@misc{Krenkel, author = {Krenkel, Lars}, title = {Relevanz von Aerosolen im klinischen Kontext}, series = {Innovationstag Hygiene 2021, Continental Arena, Regensburg, Deutschland}, journal = {Innovationstag Hygiene 2021, Continental Arena, Regensburg, Deutschland}, language = {de} } @article{TauwaldErzingerQuadrioetal., author = {Tauwald, Sandra Melina and Erzinger, Florian and Quadrio, Maurizio and R{\"u}tten, Markus and Stemmer, Christian and Krenkel, Lars}, title = {Tomo-PIV in a patient-specific model of human nasal cavities: a methodological approach}, series = {Measurement Science and Technology}, volume = {35}, journal = {Measurement Science and Technology}, number = {5}, publisher = {IOP Publishing}, doi = {10.1088/1361-6501/ad282c}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-70393}, abstract = {The human nose serves as the primary gateway for air entering the respiratory system and plays a vital role in breathing. Nasal breathing difficulties are a significant health concern, leading to substantial healthcare costs for patients. Understanding nasal airflow dynamics is crucial for comprehending respiratory mechanisms. This article presents a detailed study using tomo-Particle Image Velocimetry (PIV) to investigate nasal airflow dynamics while addressing its accuracy. Embedded in the OpenNose project, the work described aims to provide a validation basis for different numerical approaches to upper airway flow. The study includes the manufacturing of a transparent silicone model based on a clinical CT scan, refractive index matching to minimize optical distortions, and precise flow rate adjustments based on physiological breathing cycles. This method allows for spatial high-resolution investigations in different regions of interest within the nasopharynx during various phases of the breathing cycle. The results demonstrate the accuracy of the investigations, enabling detailed analysis of flow structures and gradients. This spatial high-resolution tomo-PIV approach provides valuable insights into the complex flow phenomena occurring during the physiological breathing cycle in the nasopharynx. The study's findings contribute to advancements in non-free-of-sight experimental flow investigation of complex cavities under nearly realistic conditions. Furthermore, reliable and accurate experimental data is crucial for properly validating numerical approaches that compute this patient-specific flow for clinical purposes.}, language = {en} } @unpublished{ThausHofrichterLubnowetal., author = {Thaus, Christopher and Hofrichter, Elena and Lubnow, Matthias and Krenkel, Lars and Lehle, Karla}, title = {Hemocompatibility of Membrane Lung Components from Extracorporeal Membrane Oxygenation with Different Antithrombogenic Coatings}, doi = {10.20944/preprints202412.0615.v1}, pages = {1 -- 11}, abstract = {Thrombus formation within extracorporeal membrane oxygenation (ECMO) devices remained a critical complication. One reason seems to be the contact of blood with large artificial surfaces within the membrane lung (ML). The aim was to test the hemocompatibility of different na{\"i}ve ECMO materials. Blood and platelets from five healthy volunteers were incubated with gas exchange (GF) and heat exchange fibers (HE) from four different commercial available new MLs representing different antithrombogenic coatings. Adherent platelets were stained with rhodamine-phalloidin. Surface coverage was quantified with ImageJ. Non-adherent platelets were stained with antibodies (CD62P, PAC-1, CD61) and fibrinogen to detect platelet activation with flow cytometry. Hemolysis of red blood cells after material contact was detected. All ECMO-materials were non-hemolytic and did not induce platelet activation. However, platetelet adhesion (median (IQR)) was significantly elevated on uncoated GFs made of polymethylpentene (GF-PMP; 12 (7-19)\%) and on GFs from the Hilite-MLs (GF-Hilite; 13 ((8-19)\%) compared to the other materials. In vitro testing of platelet adhesion disclosed significant differences of ECMO-materials with different antithrombogenic surface coatings. Instead, circulating platelets remained non-activated. ECMO-materials and its coatings were non-hemolytic. Finally, this study confirmed the good hemocompatibility of GFs and HEs from commerciall available MLs.