Biomedical subjects

Edward R Damiano

Publications and source records attributed to Edward R Damiano.

4 recordsLinked to original sources

PubMed2025

Evolution of the Artificial Pancreas: Components and Integration-CGMs, Insulin, and AP Systems.

The landmark Diabetes Control and Complications Trial (DCCT) showed that glucose control is critical to reducing the risk of diabetes-related complications. This chapter outlines a series of innovations and investigations that followed the DCCT, aimed at minimizing the risk of hypoglycemia while further improving glucose control. The chapter presents an example of innovations in wired enzyme technology that facilitated the movement from capillary glucose monitoring to continuous glucose monitoring (CGM) and ultimately, the first-factory calibrated CGM system. The next glycemic management innovation was to connect CGM data to an insulin pump containing an algorithm able to adjust insulin delivery based on the changing glucose levels and trends. The key features of automated insulin delivery (AID) systems, currently approved in the United States, are presented. The AID summary table includes type of pump, type and function of the insulin delivery algorithm, the data management system, and the indications for use. The next section explores the innovation of alternative routes of insulin delivery to move toward the goal of a fully automated insulin delivery system. The main trials in developing and implementing an implantable intraperitoneal programmable system are summarized. The last section explores if sensor input in addition to glucose levels such as continuous sensing of ketone, lactate, or insulin levels may provide valuable feedback to move us closer to a fully autonomous AID system. Much of this diabetes innovation and investigation work has been supported by the National Institute of Diabetes and Digestive and Kidney Diseases over that last 75 years.

Humans↗

PubMed2004

Microviscometry reveals reduced blood viscosity and altered shear rate and shear stress profiles in microvessels after hemodilution.

We show that many salient hemodynamic flow properties, which have been difficult or impossible to assess in microvessels in vivo, can be estimated by using microviscometry and fluorescent microparticle image velocimetry in microvessels >20 microm in diameter. Radial distributions in blood viscosity, shear stress, and shear rate are obtained and used to predict axial pressure gradient, apparent viscosity, and endothelial-cell surface-layer thickness in vivo. Based solely on microparticle image velocimetry data, which are readily obtainable during the course of most intravital microscopy protocols from systemically injected particle tracers, we show that the microviscometric method consistently predicted a reduction in local and apparent blood viscosity after isovolemic hemodilution. Among its clinical applications, hemodilution is a procedure that is used to treat various pathologies that require reduction in peripheral vascular-flow resistance. Our results are directly relevant in this context because they suggest that the fractional decrease in systemic hematocrit is approximately 25-35% greater than the accompanying fractional decrease in microvascular-flow resistance in vivo. In terms of its fundamental usefulness, the microviscometric method provides a comprehensive quantitative analysis of microvascular hemodynamics that has applications in broad areas of medicine and physiology and is particularly relevant to quantitative studies of angiogenesis, tumor growth, leukocyte adhesion, vascular-flow resistance, tissue perfusion, and endothelial-cell mechanotransduction.

Blood Flow Velocity↗

PubMed2003

Near-wall micro-PIV reveals a hydrodynamically relevant endothelial surface layer in venules in vivo.

High-resolution near-wall fluorescent microparticle image velocimetry (micro-PIV) was used in mouse cremaster muscle venules in vivo to measure velocity profiles in the red cell-depleted plasma layer near the endothelial lining. micro-PIV data of the instantaneous translational speeds and radial positions of fluorescently labeled microspheres (0.47 microm) in an optical section through the midsagittal plane of each vessel were used to determine fluid particle translational speeds. Regression of a linear velocity distribution based on near-wall fluid-particle speeds consistently revealed a negative intercept when extrapolated to the vessel wall. Based on a detailed three-dimensional analysis of the local fluid dynamics, we estimate a mean effective thickness of approximately 0.33 micro m for an impermeable endothelial surface layer or approximately 0.44 micro m assuming the lowest hydraulic resistivity of the layer that is consistent with the observed particle motions. The extent of plasma flow retardation through the layer required to be consistent with our micro-PIV data results in near complete attenuation of fluid shear stress on the endothelial-cell surface. These findings confirm the presence of a hydrodynamically effective endothelial surface layer, and emphasize the need to revise previous concepts of leukocyte adhesion, stress transmission to vascular endothelium, permeability, and mechanotransduction mechanisms.

Animals↗

PubMed2002

A mechano-electrochemical model of radial deformation of the capillary glycocalyx.

A mechano-electrochemical theory of the surface glycocalyx on capillary endothelial cells is presented that models the structure as a mixture of electrostatically charged macromolecules hydrated in an electrolytic fluid. Disturbances arising from mechanical deformation are introduced as perturbations away from a nearly electroneutral equilibrium environment. Under mechanical compression of the layer, such as might occur on the passing of stiff leukocytes through capillaries, the model predicts that gradients in the electrochemical potential of the compressed layer cause a redistribution of mobile ions within the glycocalyx and a rehydration and restoration of the layer to its equilibrium dimensions. Because of the large deformations of the glycocalyx arising from passing leukocytes, nonlinear kinematics associated with finite deformations of the layer are accounted for in the theory. A pseudo-equilibrium approximation is invoked for the transport of the mobile ions that reduces the system of coupled nonlinear integro-differential equations to a single nonlinear partial differential equation that is solved numerically for the compression and recovery of the glycocalyx using a finite difference method on a fixed grid. A linearized model for small strains is also obtained as verification of the finite difference solution. Results of the asymptotic analysis agree well with the nonlinear solution in the limit of small deformations of the layer. Using existing experimental and theoretical estimates of glycocalyx properties, the glycocalyx fixed-charge density is estimated from the analysis to be approximately 1 mEq/l, i.e., we estimate that there exists approximately one fixed charge on the glycocalyx for every 100 ions in blood. Such a charge density would result in a voltage differential between the undeformed glycocalyx and the capillary lumen of approximately 0.1 mV. In addition to providing insight into the mechano-electrochemical dynamics of the layer under deformation, the model suggests several methods for obtaining improved estimates of the glycocalyx fixed-charge density and permeability in vivo.

Animals↗