visual field pattern deviation). Doppler OCT is a new method to perform rapid, noncontact, and repeatable measurement of total retinal blood flow using widely available Fourier-domain OCT instrumentation. This new technology may improve the practicality of making these measurements in clinical studies and routine clinical practice.     

A Simple Flow Indicator for Use in Perfusion Fixation

In perfusion fixation, we have preferred gravity flow rather than a peristaltic forced flow because the latter may cause rupture of small blood vessels. One difficulty encountered in the gravity flow method is detection of flow stoppage, often caused by the formation of a blood clot. If this is apparent soon enough, steps can be taken to re-establish the flow, Flow stoppage is not usually detected for several minutes—resulting in poor fixation of the organ involved. To allow immediate detection of stoppage, a glass flow indicator (figure 1) was manufactured     

Selected contribution: redistribution of pulmonary perfusion during weightlessness and increased gravity.

To compare the relative contributions of gravity and vascular structure to the distribution of pulmonary blood flow, we flew with pigs on the National Aeronautics and Space Administration KC-135 aircraft. A series of parabolas created alternating weightlessness and 1.8-G conditions. Fluorescent microspheres of varying colors were injected into the pulmonary circulation to mark regional blood flow during different postural and gravitational conditions. The lungs were subsequently removed, air dried, and sectioned into approximately 2 cm(3) pieces. Flow to each piece was determined for the different conditions. Perfusion heterogeneity did not change significantly during weightlessness compared with normal and increased gravitational forces. Regional blood flow to each lung piece changed little despite alterations in posture and gravitational forces. With the use of multiple stepwise linear regression, the contributions of gravity and vascular structure to regional perfusion were separated. We conclude that both gravity and the geometry of the pulmonary vascular tree influence regional pulmonary blood flow. However, the structure of the vascular tree is the primary determinant of regional perfusion in these animals.     

The interdependent contributions of gravitational and structural features to perfusion distribution in a multiscale model of the pulmonary circulation

Recent experimental and imaging studies suggest that the influence of gravity on the measured distribution of blood flow in the lung is largely through deformation of the parenchymal tissue. To study the contribution of hydrostatic effects to regional perfusion in the presence of tissue deformation, we have developed an anatomically structured computational model of the pulmonary circulation (arteries, capillaries, veins), coupled to a continuum model of tissue deformation, and including scale-appropriate fluid dynamics for blood flow in each vessel type. The model demonstrates that both structural and the multiple effects of gravity on the pulmonary circulation make a distinct contribution to the distribution of blood. It shows that postural differences in perfusion gradients can be explained by the combined effect of tissue deformation and extra-acinar blood vessel resistance to flow in the dependent tissue. However, gravitational perfusion gradients persist when the effect of tissue deformation is eliminated, highlighting the importance of the hydrostatic effects of gravity on blood distribution in the pulmonary circulation. Coupling of large- and small-scale models reveals variation in microcirculatory driving pressures within isogravitational planes due to extra-acinar vessel resistance. Variation in driving pressures is due to heterogeneous large-vessel resistance as a consequence of geometric asymmetry in the vascular trees and is amplified by the complex balance of pressures, distension, and flow at the microcirculatory level.     

The flow rate of blood in an environment of weightlessness

To discuss the decrease in the flow rate of blood experienced by astronauts, a theory of blood flow is presented taking account of the effect of gravity. The theory of two-dimensional Poiseuille flow is adopted. It is assumed that the flow is horizontal and that the width of the upper marginal layer filled with plasma thickens as gravity increases. The parameter xi which mainly indicates the effect of thickening of the upper marginal layer is introduced. The extent of decrease in the flow rate of blood in the environment of weightlessness compared to that in the gravitational field is calculated for various values of xi. The decrease is more remarkable in the flow rate of the cell fraction than that of whole blood for the same value of xi.     

