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Development of a low-cost flow meter to grade the maximum flow rate.

We developed an inexpensive flow meter to grade the maximum flow rate of individuals at locations other than the clinical setting. This flow meter consists of a funnel connected to a collecting tube with several exit ports. Urine directed into this tube flows through one or more ports and is collected in a measuring cup to measure the voided volume. The number of ports emitting the liquid is a measure for the flow rate. We made four experimental models to test and compare some of the physical properties. One of these models was selected as a prototype and was tested in five healthy volunteers. All volunteers voided repeatedly in a standard rotating disk flow meter and in this prototype to test its accuracy. The response time of the experimental models depended on the outlet resistance of the exit ports and the volume of the collecting tube. In two models, this time was comparable with that of currently used volume-based electronic flow meters (approximately 2 seconds). In healthy volunteers, the maximum flow rates graded with the selected prototype and those measured with the rotating disk flow meter showed good agreement (difference=0.4+/-2.6 mL/s; mean+/-SD). The low-cost flow meter may be used repeatedly to grade the maximum flow rate at private and familiar locations (for example, at home), which may increase the accuracy of evaluating the urinary stream in patients with lower urinary tract symptoms.

Adult↗

Metabolic and physiological differences between zero-flow and low-flow myocardial ischemia: effects of L-acetylcarnitine.

The metabolic and physiologic differences between low-flow and zero-flow ischemia of varying duration were compared in the isolated perfused rat heart. Hearts subjected to 60 and 90 minutes of zero-flow ischemia recovered less cardiac work than hearts subjected to low-flow ischemia. Low-flow ischemia caused a build-up of both myocardial long-chain acyl coenzyme A and acyl carnitine esters, while zero-flow ischemia produced no change in long-chain acyl carnitine and only a transient increase in long-chain acyl coenzyme A. High energy phosphate depletion was greater in zero-flow ischemia. Perfusion with excess free fatty acids decreased the recovery of cardiac work after low-flow ischemia but had no effect after repeated episodes of zero-flow ischemia. L-Acetylcarnitine improved the recovery of cardiac work after low-flow ischemia in hearts perfused with 0.4 and 1.2 mM palmitate. With zero-flow ischemia, L-acetylcarnitine had no effect on the recovery of cardiac work in hearts perfused with 0.4 mM palmitate and a slight but statistically significant effect with 1.2 mM palmitate. Possible protective mechanisms of L-acetylcarnitine against ischemic damage are discussed.

Acetyl Coenzyme A↗

Bidirectional flow through the ductus arteriosus in normal newborns: evaluation by Doppler color flow imaging.

To determine the duration of bidirectional flow through the ductus arteriosus and to confirm the time of functional closure of the ductus arteriosus, 25 normal full-term newborns were studied serially using Doppler color flow imaging beginning at 2-7 h after birth and continuing until no ductal flow was detected (defined as functional closure). At the first examination, blood flow was bidirectional in 19 of 25 infants and continuously left-to-right in the remaining six. Subsequent studies revealed that bidirectional ductal flow changed to continuous left-to-right flow in 17 of 19 infants, whereas two of 19 abolished the flow completely at the second examination. Three of the 19 infants still had bidirectional flow through the ductus arteriosus at 12, 18.5, and 24 h after birth. The percentage of newborns who had bidirectional flow through the ductus arteriosus decreased roughly as a negative exponential function of age. The earliest functional closure of the ductus arteriosus was at 8 h after birth: by 24 hours 44% and by 48 h, 88% were functionally closed. By 72 h of age, the ductus arteriosus was functionally closed in all 25 infants. This study shows that bidirectional flow through the ductus arteriosus changes to continuous left-to-right flow before the functional closure, but can persist up to 24 h after birth.

Ductus Arteriosus↗

The importance of creatinine flow, age and 24 h urinary output in the interpretation of the MHPG flow.

The 3-methoxy-4-hydroxyphenylglycol (MHPG) flow, the creatinine flow in 24 h urine and the plasma creatinine level were determined in 42 psychiatric control patients. The creatinine clearance was calculated. The relationship between MHPG flow in 24 h urine and creatinine clearance, creatinine flow, 24 h urinary output, age, sex and weight of the patient were studied by means of single and multiple regression methods. The MHPG flow was significantly correlated with creatinine clearance (r = 0.597), creatinine flow (r = 0.646) and sex of the patient (rpb = 0.434). The variance of the MHPG flow can be explained by the regression with creatinine flow, age and urinary output for a maximum 51.5%. These variables have to be taken into account for the interpretation of data concerning the MHPG flow in subsequent experimental designs. The results of the measurements of the MHPG flow can best be expressed as the residual values obtained after partialling out the predictable component calculated by multiple regression with creatinine flow, age and 24 h urine output.