}, language = {en} } @article{WagnerKranzKrenkeletal., author = {Wagner, Maria Stella and Kranz, Michael and Krenkel, Lars and Pointner, Daniel and Foltan, Maik and Lubnow, Matthias and Lehle, Karla}, title = {Computer based visualization of clot structures in extracorporeal membrane oxygenation and histological clot investigations for understanding thrombosis in membrane lungs}, series = {Frontiers in Medicine}, journal = {Frontiers in Medicine}, number = {11}, editor = {Becatti, Matteo}, publisher = {Frontiers}, doi = {10.3389/fmed.2024.1416319}, abstract = {Extracorporeal membrane oxygenation (ECMO) was established as a treatment for severe cardiac or respiratory disease. Intra-device clot formation is a common risk. This is based on complex coagulation phenomena which are not yet sufficiently understood. The objective was the development and validation of a methodology to capture the key properties of clots deposed in membrane lungs (MLs), such as clot size, distribution, burden, and composition. One end-oftherapy PLS ML was examined. Clot detection was performed using multidetector computed tomography (MDCT), microcomputed tomography (μCT), and photography of fiber mats (fiber mat imaging, FMI). Histological staining was conducted for von Willebrand factor (vWF), platelets (CD42b, CD62P), fibrin, and nucleated cells (4′, 6-diamidino-2-phenylindole, DAPI). The three imaging methods showed similar clot distribution inside the ML. Independent of the imaging method, clot loading was detected predominantly in the inlet chamber of the ML. The μCT had the highest accuracy. However, it was more expensive and time consuming than MDCT or FMI. The MDCT detected the clots with low scanning time. Due to its lower resolution, it only showed clotted areas but not the exact shape of clot structures. FMI represented the simplest variant, requiring little effort and resources. FMI allowed clot localization and calculation of clot volume. Histological evaluation indicated omnipresent immunological deposits throughout the ML. Visually clot-free areas were covered with leukocytes and platelets forming platelet-leukocyte aggregates (PLAs). Cells were embedded in vWF cobwebs, while vWF fibers were negligible. In conclusion, the presented methodology allowed adequate clot identification and histological classification of possible thrombosis markers such as PLAs.}, language = {en} } @article{LingelHausPaschkeetal., author = {Lingel, Maximilian P. and Haus, Moritz and Paschke, Lukas and Foltan, Maik and Lubnow, Matthias and Gruber, Michael and Krenkel, Lars and Lehle, Karla}, title = {Clinical relevance of cell-free DNA during venovenous extracorporeal membrane oxygenation}, series = {Artificial organs}, volume = {47}, journal = {Artificial organs}, number = {11}, publisher = {Wiley}, issn = {1525-1594}, doi = {10.1111/aor.14616}, pages = {1720 -- 1731}, abstract = {BACKGROUND: Thrombosis remains a critical complication during venovenous extracorporeal membrane oxygenation (VV ECMO). The involvement of neutrophil extracellular traps (NETs) in thrombogenesis has to be discussed. The aim was to verify NETs in the form of cell-free DNA (cfDNA) in the plasma of patients during ECMO. METHODS: A fluorescent DNA-binding dye (QuantifFluor®, Promega) was used to detect cell-free DNA in plasma samples. cfDNA concentrations from volunteers (n = 21) and patients (n = 9) were compared and correlated with clinical/technical data before/during support, ECMO end and time of a system exchange. RESULTS: Before ECMO, patients with a median (IQR) age of 59 (51/63) years, SOFA score of 11 (10/15), and ECMO run time of 9.0 (7.0/19.5) days presented significantly higher levels of cfDNA compared to volunteers (6.4 (5.8/7.9) ng/μL vs. 5.9 (5.4/6.3) ng/μL; p = 0.044). Within 2 days after ECMO start, cfDNA, inflammatory, and hemolysis parameters remained unchanged, while platelets decreased (p = 0.005). After ECMO removal at the end of therapy, cfDNA, inflammation, and coagulation data (except antithrombin III) remained unchanged. The renewal of a system resulted in known alterations in fibrinogen, d-dimers, and platelets, while cfDNA remained unchanged. CONCLUSION: Detection of cfDNA in plasma of ECMO patients was not an indicator of acute and circuit-induced thrombogenesis.}, language = {en} } @article{FoltanDinhGruberetal., author = {Foltan, Maik and Dinh, D. and Gruber, Michael and M{\"u}ller, Thomas and Hart, C. and Krenkel, Lars and Schmid, C. and Lehle, Karla}, title = {Incidence of neutrophil extracellular traps (NETs) in different membrane oxygenators: pilot in vitro experiments in commercially available coated membranes}, series = {Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs}, journal = {Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs}, doi = {10.1007/s10047-024-01486-4}, abstract = {Neutrophil extracellular traps (NETs) were detected in blood samples and in cellular deposits of oxygenator membranes during extracorporeal membrane oxygenation (ECMO) therapy and may be responsible for thrombogenesis. The aim was to evaluate the effect of the base material of gas fiber (GF, polymethylpentene) and heat exchange (HE) membranes and different antithrombogenic coatings on isolated granulocytes