Visualization study of motion and deformation of red blood cells in a microchannel with straight,divergent and convergent sections

The size of red blood cells (RBC) is on the same order as the diameter of microvascular vessels. Therefore, blood should be regarded as a two-phase flow system of RBCs suspended in plasma rather than a continuous medium of microcirculation. It is of great physiological and pathological significance to investigate the effects of deformation and aggregation of RBCs on microcirculation. In this study, a visualization experiment was conducted to study the microcirculatory behavior of RBCs in suspension. Motion and deformation of RBCs in a microfluidic chip with straight, divergent, and convergent microchannel sections have been captured by microscope and high-speed camera. Meanwhile, deformation and movement of RBCs were investigated under different viscosity, hematocrit, and flow rate in this system. For low velocity and viscosity, RBCs behaved in their normal biconcave disc shape and their motion was found as a flipping motion: they not only deformed their shapes along the flow direction, but also rolled and rotated themselves. RBCs were also found to aggregate, forming rouleaux at very low flow rate and viscosity. However, for high velocity and viscosity, RBCs deformed obviously under the shear stress. They elongated along the flow direction and performed a tank-treading motion.     

Aggregation of red cells in disease: some deductions and speculations based on results of "ARC" experiment on the space shuttle "Discovery" STS 51-C

Experiment on STS 51-C in January 1985, carried out on blood samples obtained from patients with heart disease, diabetes, hyperlipidaemia and cancer showed that, under zero gravity, the morphology of red cell aggregates aggregates was normal, in contradistinction to the parallel and simultaneous observations under 1 g, which showed large and unorientated clumps of red cells. As such clumps could be considered of disadvantage in the microcirculation and tissue perfusion, the zero gravity observations were significant in a number of ways. In particular, a preliminary deduction (subject to further zero g experimentation) was that cell-cell interaction and adhesion are affected by zero gravity, and that most likely the microarchitecture of the cell membrane is modified; and that probably the receptors, their position and/or activity, are affected by zero gravity. Of particular interest could be a possible change in the properties of the discrete surface areas which respond preferentially to specific macromolecules (or ligands). There is a dissonance between these in vitro results and theoretical deductions on flow in the microcirculations by Oka, and as well of deductions on space sickness by Dintenfass, both assuming a disabling effect of zero g on the in vivo microcirculation. This dissonance should be explored, as effect of zero g might be different on blood flow in vivo and in vitro. However, the data available from the in vitro experiment suggest that studies in immunology and oncology might be enriched by zero gravity findings; and that studies under zero gravity might open a new avenue of research in these important fields.     

Effect of body posture on spatial distribution of pulmonary blood flow

Single-photon emission-computed tomography (SPECT) on intact dogs and humans suggests that one aspect of regional blood flow in the lung (Qr) is independent of gravity, e.g., the gradient in Qr between the core and the periphery. To further evaluate these findings, six anesthetized healthy dogs (approximately 30 kg), two in the supine posture, two in the prone posture, and two suspended in the upright posture, breathing spontaneously, were injected (iv) at end expiration with 20 mCi99mTc-labeled albumin macroaggregates. The animals were killed, their chests were opened, their lungs were removed and dissected free of other tissue, and the blood was drained. The lungs were dried by blowing warm air (50 degrees C) while they were inflated to full capacity for about 18 h. The fully inflated and dry lungs were placed in the supine position and SPECT was performed to determine the three-dimensional distribution of activity. One hundred and twenty projections of the activity in the entire lungs were obtained at 3 degrees steps with a rotating gamma camera and stored in computer memory. Once SPECT was completed, either a coronal slice or a sagittal slice (1 cm thick) was cut and imaged directly by placing it against the gamma camera collimator for 6 min. The tomographic-reconstructed slices revealed that at isogravity, in all body postures, Qr in the central region of the lungs was up to 10 times that in the periphery. Furthermore, the central-peripheral gradient was discernible within the individual lobes. The direct images of slices also confirmed these findings. Although flow inequalities independent of gravity were present, the central region with the highest flow often was closer to the dependent regions of the lungs, suggesting that gravity had some influence on the final distribution. The results suggest that factors other than gravity also play an important role in the distribution of pulmonary blood flow. These factors may be related to the conductance of the vascular pathways that lead to different regions in the lungs.     

Pulmonary blood flow distribution in anesthetized ponies.

