京都大学 / 新制・課程博士 / 博士(工学) / 甲第23508号 / 工博第4920号 / 新制||工||1768(附属図書館) / 京都大学大学院工学研究科材料工学専攻 / (主査)教授 乾 晴行, 教授 安田 秀幸, 教授 辻 伸泰 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.

Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.

Longitudinal growth of long bone occurs at growth plates by a process called endochondral ossification. Endochondral ossification is affected by both biological and mechanical factors. This thesis focuses on the mechanical modulation of femoral bone growth occurring at the proximal growth plate, using mechanobiological theories reported in the literature. Finite element analysis was used to simulate bone growth. The first study analyzed the effect of subject-specific growth plate geometry over simplified growth plate geometry in numerical prediction of bone growth tendency. Subject-specific femur finite element model was constructed from magnetic resonance images of one able- bodied child. Gait kinematics and kinetics were acquired from motion analysis and analyzed further in musculoskeletal modelling to determine muscle and joint contact forces. These were used to determine loading on the femur in finite element analysis. The growth rate was computed based on a mechanobiological theory proposed by Carter and Wong, and a growth model in the principal stress direction was introduced. Our findings support the use of subject- specific geometry and of the principal stress growth direction in prediction of bone growth. The second study aimed to illustrate how different muscle groups’ activation during gait affects proximal femoral growth tendency in able-bodied children. Subject-specific femur models were used. Gait kinematics and kinetics were acquired for 3 able-bodied children, and muscle and joint contact forces were determined, similar to the first study. The contribution of different muscle groups to hip contact force was also determined. Finite element analysis was performed to compute the specific growth rate and growth direction due to individual muscle groups. The simulated growth model indicated that gait loading tends to reduce neck shaft angle and femoral anteversion during growth. The muscle groups that contributes most and least to growth rate were hip abductors and hip adductors, respectively. All muscle groups’ activation tended to reduce the neck shaft and femoral anteversion angles, except hip extensors and adductors which showed a tendency to increase the femoral anteversion. The third study’s aim was to understand the influence of different physical activities on proximal femoral growth tendency. Hip contact force orientation was varied to represent reported forces from a number of physical activities. The findings of this study showed that all studied physical activities tend to reduce the neck shaft angle and anteversion, which corresponds to the femur’s natural course during normal growth. The aim of the fourth study was to study the hypothesis that loading in the absence of physical activity, i.e. static loading, can have an adverse effect on bone growth. A subject-specific model was used and growth plate was modeled as a poroelastic material in finite element analysis. Prendergast’s indicators for bone growth was used to analyse the bone growth behavior. The results showed that tendency of bone growth rate decreases over a long duration of static loading. The study also showed that static sitting is less detrimental than static standing for predicted cartilage-to-bone differentiation likelihood, due to the lower magnitude of hip contact force. The prediction of growth using finite element analysis on experimental gait data and person- specific femur geometry, based on mechanobiological theories of bone growth, offers a biomechanical foundation for better understanding and prediction of bone growth-related deformity problems in growing children. It can ultimately help in treatment planning or physical activity guidelines in children at risk at developing a femur or hip deformity. / <p>QC 20170616</p>

