Aortic Wave Dynamics and Its Influence on Left Ventricular Workload

The pumping mechanism of the heart is pulsatile, so the heart generates pulsatile flow that enters into the compliant aorta in the form of pressure and flow waves. We hypothesized that there exists a specific heart rate at which the external left ventricular (LV) power is minimized. To test this hypothesis, we used a computational model to explore the effects of heart rate (HR) and aortic rigidity on left ventricular (LV) power requirement. While both mean and pulsatile parts of the pressure play an important role in LV power requirement elevation, at higher rigidities the effect of pulsatility becomes more dominant. For any given aortic rigidity, there exists an optimum HR that minimizes the LV power requirement at a given cardiac output. The optimum HR shifts to higher values as the aorta becomes more rigid. To conclude, there is an optimum condition for aortic waves that minimizes the LV pulsatile load and consequently the total LV workload

A wave dynamics criterion for optimization of mammalian cardiovascular system

The cardiovascular system in mammals follows various optimization criteria covering the heart, the vascular network, and the coupling of the two. Through a simple dimensional analysis we arrived at a non-dimensional number (wave condition number) that can predict the optimum wave state in which the left ventricular (LV) pulsatile power (LV workload) is minimized in a mammalian cardiovascular system. This number is also universal among all mammals independent of animal size maintaining a value of around 0.1. By utilizing a unique in vitro model of human aorta, we tested our hypothesis against a wide range of aortic compliance (pulse wave velocity). We concluded that the optimum value of the wave condition number remains to be around 0.1 for a wide range of aorta compliance that we could simulate in our in-vitro system

Optimisation criterion for pulsatile timing: observation in the human fetus

Objectives: Pulsatile cardiac action is an energy consuming process. During pulse wave (PW) travel to the periphery, reflection back to the LV occurs. The concept of wave condition number, WCN, provides evidence that energy consumption of cardiac action is minimised when time of return Tr to LV takes a certain percentage of the cardiac cycle T. Our objective was to assess WCN and reflection timing Tr/T in the human fetus. Methods: Based on the WCN relation: WCN = HR×L/PWV, energy consumption of pulsatile LV action is optimised for WCN = 0.1 (HR: heart rate, L: effective aortic length, PWV: aortic PW velocity; Pahlevan 2014, 2020). Rearranging with Tr = 2L/PWV (figure) yield Tr/T = 0.2 as optimal reflection timing. To obtain Tr in the fetus by Doppler, hemodynamic modelling is required (figure): PWs arrive twice at cerebral circulation: 1st as a primary wave and 2nd after reflection and return. A systolic shoulder (S) in MCA Doppler (MCA‐S) represents this 2nd impulse and delay δt corresponds to Tr (Mills 1970). Results: Tr data of IUGR fetuses with MCA‐S were obtained by this method (Gonser 2018): Tr = 96 ± 15ms (GA 31 ± 3w). T = 423ms (FHR 140bpm) yield Tr/T = 96ms/423ms = 0.23, showing good agreement with optimal reflection timing of 20%, as suggested by the WCN. Conclusions: In spite of circulatory stress, IUGR fetuses maintain nearly optimal pulsatile timing, probably due to the priority of minimal energy consumption. Thus appearance of MCA‐S is not an artifact, but a sign of nearly optimal timed PW reflection

Effect of Magnesium Administration on Passive Avoidance Memory and Formalin-Induced Nociception in Diabetic Rats

Purpose: To investigate the effect of oral consumption of magnesium on the memory and pain sensation of diabetic rats.Methods: A total of 48 rats were divided into four groups - untreated control, untreated diabetic, magnesium-treated control and magnesium-treated diabetic. Plasma magnesium and glucose concentrations were measured after induction of diabetes with streptozotocin (STZ; 60 mg/kg). Four weeks after the administration of oral magnesium (10 g/L, MgSO4), the animals were subjected to passive avoidance test whereby latency time (LT) was assessed. This was followed by formalin test which entailed the determination of licking and flinching scoresResults: Increased level of glucose and decreased concentration of magnesium in untreated diabetic group compared to untreated control group (p < 0.001) were observed. There was also a significant reduction in mean LT of untreated diabetic group (p < 0.001) as indicated by the increased number of animals that entered the dark compartment. Plasma glucose and magnesium levels in magnesium treated diabetic rats returned to normal 4 weeks after oral magnesium consumption. There was no significant change in mean total pain score despite elevated licking in diabetic animals after oral magnesium consumption. Significant elevation of flinching scores of untreated diabetic rats was observed in the last 20 min of the 2nd chronic phase, compared with the untreated control group.Conclusion: It seems that magnesium treatment either restores rat memory performance that is impaired by diabetes or that it affects the aversive responses evoked by electrical shock.Keywords: Diabetes, Magnesium, Glucose, Passive avoidance memory, Formalin test

A Bio-Inspired Approach for the Reduction of Left Ventricular Workload

Previous studies have demonstrated the existence of optimization criteria in the design and development of mammalians cardiovascular systems. Similarities in mammalian arterial wave reflection suggest there are certain design criteria for the optimization of arterial wave dynamics. Inspired by these natural optimization criteria, we investigated the feasibility of optimizing the aortic waves by modifying wave reflection sites. A hydraulic model that has physical and dynamical properties similar to a human aorta and left ventricle was used for a series of in-vitro experiments. The results indicate that placing an artificial reflection site (a ring) at a specific location along the aorta may create a constructive wave dynamic that could reduce LV pulsatile workload. This simple bio-inspired approach may have important implications for the future of treatment strategies for diseased aorta

Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study

Background: Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections. Methods: This is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014�2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids. Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2) was injected within the subacromial joint. Results: Overall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05). During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group. Conclusion: We found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy. Trial registration: Clinical trial registration code: IRCT201302174251N9 © 2021, The Author(s)