from healthy volunteers under static culture conditions. Contact of granulocytes with membranes from different ECMO oxygenators (with different surface coatings) and uncoated-GFs allowed detection of adherent cells and NETotic nuclear structures (normal, swollen, ruptured) using nuclear staining. Flow cytometry was used to identify cell activation (CD11b/CD62L, oxidative burst) of non-adherent cells. Uncoated-GFs were used as a reference. Within 3 h, granulocytes adhered to the same extent on all surfaces. In contrast, the ratio of normal to NETotic cells was significantly higher for uncoated-GFs (56-83\%) compared to all coated GFs (34-72\%) (p < 0.001) with no difference between the coatings. After material contact, non-adherent cells remained vital with unchanged oxidative burst function and the proportion of activated cells remained low. The expression of activation markers was independent of the origin of the GF material. In conclusion, the polymethylpentene surfaces of the GFs already induce NET formation. Antithrombogenic coatings can already reduce the proportion of NETotic nuclei. However, it cannot be ruled out that NET formation can induce thrombotic events. Therefore, new surfaces or coatings are required for future ECMO systems and long-term implantable artificial lungs.}, language = {en} } @article{PaschkeFoltanWagneretal., author = {Paschke, Lukas and Foltan, Maik and Wagner, Maria S. and Lubnow, Matthias and Gruber, Michael and Krenkel, Lars and Lehle, Karla}, title = {Clinical Relevance of Platelet-Leukocyte Aggregates and Platelet P-Selectin Expression During Venovenous Extracorporeal Membrane Oxygenation}, series = {ASAIO Journal}, journal = {ASAIO Journal}, number = {April 03}, publisher = {Wolters Kluwer}, issn = {1058-2916}, doi = {10.1097/MAT.0000000000002421}, abstract = {Thrombosis continues to be a significant complication during venovenous extracorporeal membrane oxygenation (V-V ECMO). Platelet activation markers might serve as indicators of inflammation and thrombogenesis. The aim was to identify these markers in ECMO patients. Blood from 10 ECMO patients (before, during, after ECMO) and 11 healthy volunteers were collected to determine platelet-neutrophil-aggregates (PNAs), platelet-monocyte-aggregates (PMAs), fibrinogen-binding, and P-selectin-expression on platelets by flow cytometry. Critical illness was associated with significantly elevated levels of PNAs and PMAs, increased P-selectin expression, reduced fibrinogen-binding, and restricted activation of platelets. Although PNAs and PMAs decreased significantly within 2 hours after the initiation of ECMO and remained at those levels, ECMO did not affect basal P-selectin expression and fibrinogen-binding. These results correlated with coagulation activation. Platelet markers before ECMO were not indicators for an imminent system exchange and end of therapy. In conclusion, platelet dysfunction during ECMO was mainly attributed to the critical illness. Extracorporeal membrane oxygenation support strengthened the restricted response of platelets to exogenous agonists (P-selectin). Furthermore, a decrease in PNAs/PMAs after ECMO started identified a reduced inflammatory response. There was no correlation of analyzed platelet parameters with the incidence of thrombotic complications.}, language = {en} } @article{SteigerFoltanPhilippetal., author = {Steiger, Tamara and Foltan, Maik and Philipp, Alois and M{\"u}ller, Thomas and Gruber, Michael and Bredthauer, Andre and Krenkel, Lars and Birkenmaier, Clemens and Lehle, Karla}, title = {Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients?}, series = {Artificial Organs}, volume = {43}, journal = {Artificial Organs}, number = {11}, publisher = {Wiley}, address = {Hoboken}, issn = {1525-1594}, doi = {10.1111/aor.13513}, pages = {1065 -- 1076}, abstract = {Clot formation within membrane oxygenators (MOs) remains a critical problem during extracorporeal membrane oxygenation (ECMO). The composition of the clots-in particular, the presence of von Willebrand factor (vWF)-may be an indicator for prevalent nonphysiological flow conditions, foreign body reactions, or coagulation abnormalities in critically ill patients. Mats of interwoven gas exchange fibers from randomly collected MOs (PLS, Maquet, Rastatt, Germany) of 21 patients were stained with antibodies (anti-vWF and anti-P-selectin) and counterstained with 4 ',6-diamidino-2-phenylindole. The extent of vWF-loading was correlated with patient and technical data. While 12 MOs showed low vWF-loadings, 9 MOs showed high vWF-loading with highest accumulations close to crossing points of adjacent gas fibers. The presence and the extent of vWF-fibers/"cobwebs," leukocytes, platelet-leukocyte aggregates (PLAs), and P-selectin-positive platelet aggregates were independent of the extent of vWF-loading. However, the highly loaded MOs were obtained from patients with a significantly elevated SOFA score, severe thrombocytopenia, and persistent liver dysfunction. The coagulation abnormalities of these critically ill patients may cause an accumulation of the highly thrombogenic and elongated high-molecular-weight vWF multimers in the plasma which will be trapped in the MOs during the ECMO therapy.