Adult↗

Effect of 6F urethral catheterization on urinary flow rates during repeated pressure-flow studies in healthy female volunteers.

OBJECTIVES: To prospectively examine the effect of a 6F urethral catheter on the urinary flow rate in healthy women without lower urinary tract symptoms undergoing pressure-flow studies. METHODS: Women between the ages of 30 and 70 years, without lower urinary tract complaints and without a history of surgery for incontinence, were recruited. All women completed the Urogenital Distress Inventory-6 questionnaire, and only women with mild or no symptoms were enrolled. After a free flow rate was determined, cystometry and pressure-flow studies were performed once and then repeated using a 6F urethral catheter. The peak flow rates during the first and second studies were compared with one another and with the nonintubated values. RESULTS: Of the 59 women that applied, 20 volunteers (mean age 41.7 years) met the entry criteria and were evaluated. The mean nonintubated flow rate was 22.65 mL/s. With a 6F urethral catheter in place, our cohort had a mean peak flow rate of 16.25 mL/s on the first study and 15.25 mL/s on the second. A significant difference was demonstrated between the free and intubated peak flow rates for both the first (P = 0.0006) and the second (P = 0.0001) study. No significant difference was detected between the two intubated peak flow rates (P = 0.262). CONCLUSIONS: Our data suggest that the presence of a 6F urethral catheter significantly reduces the maximal flow rate compared with free flow studies. Whether these findings represent a truly obstructive effect of the catheter, detrusor fatigue, or other possible effect of the catheter remains to be elucidated.

Adult↗

Effect of coronary sinus occlusion on coronary flow, resistance, and zero flow pressure during maximum vasodilatation in swine.

The effects of coronary sinus occlusion on the relation between coronary artery pressure and flow during maximum vasodilatation were studied in seven swine. The left anterior descending (LAD) coronary artery was instrumented with two catheters, a hydraulic occluder, and a flowprobe. Mean flow was measured at a series of pressures produced by partial LAD occlusion during maximum vasodilatation induced by an intracoronary infusion of adenosine. Observations were made under control conditions and during occlusion of the coronary sinus produced by inflating the balloon on the catheter positioned in the coronary sinus. Systemic haemodynamic variables did not change significantly after the coronary sinus was occluded. The mean right atrial pressure was 4 mmHg. At any given LAD perfusion pressure mean flow during coronary sinus occlusion was always less than during the control state: at LAD pressure 30 mmHg, control flow was 53 ml.min-1 vs occluded flow 24 ml.min-1; at LAD pressure 40 mmHg, control flow 79 ml.min-1 vs occluded flow 49 ml.min-1; and at LAD pressure 50 mmHg, control flow 105 ml.min-1 vs occluded flow 74 ml.min-1; p less than 0.001 for all comparisons. The mean (SD) LAD pressure at which flow stopped (Pzf) when the coronary sinus was unobstructed was 10(2) mmHg. The Pzf during occlusion of the coronary sinus was significantly higher at 20(4) mmHg (p less than 0.001). The slopes of the mean pressure-flow relations were not significantly different during the control state (2.62(0.65) ml.min-1 per mmHg) vs the occluded state (2.47(0.63) ml.min-1 per mmHg), indicating no change in vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease.

OBJECTIVE: To study the expiratory muscle force and the ability to cough estimated by the peak expiratory flow and peak cough flow in patients with Duchenne muscular dystrophy and amyotrophic lateral sclerosis. DESIGN: A total of 27 patients with amyotrophic lateral sclerosis and 52 patients with Duchenne muscular dystrophy were studied. From the group of 144 normal subjects of this laboratory, we selected 38 for comparison. RESULTS: The maximal inspiratory pressure in patients with Duchenne muscular dystrophy and amyotrophic lateral sclerosis was 64.5 +/- 24.7% and 37.8 +/- 21.8%, respectively, and maximal expiratory pressure was 64.2 +/- 32.5% and 37.7 +/- 21.6%, respectively. Patient groups showed a significant lower peak expiratory flow than normal subjects. Higher peak cough flow than peak expiratory flow was found in all groups. The peak cough flow-peak expiratory flow difference was 46 +/- 18% in normal subjects, 43 +/- 23% in patients with Duchenne muscular dystrophy, and 11 +/- 17% in patients with amyotrophic lateral sclerosis. The peak expiratory flow and peak cough flow were not different in bulbar onset amyotrophic lateral sclerosis. In patient groups, the dynamic and static behavior correlated positively. CONCLUSIONS: These results suggest that peak cough flow-peak expiratory flow is useful to monitor expiratory muscle weakness and bulbar involvement and to assess its evolution in these patients.