Die moderne Gefäßchirurgie bedient sich bei hohen Stadien der pAVK, spezieller Gefäßrekonstruktionen in Form von distalen End-zu-Seit-Gefäßanastomosen. Das langfristige Versagen der Gefäßanastomose hängt primär von der Entstehung einer subendothelialen Intimahyperplasie (IH) ab. Diese IH-Gebiete befinden sich je nach Anastomosengeometrie im Gebiet der Hauben- und Fersenzone sowie am Boden der Anastomose. // Mit Hilfe der Particle Image Velocimetry-Technik wird eine Taylor-Patch-, eine Miller-Cuff-Anastomose und eine femoro-crurale Patch-Prothese bezüglich ihrer Flussmuster sowie ihrer hämodynamischen Eigenschaften wie Geschwindigkeit, Scherstress und Rotation in z-Richtung (Vorticity) untersucht. // In einem hydrodynamischen Kreislaufmodell werden elastische, transparente Silikonmodelle der Anastomosen hergestellt und mit einem blutanalogen Newtonschen Fluid (Glycerol-Wasser-Gemisch) unter Simulation der femorocruralen Druckkurve, pulsatil bei Variation der Strömungsbedingung perfundiert. Der periphere Widerstand beträgt 0,5 mmHg/ml/min (PRU) und die Phasenverschiebung -12 Grad (zwischen Druck- und Flusskurve). // Die Flussmuster variieren zwischen den unterschiedlichen Ausstromverhältnissen erheblich. Bei den unterschiedlichen Flussstärken hingegen ähneln sich die Flussmuster. Alle drei Modelle zeigen ausgeprägte Flussseparationszonen im Hauben- und Fersengebiet sowie geometrieabhängig auch eine Stagnationszone am Boden. Diese Bereiche wiesen die geringsten Fluidgeschwindigkeiten, deutlich unter normalem Wandscherstressniveau liegende Scherstressverhältnisse sowie geringe Vorticitywerte auf. Im Bereich der Übergangszonen finden sich hohe Scherstress- sowie Vorticitywerte. Geschwindigkeitsunterschiede des Fluids zeigten sich im Bereich der Ausstromsegmente. Variable Stressverteilungen zeigen sich auch innerhalb der Separationszonen. Eine Erklärung für die unterschiedlich beschriebenen Offenheitsraten der drei Anastomosenformen wird durch diese Arbeit nicht gefunden. / Modern vascular surgery uses special termino-lateral anastomoses for treating high levels of peripheral arterial disease (PAD). Long term stenoses and occlusions of vascular anastomoses mostly depend on the development of subendothelial myointimal hyperplasia (MIH). There are characteristic areas within the anastomoses, where this process can be examined: The heel, the tow and the floor zone. // This examination observes local hemodynamics like velocity, shear stress and vorticity (rotation in z-direction) and flow patterns of a Taylor-Patch-, a Miller-Cuff-Anastomosis and a feroro-crural patch prothesis (FCPP) with the usage of a Particle Image Velocimetry. In a hydrodynamic circulation model various elastic, transparent silicon phantoms of termino-lateral anastomoses are perfused with a Newton fluid blood analogon (glycerol-water mixture) while simulating the femorocrural pressure curve in a pulsatile manner under variation of the flow conditions. The outflow resistance is 0.5 mmHg/ml/min (PRU, peripheral resistance units) and a phase shift of -12° between flow and pressure curve is simulated. // The flow patterns differed extremely in accordance of the various outflow ratios. Using different flow intensity, the flow patterns are very similar. // All three anastomoses show characteristic heel and toe separation zones. In the FCPP centre a stagnation zone on the floor can not be examined. Shear stress inside the flow separations was significantly lower than normal wall shear stress. High shear stress levels were found inside the transition zones between flow separation and high velocity mainstream. An explanation for the different stenoses and occlusions time of the three different anastomoses can not be found.