}, language = {en} } @misc{KrenkelMichelKeiletal., author = {Krenkel, Lars and Michel, Johanna and Keil, Niklas and Daschner, Jan}, title = {Experimental Investigation of Logitudinal Folds in Endotracheal Tube Cuffs and their Correlation to Silent Breathing}, series = {23. DGLR Fach-Symposium Str{\"o}mungen mit Abl{\"o}sung, 09./10. November 2022, Berlin, Deutschland}, journal = {23. DGLR Fach-Symposium Str{\"o}mungen mit Abl{\"o}sung, 09./10. November 2022, Berlin, Deutschland}, address = {G{\"o}ttingen}, organization = {Deutsche Gesellschaft f{\"u}r Luft- und Raumfahrt e.V. / Arbeitsgemeinschaft Str{\"o}mungen mit Abl{\"o}sung, AG STAB}, abstract = {Air leakage past High-Volume-Low-Pressure (HVLP) endotracheal tube (ETT) cuffs creates a potential infection risk for health care professionals during ventilation of patients suffering from contagious airborne diseases. However, unlike silent aspiration, a phenomenon where fluids enter the airways of intubated patients, the aspect of aerosol emergence through cuff folds -what we called accordingly "silent breathing" (SB)- has not been investigated in detail so far. This study investigates air leakage past HVLP cuffs with varying cuff pressures under realistic artificial breathing scenarios experimentally and in addition numerically. The focus was laid on the parametric investigation of the occurrence and furthermore on different influencing factors of silent breathing. The morphology of the folds responsible for the leakage was captured using high-resolution 3D microcomputed tomography (μCT). For the numerical investigations (Com-putational Fluid Dynamics - CFD), the commercial CFD Software package FLUENT 2021 R2 (ANSYS, Inc., Canonsburg, PA, US), as well as the DLR in-house research code THETA has been used.}, language = {en} } @article{HausFoltanPhilippetal., author = {Haus, Moritz and Foltan, Maik and Philipp, Alois and M{\"u}ller, Thomas and Lingel, Maximilian P. and Krenkel, Lars and Gruber, Michael and Lehle, Karla}, title = {Neutrophil extracellular traps -a potential trigger for the development of thrombocytopenia during extracorporeal membrane oxygenation}, volume = {15}, publisher = {frontiers}, doi = {10.3389/fimmu.2024.1339235}, abstract = {Neutrophil extracellular traps (NETs) have recently emerged as a potential link between inflammation, immunity, and thrombosis, as well as other coagulation disorders which present a major challenge in the context of extracorporeal membrane oxygenation (ECMO). By examining blood from ECMO patients for NETs and their precursors and correlating them with clinical and laboratory biomarkers of coagulation and inflammation, this study aims to evaluate the association between the presence of NETs in the bloodstream of ECMO patients and the development of potentially severe coagulation disorders during ECMO therapy. Therefore, blood samples were collected from healthy volunteers (n=13) and patients receiving veno-venous (VV) ECMO therapy (n=10). To identify NETs and their precursors, DNA and myeloperoxidase as well as granulocyte marker CD66b were visualized simultaneously by immunofluorescence staining in serial blood smears. Differentiation of DNA-containing objects and identification of NETs and their precursors was performed semiautomatically by a specific algorithm using the shape and size of DNA staining and the intensity of MPO and CD66b signal. Neutrophil extracellular traps and their precursors could be detected in blood smears from patients requiring VV ECMO. Compared to volunteers, ECMO patients presented significantly higher rates of NETs and NET precursors as well as an increased proportion of neutrophil granulocytes in all detected nucleated cells. A high NET rate prior to the initiation of ECMO therapy was associated with both increased iL-6 and TNF-α levels as an expression of a high cytokine burden. These patients with increased NET release also presented an earlier and significantly more pronounced decrease in platelet counts and ATIII activity following initiation of therapy compared with patients with less elevated NETs. These findings provide further indications for the development of immune-mediated acquired thrombocytopenia in ECMO patients.