Results of recent investigations in humans and dogs indicate that gravity-independent factors may be important in determining the distribution of pulmonary blood flow. To further evaluate the role of gravity-independent factors, pulmonary blood flow distribution was examined using 15-microns radionuclide-labeled microspheres in five prone ponies over 5 h of pentobarbital sodium anesthesia. The ponies were killed, and the lungs were excised and dried by air inflation (pressure 45 cmH2O). The dry lungs were cut into transverse slices 1-2 cm thick along the dorsal-ventral axis, parallel to gravity. Radioactivity of pieces cut from alternate slices was measured with a gamma well counter. The main finding was a preferential distribution of pulmonary blood flow to dorsal-caudal regions and higher flow in the center of each lung slice when compared with the slice periphery. Flow was lowest in cranial and ventral areas. Differences of +/- 2 SD were observed between core and peripheral blood flow. No medial-lateral differences were found. Pulmonary blood flow distribution did not change over 5 h of anesthesia, and the basic flow pattern was not different in the left vs. right lung. These results suggest that in the intact prone mechanically ventilated pony (inspired O2 fraction greater than or equal to 0.95) factors other than gravity are primary determinants of pulmonary blood flow.     

Gravity-independent inequality in pulmonary blood flow in humans

Single-photon emission computerized tomography of the lung with 99mTc-labeled human albumin macroaggregates (99mTc-MAA) was used in six healthy subjects to study the three-dimensional distribution of pulmonary blood flow. 99mTc-MAA was injected while the subjects were resting in the supine position and holding their lung volume at normal end expiration. Tomography was performed on each subject from 120 projections of radioactivity in the lungs acquired with a rotating gamma camera. To minimize lung motion artifacts, the subjects were asked to hold their breath at end expiration during the 10-s duration of data acquisition in each projectional angle. Perfusion images of lung slices (11 mm thick) were reconstructed, and the radioactivity within each slice was expressed per unit lung volume of 3.7 X 3.7 X 11 mm. Perfusion images of a midcoronal slice from each subject manifested a concentric pattern of radioactivity that decreased significantly from the center to the periphery, suggesting that blood flow rate per unit lung volume was up to 10 times larger near the central region. This gradient in activity between the center and the periphery of the coronary slices was gravity independent as the subjects were supine. Images of sagittal slices from the middle of the right lung also manifested a similar pattern of concentric gradient in activity, with the vertical distribution (gravity related) almost comparable with the horizontal distribution (gravity independent). These results indicate that pulmonary blood flow in resting supine humans is spatially stratified with a marked central-to-peripheral gradient in all directions. It appears that zone 4 (reduced blood flow) is not a phenomenon limited to the dependent region of the lung as commonly thought but rather is a manifestation of this spatial distribution whereby blood flow is lowest in all peripheral regions of the lung.     

Development of a platelet adhesion transport equation for a computational thrombosis model

Thrombosis is a significant issue for cardiovascular device development and use. While thrombosis models are available, very few are device-related and none have been thoroughly validated experimentally. Here, we introduce a surface adherent platelet transport equation into a continuum model to account for the biomaterial interface/blood interaction. Using a rotating disc system and polyurethane-urea material, we characterize steady and pulsatile flow fields using laser Doppler velocimetry. In vitro measurements of platelet adhesion are used in combination with the LDV data to provide further experimental validation. The rotating disc system is computationally studied using the device-induced thrombosis model with the surface platelet adherent transport equation. The results indicate that the flow field is in excellent agreement to the experimental LDV data and that the platelet adhesion simulations are in good agreement with the in vitro platelet data. These results provide good evidence that this transport equation can be used to express the relationship between blood and a biomaterial if the correct platelet adhesion characteristics are known for the biomaterial. Further validation is necessary with other materials.     

Paradoxical redistribution of pulmonary blood flow in prone and supine humans exposed to hypergravity.

We hypothesized that exposure to hypergravity in the supine and prone postures causes a redistribution of pulmonary blood flow to dependent lung regions. Four normal subjects were exposed to hypergravity by use of a human centrifuge. Regional lung perfusion was estimated by single-photon-emission computed tomography (SPECT) after administration of (99m)Tc-labeled albumin macroaggregates during normal and three times normal gravity conditions in the supine and prone postures. All images were obtained during normal gravity. Exposure to hypergravity caused a redistribution of blood flow from dependent to nondependent lung regions in all subjects in both postures. We speculate that this unexpected and paradoxical redistribution is a consequence of airway closure in dependent lung regions causing alveolar hypoxia and hypoxic vasoconstriction. Alternatively, increased vascular resistance in dependent lung regions is caused by distortion of lung parenchyma. The redistribution of blood flow is likely to attenuate rather than contribute to the arterial desaturation caused by hypergravity.     

