Computational modelling of blood flow through sutured and coupled microvascular anastomoses

The research presented in this thesis uses Computational Fluid Dynamics (CFD) to model blood flow through idealised sutured and coupled microvascular Anastomoses to investigate the affect of each surgical technique on the flow within the vessel. Local flow phenomena are examined in detail around suture and coupler sites to study characteristics that could potentially initiate thrombus formation; for example, changes in velocity profile, wall shear stress or recirculating flow (vorticity). Idealised geometries of sutured and coupled blood vessels were created using CFD software with dimensions identical to microvascular suture material and coupling devices. Vessels were modelled as non‐compliant 1mm diameter ducts, and blood was simulated as a Newtonian fluid, in keeping with previous similar studies. All analyses were steady-state and performed on arteries. Comparison of the sutured and coupled techniques in the simulated microarterial anastomoses revealed a reduced boundary velocity profile; high Wall Shear Stress (WSS); high Shear StrainRate(SSR);and elevated vorticity at the suturesites. The coupled anastomosis simulation showed a small increase in maximum WSS at the anastomotic region compared to a pristine vessel. However, this was less than half that of the sutured model. The coupled vessel displayed an average WSS equal to a pristine vessel. Taken together, these observations demonstrate an increased thrombogenic profile in the sutured anastomosis when compared to a pristine, or indeed a coupled vessel. Data from the simulations on a coupled anastomosis reveal a profile that is less thrombogenic than that of the sutured anastomosis, and one that is nearly equivalent to that of a pristine vessel. Overall, it can be concluded that, within the limits of CFD simulations and the assumptions taken in this study, a sutured anastomosis is potentially more likely to generate an intravascular thrombosis than a coupled anastomosis

Computational Simulation: Selected Applications In Medicine, Dentistry, And Surgery

This article presents the use of computational modelling software (e.g. ANSYS) for the purposes of simulating, evaluating and developing medical and surgical practice. We provide a summary of computational simulation mo delling that has recently been employed through effective collaborations between the medical, mathematical and engineering research communities. Here, particular attention is being paid to the modelling of medical devices as well as providing an overview o f modelling bone, artificial organs and microvascular blood flows in the machine space of a High Performance Computer (HPC)

Microarterial anastomoses: A parameterised computational study examining the effect of suture position on intravascular blood flow

This study investigates the extent to which individual aspects of suture placement influence local haemodynamics within microarterial anastomoses. An attempt to physically quantify flow characteristics of blood past microvascular sutures is made using computational fluid dynamics (CFD) software. Particular focus has been placed on increased shear strain rate (SSR), a known precipitant of intravascular platelet activation and thrombosis. Measurements were taken from micrographs of sutured anastomoses in chicken femoral vessels, with each assessed for bite width, suture angle and suture spacing. Computational geometries were then created to represent the anastomosis. Each suture characteristic was parameterised to allow independent or simultaneous adjustment. Flow rates were obtained from anonymised Doppler ultrasound scans of analogous vessels during preoperative assessment for autologous breast reconstruction. Vessel simulations were performed in 2.5 mm ducts with blood as the working fluid. Vessel walls were non-compliant and a continuous Newtonian flow was applied, in accordance with current literature. Suture bite angle and spacing had significant effects on local haemodynamics, causing notably higher local SSRs, when simulated at extremes of surgical practice. A combined simulation, encompassing subtle changes of each suture parameter simultaneously i.e. representing optimum technique, created a more favourable SSR profile. As such, haemodynamic changes associated with optimum suture placement are unlikely to influence thrombus formation significantly. These findings support adherence to the basic principles of good microsurgical practice

On the Reological Properties of Human Blood

This short communication will establish a reasonably robust procedure to evaluate each of the parameters required in non-Newtonian constitutive relationships for human blood, viz. Cross, Carrau-Yasuda and modifications to Oswald-de Waele and Sisko fluids. For each of the rheological models presented herein the free parameter set to is optimally fitted to a compilation of digitized experimental data evident in the literature. It is shown that for three of the models to conserve structural identification the so-called low shear viscosity term should be set. The method presented herein is shown to minimize the square of the errors between the four suggested constitute relationships and empirical data. It is shown that, for the data set investigated here, parameters which had previously been assumed to be fluid properties exhibit different values depending on the selection of the constitutive relationship

Non-identifiability of parameters for a class of shear-thinning rheological models, with implications for haematological fluid dynamics

Choosing a suitable model and determining its associated parameters from fitting to experimental data is fundamental for many problems in biomechanics. Models of shear-thinning complex fluids, dating from the work of Bird, Carreau, Cross and Yasuda, have been applied in highly-cited computational studies of hemodynamics for several decades. In this manuscript we revisit these models, first to highlight a degree of uncertainty in the naming conventions in the literature, but more importantly to address the problem of inferring model parameters by fitting to rheology experiments. By refitting published data, and also by simulation, we find large, flat regions in likelihood surfaces that yield families of parameter sets which fit the data equally well. Despite having almost indistinguishable fits to experimental data these varying parameter sets can predict very different flow profiles, and as such these parameters cannot be used to draw conclusions about physical properties of the fluids, such as zero-shear viscosity or relaxation time of the fluid, or indeed flow behaviours. We verify that these features are not a consequence of the experimental data sets through simulations; by sampling points from the rheological models and adding a small amount of noise we create a synthetic data set which reveals that the problem of param-eter identifiability is intrinsic to these models