}, language = {en} } @misc{BroserFalterŁawrowskietal., author = {Broser, Christian and Falter, Thomas and Ławrowski, Robert Damian and Altenbuchner, Amelie and V{\"o}gele, Daniel and Koss, Claus and Schlamp, Matthias and Dunnweber, Jan and Steffens, Oliver and Heckner, Markus and Jaritz, Sabine and Schiegl, Thomas and Corsten, Sabine and Lauer, Norina and Guertler, Katherine and Koenig, Eric and Haug, Sonja and Huber, Dominik and Birkenmaier, Clemens and Krenkel, Lars and Wagner, Thomas and Justus, Xenia and Saßmannshausen, Sean Patrick and Kleine, Nadine and Weber, Karsten and Braun, Carina N. and Giacoppo, Giuliano and Heinrich, Michael and Just, Tobias and Schreck, Thomas and Schnabl, Andreas and Gilmore, Amador T{\´e}ran and Roeslin, Samuel and Schmid, Sandra and Wellnitz, Felix and Malz, Sebastian and Maurial, Andreas and Hauser, Florian and Mottok, J{\"u}rgen and Klettke, Meike and Scherzinger, Stefanie and St{\"o}rl, Uta and Heckner, Markus and Bazo, Alexander and Wolff, Christian and Kopper, Andreas and Westner, Markus and Pongratz, Christian and Ehrlich, Ingo and Briem, Ulrich and Hederer, Sebastian and Wagner, Marcus and Schillinger, Moritz and G{\"o}rlach, Julien and Hierl, Stefan and Siegl, Marco and Langer, Christoph and Hausladen, Matthias and Schreiner, Rupert and Haslbeck, Matthias and Kreuzer, Reinhard and Br{\"u}ckl, Oliver and Dawoud, Belal and Rabl, Hans-Peter and Gamisch, Bernd and Schmidt, Ottfried and Heberl, Michael and G{\"a}nsbauer, Bianca and Bick, Werner and Ellermeier, Andreas and Monkman, Gareth J. and Prem, Nina and Sindersberger, Dirk and Tschurtschenthaler, Karl and Aurbach, Maximilian and Dendorfer, Sebastian and Betz, Michael A. and Szecsey, Tamara and Mauerer, Wolfgang and Murr, Florian}, title = {Forschung 2018}, editor = {Baier, Wolfgang}, address = {Regensburg}, organization = {Ostbayerische Technische Hochschule Regensburg}, isbn = {978-3-9818209-5-9}, doi = {10.35096/othr/pub-1382}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:898-opus4-13826}, pages = {98}, subject = {Forschung}, language = {de} } @article{DeuterHajBrawanskietal., author = {Deuter, Daniel and Haj, Amer and Brawanski, Alexander and Krenkel, Lars and Schmidt, Nils Ole and Doenitz, Christian}, title = {Fast simulation of hemodynamics in intracranial aneurysms for clinical use}, series = {Acta Neurochirurgica}, volume = {167}, journal = {Acta Neurochirurgica}, publisher = {Springer}, doi = {10.1007/s00701-025-06469-9}, pages = {14}, abstract = {BACKGROUND: A widely accepted tool to assess hemodynamics, one of the most important factors in aneurysm pathophysiology, is Computational Fluid Dynamics (CFD). As current workflows are still time consuming and difficult to operate, CFD is not yet a standard tool in the clinical setting. There it could provide valuable information on aneurysm treatment, especially regarding local risks of rupture, which might help to optimize the individualized strategy of neurosurgical dissection during microsurgical aneurysm clipping. METHOD: We established and validated a semi-automated workflow using 3D rotational angiographies of 24 intracranial aneurysms from patients having received aneurysm treatment at our centre. Reconstruction of vessel geometry and generation of volume meshes was performed using AMIRA 6.2.0 and ICEM 17.1. For solving ANSYS CFX was used. For validational checks, tests regarding the volumetric impact of smoothing operations, the impact of mesh sizes on the results (grid convergence), geometric mesh quality and time tests for the time needed to perform the workflow were conducted in subgroups. RESULTS: Most of the steps of the workflow were performed directly on the 3D images requiring no programming experience. The workflow led to final CFD results in a mean time of 22 min 51.4 s (95\%-CI 20 min 51.562 s-24 min 51.238 s, n = 5). Volume of the geometries after pre-processing was in mean 4.46\% higher than before in the analysed subgroup (95\%-CI 3.43-5.50\%). Regarding mesh sizes, mean relative aberrations of 2.30\% (95\%-CI 1.51-3.09\%) were found for surface meshes and between 1.40\% (95\%-CI 1.07-1.72\%) and 2.61\% (95\%-CI 1.93-3.29\%) for volume meshes. Acceptable geometric mesh quality of volume meshes was found. CONCLUSIONS: We developed a semi-automated workflow for aneurysm CFD to benefit from hemodynamic data in the clinical setting. The ease of handling opens the workflow to clinicians untrained in programming. As previous studies have found that the distribution of hemodynamic parameters correlates with thin-walled aneurysm areas susceptible to rupture, these data might be beneficial for the operating neurosurgeon during aneurysm surgery, even in acute cases.