Die vorliegende Arbeit behandelt die Prinzipien und Grundlagen der koronaren Bypassoperation. Die Resultate wie Operationsrisiko, Überlebens- und Krankheitsraten sowie die Durchgängigkeitsraten der verschiedenen Grafttypen werden basierend auf dem aktuellen Stand der Literatur erläutert. Die Ätiologie und Pathogenese der Atheromatose sowie die Venengraftsklerose werden diskutiert. Bei der Sklerose der Venengrafts handelt es sich primär im Wesentlichen um einen Adaptationsprozess des Gefäßes an die arteriellen Blutdrücke (Wandstress) und Strömungsverhältnisse (Scherkraft), der sekundär durch die grundsätzlichen Mechanismen der Atheromatoseentwicklung überlagert wird. Schließlich wird das Biocompound-Verfahren vorgestellt, welches durch die Umhüllung der Graftvene mit einem hoch flexiblen Flechtschlauch aus einer Stahllegierung den Wandstress herabsetzt sowie in Folge des verringerten Graftdurchmesseres zu einem günstigen Ausmaß der Scherkraft führt und so die Graftsklerose reduziert. Abschließend folgt eine Übersicht der aktuellen Literatur über die verschiedenen medikamentösen Therapien zur Verzögerung der Graftsklerose. / This review treats the principles and fundamentals of the coronary bypass operation. The results in terms of the risk involved in the operation, survival and morbidity rates and the patency rates of the different types of graft are dealt with on the basis of the current literature. The etiology and pathogenesis of atheromatosis and vein graft sclerosis are discussed. Sclerosis of the vein graft is primarily a process by which the vessel adapts to the arterial blood pressure (wall stress) and flow factors (shear stress); it is, secondarily, overlaid by the basic mechanisms at work in the development of atheromatosis. Finally, the biocompound procedure is introduced. This method reduces the wall stress by sheathing the grafted vein with a highly flexible mesh tubing of steel alloy, leading to more favorable shear force conditions by reducing the diameter of the graft and thereby reducing graft sclerosis. The study closes with an overview of the current literature on the different drug therapies used to delay graft sclerosis.

Nesse trabalho, foi analisada a redução de arrasto, a partir da utilização de duas bancadas experimentais, onde uma delas está situada no laboratório de Mecânica dos Fluidos (EPUSP) e a outra, no laboratório de Fisiologia Vascular (ICB-USP). A redução de arrasto foi investigada a partir do uso dos seguintes polímeros: poliacrilamida 1822S e 1340S, polietileno glicol (PEG4000) e óxido de polietileno (Polyox WSR-301). O comportamento reológico das soluções poliméricas do PEG4000 e das poliacrilamidas foi adquirido experimentalmente, enquanto do Polyox WSR-301 foi obtido da literatura. Esses polímeros foram utilizados na bancada experimental da EPUSP, simulador hidrodinâmico, mas somente o PEG4000 foi utilizado na bancada experimental do ICBI em leitos arteriais caudais de ratos normotensos (Wistar) e espontaneamente hipertensos (SHR). No simulador hidrodinâmico, foi estudada a redução de arrasto em escoamentos pulsáteis laminares e turbulentos, cuja faixa de Reynolds varia entre 2300 a 13700, com concentrações poliméricas que variaram entre 5 e 100 ppm, porém para o PEG4000 essa concentração atingiu valor de 5000 ppm. Em leitos arteriais caudais de ratos, a redução de arrasto foi analisada para escoamento laminar, cuja faixa de Reynolds varia entre 100 e 700, com concentração polimérica de 5000 ppm. Além disso, a redução de arrasto foi estudada na presença e ausência das células endoteliais. Simulações computacionais utilizando o método dos volumes finitos (Fluent) foram realizadas a partir dos dados obtidos da bancada experimental do ICB-I, para avaliar a distribuição da tensão de cisalhamento sobre a parede do vaso na presença e ausência das células endoteliais e do PEG4000, considerando a parede da artéria rígida. A partir dos dados obtidos da análise da viscosidade, ficou constatado que o PEG4000 com concentração de 5000 ppm e as poliacrilamidas 1822S e 1340S com concentrações de 5 e 10 ppm apresentaram comportamento de fluido Newtoniano. Para as poliacrilamidas, concentrações poliméricas acima de 10 ppm apresentaram comportamento de fluido não-Newtoniano. De acordo com a literatura, o Polyox WSR-301 apresentou comportamento de fluido Newtoniano para todas as concentrações poliméricas utilizadas nesse trabalho. O PEG4000 não apresentou o fenômeno da redução de arrasto em nenhuma concentração polimérica analisada, quando aplicado na bancada experimental da EPUSP. As poliacrilamidas e o Polyox WSR-301 apresentaram reduções de arrasto que foram dependentes do número de Reynolds e da concentração utilizada, muito embora o Polyox WSR-301 tenha se mostrado mais eficiente em promover esse fenômeno. Nos leitos arteriais