Whole-genome sequencing for national surveillance of Shiga toxin–producing Escherichia coli O157

Background. National surveillance of gastrointestinal pathogens, such as Shiga toxin–producing Escherichia coli O157 (STEC O157), is key to rapidly identifying linked cases in the distributed food network to facilitate public health interventions. In this study, we used whole-genome sequencing (WGS) as a tool to inform national surveillance of STEC O157 in terms of identifying linked cases and clusters and guiding epidemiological investigation. Methods. We retrospectively analyzed 334 isolates randomly sampled from 1002 strains of STEC O157 received by the Gastrointestinal Bacteria Reference Unit at Public Health England, Colindale, in 2012. The genetic distance between each isolate, as estimated by WGS, was calculated and phylogenetic methods were used to place strains in an evolutionary context. Results. Estimates of linked clusters representing STEC O157 outbreaks in England and Wales increased by 2-fold when WGS was used instead of traditional typing techniques. The previously unidentified clusters were often widely geographically distributed and small in size. Phylogenetic analysis facilitated identification of temporally distinct cases sharing common exposures and delineating those that shared epidemiological and temporal links. Comparison with multi locus variable number tandem repeat analysis (MLVA) showed that although MLVA is as sensitive as WGS, WGS provides a more timely resolution to outbreak clustering. Conclusions. WGS has come of age as a molecular typing tool to inform national surveillance of STEC O157; it can be used in real time to provide the highest strain-level resolution for outbreak investigation. WGS allows linked cases to be identified with unprecedented specificity and sensitivity that will facilitate targeted and appropriate public health investigations

Active site manipulation in MoS2 cluster electrocatalysts by transition metal doping

The development of non-platinum group metal catalysts for the hydrogen evolution reaction (HER) in water electrolyser devices is essential for their widespread and sustainable deployment. In recent years, molybdenum disulfide (MoS2) catalysts have received significant attention as they not only exhibit good electrocatalytic HER activity but also, crucially, acid-stability. However, further performance enhancement is required for these materials to be competitive with Pt and to that end transition metal doping of MoS2 has been explored as a route to further increasing its catalytic activity. In this work, cluster beam deposition was employed to produce controlled cobalt-doped MoS2 clusters (MoS2–Co). We demonstrate that, in contrast to previous observations of performance enhancement in MoS2 resulting from nickel doping (MoS2–Ni), the introduction of Co has a detrimental effect on HER activity. The contrasting behaviours of Ni and Co doping are rationalized by density functional theory (DFT) calculations, which suggest that HER-active surface vacancies are deactivated by combination with Co dopant atoms, whilst their activity is retained, or even partially enhanced, by combination with Ni dopant atoms. Furthermore, the adatom dopant–vacancy combination kinetics appear to be more than three orders of magnitude faster in MoS2–Co than for MoS2–Ni. These findings highlight a fundamental difference in the influence of transition metal dopants on the HER performance of MoS2 electrocatalysts and stress the importance of considering surface atomic defects when predicting their behaviour

Influence of microvascular sutures on shear strain rate in realistic pulsatile flow

Arterial thrombus formation is directly related to the mechanical shear experienced by platelets within flow. High shear strain rates (SSRs) and large shear gradients cause platelet activation, aggregation and production of thrombus. This study, for the first time, investigates the influence of pulsatile flow on local haemodynamics within sutured microarterial anastomoses. We measured physiological arterial waveform velocities experimentally using Doppler ultrasound velocimetry, and a representative example was applied to a realistic sutured microarterial geometry. Computational geometries were created using measurements taken from sutured chicken femoral arteries. Arterial SSRs were predicted using computational fluid dynamics (CFD) software, to indicate the potential for platelet activation, deposition and thrombus formation. Predictions of steady and sinusoidal inputs were compared to analyse whether the addition of physiological pulse characteristics affects local intravascular flow characteristics. Simulations were designed to evaluate flow in pristine and hand-sutured microarterial anastomoses, each with a steady-state and sinusoidal pulse component. The presence of sutures increased SSR in the anastomotic region by factors of 2.1 and 2.3 in steady-state and pulsatile flows respectively, when compared to a pristine vessel. SSR values seen in these simulations are analogous to the presence of moderate arterial stenosis. Steady-state simulations, driven by a constant inflow velocity equal to the peak systolic velocity (PSV) of the measured pulsatile flow, underestimated SSRs by ∼ 9% in pristine, and ∼ 19% in sutured vessels compared with a realistic pulse. Sinusoidal flows, with equivalent frequency and amplitude to a measured arterial waveform, represent a slight improvement on steady-state simulations, but still SSRs are underestimated by 1-2%. We recommend using a measured arterial waveform, of the form presented here, for simulating pulsatile flows in vessels of this nature. Under realistic pulsatile flow, shear gradients across microvascular sutures are high, of the order ∼ 7.9 × 10 m s , which may also be associated with activation of platelets and formation of aggregates. [Abstract copyright: Copyright © 2018. Published by Elsevier Inc.