}, language = {en} } @inproceedings{RuettenKrenkelQuadrio, author = {R{\"u}tten, Markus and Krenkel, Lars and Quadrio, Maurizio}, title = {Simulation and Analyis of the Unsteady Flow within Nasal Airways}, series = {9th European Congress on Computational Methods in Applied Sciences and Engineering - ECCOMAS Congress, 3-7 June 2024, Lisbon, Portugal}, booktitle = {9th European Congress on Computational Methods in Applied Sciences and Engineering - ECCOMAS Congress, 3-7 June 2024, Lisbon, Portugal}, language = {en} } @inproceedings{KrenkelWagnerWolfetal., author = {Krenkel, Lars and Wagner, Claus and Wolf, Ursula and Scholz, Alexander-Wigbert K. and Terekhov, Maxim and Rivoire, Julien and Schreiber, W.}, title = {Protective Artificial Lung Ventilation: Impact of an Endotracheal Tube on the Flow in a Generic Trachea}, series = {New Results in Numerical and Experimental Fluid Mechanics VII : Contributions to the 16th STAB/DGLR Symposium Aachen, Germany 2008}, booktitle = {New Results in Numerical and Experimental Fluid Mechanics VII : Contributions to the 16th STAB/DGLR Symposium Aachen, Germany 2008}, editor = {Hirschel, Ernst Heinrich and Schr{\"o}der, Wolfgang and Fujii, Kozo and Haase, Werner and Leer, Bram and Leschziner, Michael A. and Pandolfi, Maurizio and Periaux, Jacques and Rizzi, Arthur and Roux, Bernard and Shokin, Yurii I. and Dillmann, Andreas and Heller, Gerd and Klaas, Michael and Kreplin, Hans-Peter and Nitsche, Wolfgang}, publisher = {Springer Berlin Heidelberg}, address = {Berlin, Heidelberg}, isbn = {978-3-642-14242-0}, doi = {10.1007/978-3-642-14243-7_62}, pages = {505 -- 512}, abstract = {Computational Fluid Dynamics (CFD) and experimental investigations on a generic model of the trachea have been carried out focusing on the impact of an endotracheal tube (ETT) on the resulting flow regime. It could be shown that detailed modelling of the airway management devices is essential for proper flow prediction, but secondary details as Murphy Eyes can be neglected. Models with bending and connector promote the formation of stronger secondary flows and disturbances which persist for a longer time.}, language = {en} } @misc{FriedrichRivoireScholzetal., author = {Friedrich, Janet and Rivoire, Julien and Scholz, Alexander-Wigbert K. and Wiegbert, and Terekov, Maxim and Kbrich, Rainer and Krenkel, Lars and Wagner, Claus and Schreiber, Laura Maria}, title = {Exploration of Gas Flow During High Frequency Oscillated Ventilation by 19F-Gas-MRI}, series = {Proceedings of the International Society for Magnetic Resonance in Medicine}, volume = {18}, journal = {Proceedings of the International Society for Magnetic Resonance in Medicine}, abstract = {To detect convective gas flow inside the large airways during high frequency oscillated ventilation (HFOV) the fluorinated contrast gas Heptafluoropropane was used for 19F-MRI. In a first study the comparison between constant flow measurements and Computational Fluid Dynamics (CFD) simulations provided a good agreement. In a following experiment oscillated flow was applied to a lung phantom consisting of ventilation bag and long pipe. The pressure wave inside the pipe was explored point-by-point and corresponding velocities were determined. With these experiments it could be shown for the first time that flow measurement during HFOV using fluorinated contrast gas is feasible.}, language = {en} } @misc{KreftingZaunsederSaeringetal., author = {Krefting, Dagmar and Zaunseder, Sebastian and S{\"a}ring, Dennis and Wittenberg, Thomas and Palm, Christoph and Schiecke, Karin and Krenkel, Lars and Hennemuth, Anja and Schnell, Susanne and Spicher, Nicolai}, title = {Blutdruck, H{\"a}modynamik und Gef{\"a}ßzustand: Innovative Erfassung und Bewertung - Schwerpunkt bildbasierte Verfahren}, series = {66. Jahrestagung der Deutschen Gesellschaft f{\"u}r Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS), 12. Jahreskongress der Technologie- und Methodenplattform f{\"u}r die vernetzte medizinische Forschung e. V. (TMF), 26. - 30.09.2021, online}, journal = {66. Jahrestagung der Deutschen Gesellschaft f{\"u}r Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS), 12. Jahreskongress der Technologie- und Methodenplattform f{\"u}r die vernetzte medizinische Forschung e. V. (TMF), 26. - 30.09.2021, online}, doi = {10.3205/21gmds016}, url = {http://nbn-resolving.de/urn:nbn:de:0183-21gmds0167}, abstract = {Einleitung: Blutdruck gilt als sogenannter Vitalparameter als einer der grundlegenden Indikatoren f{\"u}r den Gesundheitszustand einer Person. Sowohl zu niedriger als auch zu hoher Blutdruck kann lebensbedrohend sein, letzerer ist dar{\"u}ber hinaus ein Risikofaktor insbesondere f{\"u}r Herz-Kreislauferkrankungen, die trotz wichtiger Fortschritte in der Behandlung immer noch die h{\"a}ufigste Todesursache in Deutschland darstellen. Die H{\"a}modynamik, also die raumzeitliche Dynamik des Blutflusses, und der Gef{\"a}ßzustand sind eng verbunden mit dem Blutdruck