上游充通大￥ SHANGHAI JIAO TONG UNIVERSITY 生物力学的发展前景 梁夫友 船舶海洋与建筑工程学院 上海交通大学
生物力学的发展前景 船舶海洋与建筑工程学院 上海交通大学 梁夫友
个性化医疗(Personalized Medicine) 上游充通大粤 SHANGHAI JIAO TONG UNIVERSITY Personalized medicine is a medical model that proposes the customization of healthcare,with decisions and practices being tailored to the individual patient by use of genetic or other information ICited from Wikipadial 758万条 2012年到月 .w ftni之d四a回 牌平料 2730万条 22-2 2013年1月 enay2222 g4-444n年中件华m G下Gos0 单arsonlged medicins 多和提理 细面时学种即家 有2,700,00，位是第1页 3270万条 2015年2月 一年内
Personalized medicine is a medical model that proposes the customization of healthcare, with decisions and practices being tailored to the individual patient by use of genetic or other information [Cited from Wikipadia] 2012年9月 2013年11月 2015年2月 758万条 2730万条 3270万条 个性化医疗（Personalized Medicine）
为什么需要个性化医疗？ 上游充通大学 SHANGHAI JIAO TONG UNIVERSITY General medicine Population- Contradictory Individual based trends treatment plans variability Personalized medicine Population- Individual Well-suited based trends variability treatment plans [Kilner et al,Nature,2000; Gebker et al.J.Cardiovasc.Magn.Reson.2007; Ecabert and Smith.Newsroom,SPIE,2010]
为什么需要个性化医疗? [Kilner et al, Nature, 2000; Gebker et al. J. Cardiovasc. Magn. Reson. 2007; Ecabert and Smith. Newsroom, SPIE, 2010] Contradictory treatment plans Populationbased trends Individual variability General medicine Populationbased trends Individual variability Personalized medicine + Well-suited treatment plans
瓶颈问题 上游充通大￥ SHANGHAI JIAO TONG UNIVERSITY ·信息不足（临床检测手段有限） ·不可预知性（手术前后血流变化无法准确预测）
瓶颈问题 ▪信息不足（临床检测手段有限） ▪不可预知性（手术前后血流变化无法准确预测）
解决方案 上游充通大粤 SHANGHAI JIAO TONG UNIVERSITY Cardiovascular pathophysiology Experimental methods Computational methods (In vivo vascular imaging,hemodynamic measurements) (Hemodynamic computations&physiological simulations) Higher precision Easier operation Higher fidelity Flexible simulation Personalized and predicative medicine
Higher precision & Easier operation Computational methods (Hemodynamic computations& physiological simulations) Experimental methods (In vivo vascular imaging, hemodynamic measurements) Higher fidelity & Flexible simulation Cardiovascular pathophysiology Personalized and predicative medicine 解决方案
案例1：辅助人工心脏与患者个体的匹配 上游充通大￥ SHANCHALILAO TONC LIAIVERSITY Pulmonary Circulation RA Bio-heart Aortic valve LV M37800 AA Constant R。 Po Pulsatile Artificial heart pump Vascular system 关键问题： 1)在体心脏负荷的最小化 2)心输出量的最大化
关键问题: 1) 在体心脏负荷的最小化 2) 心输出量的最大化 P0 F Vascular system Pulmonary Circulation AA Bio-heart Artificial heart pump Aortic valve LV RA LA RV Rp Constant Pulsatile 案例1： 辅助人工心脏与患者个体的匹配
Comparisons of simulations with in vivo measurements in a sheep 上 游充通大￥ 110 100 50 Aortic Blood Pressure Blood FLow throuch Pumo 100 90 40 40 ⑦ 60 Pump Flowm/s) Pump Flowml/s) 20 10 30- 10 36.0 36.5 37.0 37.5 38.0 38.5 39.0 7.07.2747.67.880828.4868.89.092949.69.810.0 Time(s) The CVS-artificial-heart model might contribute as a mathematical tool for designing patient-specific artificial heart. Without Pump 30- Pump Mean:72.59 ml/s -Wth Pump With Pump -Without Pump 90 130 20 150 80 ean:77.38 ml/s 70 50 0 g0- 50 359 372 50 39 372 369 32 Time(s) Time(s) Time(s) Left ventricular volume Blood flow through the ascending aorta Ascending aortic pressure