caudais, o PEG4000 apresentou redução de arrasto para a concentração de 5000 ppm, que foi acentuada pela presença das células endoteliais. Os valores da tensão de cisalhamento foram maiores para o animal SHR quando comparados com o animal Wistar. Além disso, no animal Wistar, o endotélio controlou o aumento dessa tensão via produção de substâncias vasodilatadoras, mas apresentou disfunção no animal SHR. A partir dos resultados apresentados acima, podese concluir que o Polyox WSR-301 é mais eficiente para promover a redução de arrasto em tubos rígidos. Por outro lado, muito embora o PEG4000 não tenha apresentado efeito na bancada experimental da EPUSP, esse se mostrou um bom redutor de arrasto em leitos arteriais caudais, tendo sua ação intensificada pela presença das células endoteliais. / In this work, the drag reduction was analyzed in two benches located at Laboratory of Fluid Mechanics at Polytechnic School (EPUSP) and at Laboratory of Vascular Physiology at Institute of Biomedical Science (ICB-USP). The drag reduction was investigated for the following polymers: polyacrilamide 1822S and 1340S, polyethylene glycol (PEG4000) and polyethylene oxide (Polyox WSR-301). The rheological behavior of polymeric solutions of polyacrilamide and PEG4000 was acquired experimentally; while it was obtained from the literature for Polyox WSR-301. All of these polymers were used in the hydrodynamic simulator, but only PEG4000 was employed in the tails arterial bed from normotensive (Wistar) and spontaneously hypertensive rats (SHR) at ICB-1. In the hydrodynamic simulator, the drag reduction was analyzed in laminar and turbulent pulsatile flow, in the range varying between 2300 and 13700, with polymeric concentrations between 5 and 100 ppm, but for PEG4000, concentration has reached 5000 ppm. On the other hand, in the tail arterial beds, the drag reduction was analyzed for laminar flow, in the range between 100 and 700, with polymeric concentration of 5000 ppm. In addition, it was studied in the presence and absence of endothelial cells. Computational simulation using the finite volume method (Fluent) was performed using data obtained from ICB-1 in order to analyze the wall shear stress distribution along of wall vessel both in the presence and absence of endothelial cells and PEG4000, considering the rigid walls. Polyacrilamide 1822S and 1340S as well as PEG4000 showed behavior of Newtonian fluid in the following concentrations: 5 and 10 ppm and 5000 ppm, respectively. On the other hand, for polyacrilamides, concentrations higher than 10 ppm showed behaviour of non- Newtonian fluids. According to the literature, the Polyox WSR-301 behaved as a Newtonian fluid in all concentrations used in this work. At EPUSP\'s bench, while PEG4000 did not show drag reduction for any polymeric concentration analyzed, this phenomenon could be seen for polyacrilamides and Polyox WSR-301, being dependent on Reynolds number as well as polymeric concentration. More important, Polyox WSR- 301 showed to be the most efficient drag reducer of them. Interestingly, in the assays employing the tail arterial beds, PEG4000 showed drag reduction in the concentration of 5000 ppm and it was increased by the presence of the endothelial cells. Thus, Polyox WSR-301 seems to be more efficient to promote drag reduction in the rigid tubes. On the other hand, while PEG4000 did not show drag reduction at EPUSP\'s bench, it was a good drag reducer in the tail arterial beds, being intensified by the action of endothelial cells.

I denna studie analyseras en byggnad producerad med volymmoduler med lastbärande stomme av KL-trä. Resultat från analysen av hur laster påverkar byggnaden jämförs med resultat från motsvarande analys av en stomme producerad med reglar och balkar. I studien redovisas de krafter byggnaden utsätts för och förband mellan vägg och bjälklag. Ett förslag på förband mellan vägg och bjälklag presenteras och en jämförelse av bärförmågan i en volymmodul med KL-trästomme kontra träregelstomme genomförs. / In this study, a building produced with volume modules with a load bearing CLT-system is analyzed. Results from the analysis of how loads affect the building are compared with results from the corresponding analysis of a conventionally produced volumetric element and how vertical loads as well as wind loads affect its design. In the study, the forces that the building is exposed to are examined and the connection between wall and floor joints is designed. The forces and torque a construction built up of volume modules is exposed to are also presented. In the study the connection between the floor joints and the supporting wall is designed according to Eurocode. A comparison is presented with respect to the load carrying capacity of a volume module with CLT and a conventional load bearing frame.