und ebenfalls von hoher klinischer Relevanz, u.a. zur Identifikation von Durchblutungsst{\"o}rungen und ung{\"u}nstigen Druckverteilungen der Gef{\"a}ßwand. Innovationen in der Messtechnik als auch in der Datenanalyse bieten heute neue M{\"o}glichkeiten der Erfassung und Bewertung von Blutdruck, H{\"a}modynamik und Gef{\"a}ßzustand [1], [2], [3], [4]. Methodik: In einer gemeinsamen Workshopserie der AG Medizinische Bild- und Signalverarbeitung der GMDS und des Fachausschusses Biosignale der DGBMT werden wir neue Ans{\"a}tze und L{\"o}sungen f{\"u}r Mess- und Analyseverfahren zu Blutdruck und -fluss sowie zum Gef{\"a}ßzustand vorstellen und diskutieren. Dabei stehen im ersten Workshop auf der GMDS Jahrestagung Bildbasierte Verfahren im Zentrum, w{\"a}hrend der zweite Workshop auf der DGBMT Jahrestagung den Fokus auf Biosignalbasierten Verfahren legt. Es werden aktuelle Forschungsergebnisse vorgestellt und diskutiert. Es sind jeweils mehrere Vortr{\"a}ge geplant mit ausreichend Zeit zur Diskussion. Folgende Vortr{\"a}ge sind geplant (Arbeitstitel): Sebastian Zaunseder: Videobasierte Erfassung des Blutdrucks Anja Hennemuth: A Visualization Toolkit for the Analysis of Aortic Anatomy and Pressure Distribution Lars Krenkel: Numerische Analyse der Rupturwahrscheinlichkeit zerebraler Aneurysmata Susanne Schnell: Messung des Blutflusses und h{\"a}modynamischer Parameter mit 4D flow MRI: M{\"o}glichkeiten und Herausforderungen Ergebnisse: Ziel des Workshops ist die Identifikation von innovativen Ans{\"a}tzen und neuen Methoden zur qualitativen und quantitativen Bestimmung von h{\"a}modynamischen Parametern sowie deren kritische Bewertung durch die Community f{\"u}r die Eignung in der klinischen Entscheidungsunterst{\"u}tzung. Diskussion: Der Workshop leistet inhaltlich einen Beitrag zu zentralen Aspekten f{\"u}r die Herz-Kreislauf-Medizin. Er bringt dabei Expertise aus verschiedenen Bereichen zusammen und schl{\"a}gt die Br{\"u}cke zwischen Kardiologie, Medizininformatik und Medizintechnik. Schlussfolgerung: Innovative Technologien aus Medizintechnik und Informatik erm{\"o}glichen zunehmend einfache und raumzeitlich aufgel{\"o}ste Erfassung und Bewertung wichtiger Informationen zur Unterst{\"u}tzung von Diagnose und Therapieverfolgung. [1] Zaunseder S, Trumpp A, Wedekind D, Malberg H. Cardiovascular assessment by imaging photoplethysmography - a review. Biomed Tech (Berl). 2018 Oct 25;63(5):617-34. [2] Huellebrand M, Messroghli D, Tautz L, Kuehne T, Hennemuth A. An extensible software platform for interdisciplinary cardiovascular imaging research. Comput Methods Programs Biomed. 2020 Feb;184:105277. [3] Schmitter S, Adriany G, Waks M, Moeller S, Aristova M, Vali A, et al. Bilateral Multiband 4D Flow MRI of the Carotid Arteries at 7T. Magn Reson Med. 2020 Oct;84(4):1947-60. [4] Birkenmaier C, and Krenkel, L. Flow in Artificial Lungs. In: New Results in Numerical and Experimental Fluid Mechanics XIII. Contributions to the 22nd STAB/DGLR Symposium. Springer; 2021.}, subject = {Blutdruck}, language = {de} } @article{LehlePhilippKrenkeletal., author = {Lehle, Karla and Philipp, Alois and Krenkel, Lars and Gruber, Michael and Hiller, Karl-Anton and M{\"u}ller, Thomas and Lubnow, Matthias}, title = {Thrombocytopenia During Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Bacterial, Viral, and COVID-19 Pneumonia}, series = {ASAIO Journal}, journal = {ASAIO Journal}, publisher = {Wolters Kluwer}, issn = {1058-2916}, doi = {10.1097/MAT.0000000000002383}, abstract = {Contact of blood with artificial surfaces triggers platelet activation. The aim was to compare platelet kinetics after venovenous extracorporeal membrane oxygenation (V-V ECMO) start and after system exchange in different etiologies of acute lung failure. Platelet counts and coagulation parameters were analyzed from adult patients with long and exchange-free (≥8 days) ECMO runs (n = 330) caused by bacterial (n = 142), viral (n = 76), or coronavirus disease 2019 (COVID-19) (n = 112) pneumonia. A subpopulation requiring a system exchange and with long, exchange-free runs of the second oxygenator (≥7 days) (n = 110) was analyzed analogously. Patients with COVID-19 showed the highest platelet levels before ECMO implantation. Independent of the underlying disease and ECMO type, platelet counts decreased significantly within 24 hours and reached a steady state after 5 days. In the subpopulation, at the day of a system exchange, platelet counts were lower compared with ECMO start, but without differences between underlying diseases. Subsequently, platelets remained unchanged in the bacterial pneumonia group, but increased in the COVID-19 and viral pneumonia groups within 2-4 days, whereas D-dimers decreased and fibrinogen levels increased. Thus, overall platelet counts on V-V ECMO show disease-specific initial dynamics followed by an ongoing consumption by the ECMO device, which is not boosted by new artificial surfaces after a system exchange.