Effect of spaceflight on the subcutaneous venoarteriolar reflex in the human lower leg.

Whenever the legs are lowered in humans, a venoarteriolar reflex is activated by the hydrostatic distension of the venules. Through local axon reflexes, the adjacent arterioles are contracted to decrease blood flow and prevent formation of edema. Because the venoarteriolar reflex is activated by gravity, we tested the hypothesis that long-term weightlessness would attenuate it. The reduction in subcutaneous blood flow was measured by the (133)Xe washout technique just proximal to the ankle joint in dependent lower legs of eight supine astronauts, where the knee joint was passively bent by 90 degrees . The measurements were conducted before spaceflight and 3-6 h on landing following 4-6.5 mo in space. Activation of the venoarteriolar reflex reduced subcutaneous blood flow by 37 +/- 9% (P = 0.016) before flight and by 64 +/- 8% (P < 0.001) following landing with no statistical significant difference between the two reductions (P = 0.062). Therefore, our results show that the venoarteriolar reflex is not attenuated by weightlessness and therefore does not need the everyday stimulus of gravity to maintain efficiency.     

Numerical simulation of local blood flow in the carotid and cerebral arteries under altered gravity

A computational fluid dynamics (CFD) approach was presented to model the blood flows in the carotid bifurcation and the brain arteries under altered gravity. Physical models required for CFD simulation were introduced including a model for arterial wall motion due to fluid-wall interactions, a shear thinning fluid model of blood, a vascular bed model for outflow boundary conditions, and a model for autoregulation mechanism. The three-dimensional unsteady incompressible Navier-Stokes equations coupled with these models were solved iteratively using the pseudocompressibility method and dual time stepping. Gravity source terms were added to the Navier-Stokes equations to take the effect of gravity into account. For the treatment of complex geometry, a chimera overset grid technique was adopted to obtain connectivity between arterial branches. For code validation, computed results were compared with experimental data for both steady-state and time-dependent flows. This computational approach was then applied to blood flows through a realistic carotid bifurcation and two Circle of Willis models, one using an idealized geometry and the other using an anatomical data set. A three-dimensional Circle of Willis configuration was reconstructed from subject-specific magnetic resonance images using an image segmentation method. Through the numerical simulation of blood flow in two model problems, namely, the carotid bifurcation and the brain arteries, it was observed that the altered gravity has considerable effects on arterial contraction/dilatation and consequent changes in flow conditions.     

Tolerance of snakes to hypergravity

Sensitivity of carotid blood flow to increased gravitational force acting in the head-to-tail direction(+Gz) was studied in diverse species of snakes hypothesized to show adaptive variation of response. Tolerance to increased gravity was measured red as the maximum graded acceleration force at which carotid blood flow ceased and was shown to vary according to gravitational adaptation of species defined by their ecology and behavior. Multiple regression analysis showed that gravitational habitat, but not body length, had a significant effect on Gz tolerance. At the extremes, carotid blood flow decreased in response to increasing G force and approached zero near +1 Gz in aquatic and ground-dwelling species, whereas in climbing species carotid flow was maintained at forces in excess of +2 Gz. Tolerant (arboreal) species were able to withstand hypergravic forces of +2 to +3 Gz for periods up to 1 h without cessation of carotid blood flow or loss of body movement and tongue flicking. Data suggest that the relatively tight skin characteristic of tolerant species provides a natural antigravity suit and is of prime importance in counteracting Gz stress on blood circulation.     

一种基于视网膜主血管方向的视盘定位及提取方法

为分割出眼底图像中的视盘,构建基于眼底图像的计算机辅助诊断系统,提出了一种基于视网膜主血管方向的视盘定位及提取方法。首先,利用Otsu阈值分割眼底图像R通道获取视盘候选区域;然后利用彩色眼底图像的HSV空间的H通道提取视网膜主血管并确定主血管方向;在此基础上,通过在方向图内寻找出对加权匹配滤波器响应值最高的点确定视盘中心位置;最后,利用该位置信息从视盘候选区域中"挑选"出真正的视盘。利用该方法对100幅不同颜色、不同亮度的眼底图像进行视盘分割,得到准确率98%,平均每幅图像处理时间1.3 s。结果表明:该方法稳定可靠,能快速、有效分割出眼底图像中的视盘。