A crescente demanda por biocombustíveis e a concorrência dos combustíveis fósseis torna necessária a otimização dos meios já existentes e o desenvolvimento de novas tecnologias para produção de biocombustíveis, principalmente em projetos envolvendo biorreatores e fotobiorreatores (FBR) industriais. A dinâmica dos fluidos computacional (CFD) vem sendo utilizada em vários trabalhos para o estudo de parâmetros fluidodinâmicos que podem influenciar no rendimento dos processos químicos envolvidos, como tensão de cisalhamento, perfis de velocidade, tempo de residência e a influência da geometria sobre esses parâmetros. Contudo, não existe ainda um número abrangente de trabalhos que utilize técnicas de otimização acopladas com a resolução numérica do problema fluidodinâmico. Em alguns estudos, algoritmos de otimização são utilizados para determinar os melhores coeficientes das reações químicas. No entanto, não há estudos, até o momento, que reportem a otimização multiobjetivo simultânea dos parâmetros geométricos e do escoamento aplicados a equipamentos da indústria sucro-energética. Neste contexto, o presente trabalho de pesquisa tem como objetivo contribuir para o avanço científico e tecnológico através da implementação de um software aberto (PyCFD-O) que permita o acoplamento CFD-otimização e o desenvolvimento das bases de uma metodologia de projeto otimizado bem como de operação de biorreatores e FBRs de escala industrial. O PyCFD-O foi testado em dois estudos de caso que podem ser estendidos a um fermentador contínuo e um FBR. Os parâmetros geométricos de ambos os reatores foram otimizados de forma a minimizar simultaneamente a tensão de cisalhamento e a variância da distribuição do tempo de residência. O software PyCFD-O mostrou-se robusto, revelando que o processo global de otimização realiza de fato a busca pela fronteira de Pareto. Além da obtenção das geometrias otimizadas, também foram discutidos a influência dos parâmetros geométricos na hidrodinâmica do escoamento em ambos os casos. / The growing demand for biofuels and its competition with fossil fuels create the need to optimize the existing resources and development of new technologies for production of biofuels, particularly in projects involving industrial bioreactors and photobioreactors (PBR). Computational fluid dynamics (CFD) has been used in several studies for the study of fluid dynamics parameters that can influence the performance of the chemical process involved, such as shear stress, velocity profiles, residence time and the influence of these parameters on the reactor geometry. However, there are lacks of studies that utilize optimization techniques coupled with the numerical resolution of the fluid dynamic problem. The use of optimization algorithms has been reported in some cases, but there have not been reports on studies combining the optimization of flow parameters and multiobjective algorithms to choose ideal geometric parameters applied to the equipment of the sugar-energy industry. In this context, this research project aims to contribute to the advancement of scientific and technological knowledge trhough the implementation of open source software (PyCFD-O) for the CFD-optimization coupling and the development of the bases of a methodology for optimal design and operation of industrial scale bioreactors and PBR. The PyCFD-O software was tested in two case studies with characteristics that can be extended to a continuos fermenter and PBR. The geometric parameters of both reactors were simultaneously optimized in order to minimize the shear stress and the variance of residence time distribuition. The PyCFD-O software showed robustness, revealing that overall optimization process actually performs the search of Pareto frontier. In addition to the geometry optimization, the influence of the geometrical parameters of the hydrodynamic of the flow was discussed in both case studies.