Comparisons of simulations with in vivo measurements in a sheep 7.0 7.2 7.4 7.6 7.8 8.0 8.2 8.4 8.6 8.8 9.0 9.2 9.4 9.6 9.8 10.0 30 40 50 60 70 80 90 100 110 Aortic Blood Pressure Blood FLow through Pump Time(s) Aortic Pressure(mmHg) 10 20 30 40 50 Pump Flow(ml/s) 36.0 36.5 37.0 37.5 38.0 38.5 39.0 70 80 90 100 Time(s) Aortic Pressure(mmHg) 10 20 30 40 50 Pump Flow(ml/s) Measurements Predictions 36.9 37.2 90 100 110 120 130 140 150 Left Ventricular Volume(ml) Time(s) Without Pump With Pump 36.9 37.2 -50 0 50 100 150 200 250 300 Mean:77.38 ml/s Mean:72.59 ml/s Blood Flow towards Aorta(ml/s) Time(s) With Pump Without Pump 36.9 37.2 50 60 70 80 90 100 Aortic Pressure(mmHg) Time(s) With Pump Without Pump Left ventricular volume Blood flow through the ascending aorta Ascending aortic pressure The CVS-artificial-heart model might contribute as a mathematical tool for designing patient-specific artificial heart
案例2：计算模型介导的患者个体化心血管功能评街 上游充通大粤 SHANGHAI JIAO TONG UNIVERSITY (1)Dataset 1 obtained in preoperative diagnosis Diagnosis effort angina pectoris PHILIPS 09/19120080953:35T1s07W0.1 Ope off-pump coronary artery bypass grafting 3No3 S5-1/EchoLab Age 64 Gender male height 154cm weight 535kg Vmean 126 cms Max PG 14 mmHe Mean PG Preope echo 本AV Vmax LVDd 43 mm Vmax 190.4 cms LVDs 27 mm Max PG 14.5 mmHg S 11mm PWT 10mm LVEF 62% TR MR 0 AR 0 TPG mmHg (trans tricuspid valve pressure gradient) APG mmHg (trans-aortic valve pressure gradient) LVEDV 764ml PHILIPS 100mm/s LVESV 21 ml AVA cm2 aortic valve area) (2)Dataset 2 recorded by Sw Not direct indicators.of 時刻 AB cardiovascular function CCO EDV ESV 2008/12/51018 2876.4 29.0
案例2：计算模型介导的患者个体化心血管功能评估 (2) Dataset 2 recorded by Swan-Ganz Catheter and pressure monitor during operation 76.4 29.0 (1) Dataset 1 obtained in preoperative diagnosis Not direct indicators of cardiovascular function
Methodology 上帝充通大粤 SHANGHAI JIAO TONG UNIVERSITY General computational model Estimated model of the cardiovascular system parameters Clinical data of an Cardiovascular individual patient function
Clinical data of an individual patient General computational model of the cardiovascular system Methodology Estimated model parameters Cardiovascular function
A lumped-parameter (0-D)model of the cardiovasculansystem Rven u Lven_u Rcap_u Lcap_u Rart u Lart u 的JAO TONG UNIVROTY Cven_u Ccap_u 士 Cart_u Veins Capillary bed Arteries Right heart Pulmonary circulation Left heart Vena cava Btv Rlv Lpv Bpv Rpv Lpua Rpua Lpuc Rpuc Lpuv Rpuv Lmv Bmv Rmv Lav Bav Rav *m硒Ww m-Ww m mm☒WT*mmWM Aorta Cpua Cpuc Cpuv ela Sla 由Ppc ⊕ Pit Rven I Rcap +Lcap_u Rart I Lart I W m Cven I Ccap_I Cart Lower body [Liang and Liu.JSME International Journal C.2005] [Liang and Liu.Journal of Physiological Sciences.2006]
Pit Ppc era Lpua Cpua Rpua Lpuc Rpuc Cpuc Cpuv Lpuv Rpuv ela Lmv Bmv Rmv Lav Bav Rav elv Ccap_l Rcap_l Lcap_u Cven_l Rven_l Lven_l Cart_l Rart_l Lart_l Cao Ccap_u Rcap_u Lcap_u Cven_u Rven_u Lven_u Cart_u Rart_u Lart_u Civc Csvc Rsvc Lsvc Rivc Livc Rao_u Rao_l Lao_u Lao_l erv Ltv Btv Rtv Lpv Bpv Rpv Sra Srv Sla Slv Pit Ppc era Lpua Cpua Rpua Lpuc Rpuc Cpuc Cpuv Lpuv Rpuv ela Bmv Rmv Bav Rav elv Ccap_l Rcap_l Lcap_u Cven_l Rven_l Lven_l Cart_l Rart_l Lart_l Cao Civc Rsvc Lsvc Rivc Livc Rao_u Rao_l Lao_u Lao_l erv Ltv Btv Lpv Bpv Rpv Sra Srv Sla Slv A lumped-parameter (0-D) model of the cardiovascular system Veins Capillary bed Arteries Vena cava Right heart Pulmonary circulation Left heart Aorta Upper body Lower body [Liang and Liu. JSME International Journal C. 2005] [Liang and Liu. Journal of Physiological Sciences. 2006]