Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff：Implications for noninvasive blood pressure measurement

An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement.However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element（FE） models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

Multi-scale modeling of hemodynamics in the cardiovascular system

The human cardiovascular system is a closed- loop and complex vascular network with multi-scaled het- erogeneous hemodynamic phenomena. Here, we give a selective review of recent progress in macro-hemodynamic modeling, with a focus on geometrical multi-scale model- ing of the vascular network, micro-hemodynamic modeling of microcirculation, as well as blood cellular, subcellular, endothelial biomechanics, and their interaction with arter- ial vessel mechanics. We describe in detail the methodology of hemodynamic modeling and its potential applications in cardiovascular research and clinical practice. In addition, we present major topics for future study： recent progress of patient-specific hemodynamic modeling in clinical applica- tions, micro-hemodynamic modeling in capillaries and blood cells, and the importance and potential of the multi-scale hemodynarnic modeling.

Numerical Simulation of Blood Flow in Aorta with Dilation:A Comparison between Laminar and LES Modeling Methods

Computational modeling methods have been increasingly employed to quantify aortic hemodynamic parameters that are challenging to in vivo measurements but important for the diagnosis/treatment of aortic disease.Although the presence of turbulence-like behaviors of blood flow in normal or diseased aorta has long been confirmed,the majority of existing computational model studies adopted the laminar flow assumption(LFA)in the treatment of sub-grid flow variables.So far,it remains unclear whether LFA would significantly compromise the reliability of hemodynamic simulation.In the present study,we addressed the issue in the context of a specific aortopathy,namely aortic dilation,which is usually accompanied by disturbed flow patterns.Three patient-specific aortas with treated/untreated dilation of the ascending segment were investigated,and their geometrical models were reconstructed from computed tomography angiographic images,with the boundary conditions being prescribed based on flow velocity information measured in vivo with the phase contrast magnetic resonance imaging technique.For the modeling of blood flow,apart from the traditional LFA-based method in which sub-grid flow dynamics is ignored,the large eddy simulation(LES)method capable of incorporating the dissipative energy loss induced by turbulent eddies at the sub-grid level,was adopted and taken as a reference for examining the performance of the LFA-based method.Obtained results showed that the simulated large-scale flow patterns with the two methods had high similarity,both agreeing well with in vivo measurements,although locally large between-method discrepancies in computed hemodynamic quantities existed in regions with high intensity of flow turbulence.Quantitatively,a switch from the LES to the LFAbased modeling method led to mild(<6%)changes in computed space-averaged wall shear stress metrics(i.e.,SA-TAWSS,SA-OSI)in the ascending aortic segment where intensive vortex evolution accompanied by high statistical Reynolds stress was observed.In addition,comparisons among the three aortas revealed that the treatment status of aortic dilation or the concomitant presence of aortic valve disease,despite its remarkable influence on flow patterns in the ascending aortic segment,did not significantly affect the degrees of discrepancies between the two modeling methods in predicting SA-TAWSS and SA-OSI.These findings suggest that aortic dilation per se does not induce strong flow turbulence that substantially negates the validity of LFA-based modeling,especially in simulating macro-scale hemodynamic features.

Computational methods applied to analyze the hemodynamic effects of flow-diverter devices in the treatment of cerebral aneurysms:Current status and future directions

Flow diverter(FD)devices have been widely employed to treat cerebral aneurysms.Despite the well-documented clinical benefits,considerable inter-patient variability in clinical outcome has been reported,which implies the necessity of patient-specifically evaluating hemodynamic changes following FD treatment,especially those associated with posttreatment intra-aneurysmal thrombus formation or complications.Computational fluid dynamics(CFD)methods,owing to the advantages in hemodynamic quantification,cost,and flexibility over traditional in vivo measurement or in vitro experiment methods,have increasingly become a major means for addressing hemodynamic problems related to FD treatment.Relevant CFD-based studies have extensively demonstrated that the results of hemodynamic computation can reasonably explain the clinical outcomes in different patient cohorts and provide useful insights for guiding the selection or optimization of FD devices.Nevertheless,CFD models are inherently unable to predict FD implantation-induced mechanical changes in the walls of aneurysm and its parent artery.In addition,the boundary conditions of most existing CFD models were not fully personalized for purpose of simplicity or due to the difficulty of measuring flow velocity in nearaneurysm regions,which may however considerably compromise the fidelity of the models in reproducing in vivo hemodynamics.To address these issues,the following studies would be expected:(1)perform fluid structure interaction simulations to explore the associations between wall stress/tension and posttreatment adverse vascular remodeling or aneurysm rupture,and(2)develop geometrical multiscale models based on available in vivo data to generate patient-specific boundary conditions for CFD models localized to aneurysm regions.