Le coeur et les vaisseaux sanguins sont directement issus de l'endothélium et dépendent de sa fonction. Le coeur ne représente pas la seule force motrice de notre système circulatoire, la plupart des stratégies thérapeutiques actuelles des maladies cardiovasculaires sont encore focalisées sur le coeur, négligeant l'ensemble du système circulatoire et le système endothélial. Par exemple, le développement de Dispositifs d'Assistance Cardiaque (DAC) est influencé par le coeur, conçu pour suivre,obéir et doit être synchronisé avec un organe malade.De nombreux « signaux » de nature différente sont capables d’activer les cellules endothéliales : les forces de cisaillement créées par le flux sanguin parallèle à la surface de la paroi des vaisseaux, mais également les forces perpendiculaires provoquées par l’étirement de la paroi artérielle par les variations de la pression et la qualité cyclique de ces forces. L’activation de cellules endothéliales est due à la pulsatilité du flux mais aussi à l’action de substances vasoactives et des médiateurs de l’inflammation.Dans notre travail de thèse, nous proposons une nouvelle approche thérapeutique,basée sur une révision fondamentale de l'ensemble du système circulatoire: exposer les défauts de la gestion courante des maladies cardiovasculaires (MCV). Notre nouveau concept se concentre sur la dynamique des flux sanguins pour stimuler,restaurer et maintenir la fonction endothéliale, et compris le coeur lui-même. Nous avons développé et évalué une nouvelle génération de DAC pulsatiles, testée in vitro et in vivo.Pendant le déroulement de cette thèse nous avons effectué les études suivantes:1. Etude d’un prototype de cathéter pulsatile. Il est testé de manière isolée dans un modèle expérimental d’ischémie aiguë du myocarde et dans un modèle d’hypertension pulmonaire aiguë.2. Etude d’un prototype de tube pulsatile à double lumière. Il est testé in-vitro dans un circuit de circulation extracorporelle, et in vivo comme assistance ventriculaire gauche.73. Etude d’un prototype de combinaison pulsatile. Il est testé sur un modèle animal présentant une défaillance aiguë du ventricule droit. Des prototypes de masques et de pantalons pulsatiles sont en développement.En conclusion, notre approche est basée sur l’activation de la fonction endothéliale plutôt qu’en une assistance cardiaque directe. Ce concept permet une meilleure gestion thérapeutique des maladies circulatoires et cardio-pulmonaires. / The “Heart” is still considered as the main organ to be dealt with, in case ofcardiovascular disease. Nevertheless, the heart is not the only driving force in ourcirculatory system. In fact, the heart and blood vessels are the direct issues of theendothelium and depend on its function. Moreover, almost all current therapeuticstrategies are still focusing on the heart and neglecting the entire circulatoryendothelialsystem. For example, development of cardiac assist devices (CAD) is stillrestrained by the heart, designed to follow, obey and must be synchronized with adiseased organ.Many "signals" of different nature are capable of activating endothelial cells: the shearforces created by the blood flow parallel to the surface of the vessel wall, but alsoforces caused by stretching perpendicular to the artery wall by the cyclic pressuregradient and the quality of these forces. The activation of endothelial cells is due tothat pressurized flow dynamic forces, but also to the action of vasoactive substancesand inflammatory mediators.In this thesis we are proposing a new therapeutic approach, based on a fundamentalrevision of the entire systems: exposing those defects of current management ofcardiovascular diseases (CVD). A concept that focuses on flow dynamics to stimulate,restore and maintain endothelial function including the heart itself. This includespreliminary results of new generations of pulsatile CAD that promote endothelial shearstress (ESS) enhancement. Devices prototypes were tested.During this thesis, pulsatile devices prototypes were tested in vivo, in vitro as well aswith pre-clinical volunteers as follow:1. A pulsatile catheter prototype was tested in 2 pediatric animal models (piglets) of:acute myocardial ischemia; and acute pulmonary arterial hypertension.2. A pulstile tube prototype was tested in vitro (mock circuit) and in vivo (piglets) as aleft ventricular assist device (ongoing).3. Pulsatile suit prototypes were tested: in vivo (piglets) for acute right ventricularfailure treatment. Prototypes of pulsatile mask and trousers are currently in plannedfor pre-clinical studies.9Conclusion, Think endothelial instead of cardiac is our policy for better management ofCVD.