}, language = {en} } @article{BartschEigenbergerFelthausetal., author = {Bartsch, Alexander and Eigenberger, Andreas and Felthaus, Oliver and Booth, Brian W. and Krenkel, Lars and Schratzenstaller, Thomas and Prantl, Lukas}, title = {Quantification of Cannula Influence on Negative Pressure in Syringe Assisted Liposuction}, series = {Plastic \& Reconstructive Surgery}, journal = {Plastic \& Reconstructive Surgery}, publisher = {American Society of Plastic Surgeons}, issn = {0032-1052}, doi = {10.1097/PRS.0000000000012477}, abstract = {To make the results of the autologous fat transfer more satisfactory, all parameters of suction, preparation, and reapplication must be well understood. Since syringe-assisted liposuction is frequently used for small-volume procedures, we quantified the influence of the cannula on negative pressure. For these experiments, we used a digital manometer to which a syringe and one of seven different cannulas were connected. Data was collected and analyzed using LabVIEW and Matlab. The volume of our measurement setup was calculated using Boyle-Mariotte's law to ease interpretation, which revealed a volume of 2.82 ± 0.03 mL. We demonstrate that the volume of the measurement setup significantly affects the measurement results. Consequently, we accounted for this factor and calculated the theoretical values accordingly. Statistical analysis shows a significant influence on negative pressure across different cannulas, except for two pairs, which had minimal volume differences. Exemplary, for cannulas with volumes under 1.75 mL, a 2 mL syringe plunger pull was sufficient to create a - 0.5 bar (- 14.8 inHg) negative pressure. The present data indicate that the size of the suction cannula must be considered in syringe-assisted suction to ensure a specific negative pressure is not exceeded. Other research groups have demonstrated that adipocyte vitality and the amount of stromal vascular fraction are reduced by excessively strong negative pressure.}, language = {en} } @article{KranzWagnerPointneretal., author = {Kranz, Michael and Wagner, Maria Stella and Pointner, Daniel and Haus, Moritz and Lubnow, Matthias and Lehle, Karla and Krenkel, Lars}, title = {Polymer embedding of membrane lungs for histological investigations of intra-device clot formation}, series = {Cardiovascular Medicine}, volume = {13}, journal = {Cardiovascular Medicine}, publisher = {Frontiers}, address = {Lausanne}, doi = {10.3389/fcvm.2026.1650978}, pages = {21}, abstract = {Extracorporeal membrane oxygenation (ECMO) is an invasive but potentially lifesaving treatment option for severe cardiac or respiratory failure. Despite its beneficial effect, coagulation-related complications, mainly due to clot formation, excessive bleeding and the accumulation of deposits in the membrane lung (ML) remain common, causing higher mortality. In this context, the formation of clots and other deposits in the ML is of particular interest. Previous histological examinations of the polymethylpentene fiber mats inside the ML could only be performed in a top view, prohibiting valid quantification and examination of the multi-layered deposits or fiber mat spanning structures. Our objective was the establishment of a polymer embedding to increase the mechanical stability of the deposits and thus enable cross-sectional microtome cutting through the ML hollow-fibers. Clinically used MLs (PLS, Getinge, Rastatt, Germany) were stabilized with a polymer resin (HistoCURE 8100). Specimens were cut out of the embedded MLs and microtome sections with a thickness of 10 µm were performed. In addition to standard histological staining with hematoxylin-eosin (HE) and Pappenheim (May-Grunwald-Giemsa), fluorescence DNA staining for nucleated cells with 4′,6-diamidino-2-phenylindole (DAPI) and SYTOX™ Green as well as immunohistochemical and immunofluorescence staining for the lysosomal enzyme myeloperoxidase (MPO) and von Willebrand factor (vWF) were established. The protocol provides a method for large volume embedding (400 mL). The cellular and extracellular deposits were securely fixed by the polymer scaffold allowing the examination of clots in MLs in native position which was not possible with conventional paraffin embedding. Multi-layered deposits and fiber mat spanning structures are no longer disrupted during specimen extraction and can now be quantified. Staining with HE, Pappenheim, DAPI, SYTOX™ Green, MPO, and vWF was successfully tested with this protocol. This method may be the foundation for new insights into the complex clotting phenomena observed in MLs}, language = {en} }