Adolescent↗

The velocity distribution in the aortic annulus at different times during systole is mainly determined by the pattern of flow convergence in the left ventricular outflow tract--an experimental study using Doppler colour flow mapping.

An experimental study in 10 open chest normal pigs (body weight: 24 +/- 1 kg) was carried out to explore the relationship between the velocity distribution in the aortic annulus and the pattern of flow convergence in the left ventricular outflow tract. The cross-sectional velocity profiles in the aortic annulus were constructed by using Doppler colour flow mapping with a previously validated time-interpolation method. The pattern of flow convergence in the left ventricular outflow tract was quantified by measuring the colour flow areas on the anterior and posterior sides of the central axis of the aortic annulus, and calculating their difference. The dynamic changes of the velocity distribution, the pattern of flow convergence and the septal angle throughout systole were observed. The velocity distribution in the aortic annulus changed according to the pattern of flow convergence in the left ventricular outflow tract. During early systole, the pattern of flow convergence was most asymmetrical. With the central longitudinal axis of the aortic annulus as a reference, the main part of the converging flow was along the anterior wall of the left ventricular outflow tract. Consequently, the velocity profile in the aortic annulus was most skewed during the early systole, with the highest velocity along the anterior wall. Towards late systole, the pattern of flow convergence became more and more symmetrical, and the velocity distribution in the aortic annulus gradually became flat. A significant correlation was found between the extent of asymmetry of the pattern of flow convergence in the left ventricular outflow tract and the extent of skewness of the velocity distribution in the aortic annulus (r = 0.69, P < 0.001). Throughout systole, septal angle increased very slightly (from 35 +/- 3 to 38 +/- 3 degrees, P < 0.01). The pattern of flow convergence in the left ventricular outflow tract is a major determinant of the velocity distribution in the aortic annulus in pigs.

Animals↗

Effect of blood flow rate and blood flow history on newborn pulmonary microcirculation.

The purpose of this study was to determine whether increased pulmonary blood flow and/or the history of pulmonary blood flow alters microvascular pressures in lungs of newborns. Using the direct micropuncture technique, we measured pressures in 20- to 60-microns-diameter arterioles and venules in isolated lungs of newborn rabbits at consecutive blood flow rates of 50 (baseline), 100, and/or 200 ml.min-1.kg-1. Then in some lungs we returned blood flow rate to baseline and repeated microvascular pressure measurements. We kept left atrial pressure the same at all blood flow rates. When blood flow rate increased and left atrial pressure was maintained constant, pulmonary arterial, 20- to 60-microns-diameter arteriolar, and 20- to 60-microns-diameter venular pressures increased such that the percentage of total pressure drop that occurred across veins increased. When we returned blood flow to baseline, venular pressure returned to baseline, but arteriolar and pulmonary arterial pressures returned to values less than baseline so that the percentage of the total pressure drop that occurred across microvessels decreased. Thus both blood flow rate and blood flow history are important determinants of the longitudinal distribution of pulmonary vascular pressures across newborn lungs. These findings also suggest that in newborn lungs venules greater than 60 microns diameter are poorly distensible such that higher blood flow rates result in increased microvascular pressures. Hence, under conditions of increased pulmonary blood flow, such as occurs with left to right shunts, the tendency for edema formation will increase in newborn lungs even if left atrial pressure does not increase.

Animals↗

Effects of pulmonary blood flow on the fractal nature of flow heterogeneity in sheep lungs.

The spatial heterogeneity of pulmonary blood flow can be described by the relative dispersion (RD) of weight-flow histograms (RD = SD/mean). Glenny and Robertson (J. Appl. Physiol. 69: 532-545, 1990) showed that RD of flow in the lung is fractal in nature, characterized by the fractal dimension (D) and RD for the smallest realizable volume element (RDref). We studied the effects of increasing total pulmonary blood flow on D and RDref. In eight in situ perfused sheep lung preparations, 15-microns radio-labeled microspheres were injected into the pulmonary artery at five different blood flows ranging, in random order, from 1.5 to 5.0 l/m. The lungs were in zone 2 at the lower flows and in zone 3 at the higher flows. The lungs were removed, dried, cut into 2 x 2 x 2-cm3 pieces, weighed, and then counted for microsphere radioactivity. Fractal plots of log(weight) vs. log(RD) were constructed by iteratively combining neighboring pieces and then calculating RD with the increasingly larger portion size. D, which is one minus the slope of the fit through this plot, was 1.14 +/- 0.09 and did not change as blood flow increased. However, RDref decreased significantly (P < 0.01) as total flow increased. We conclude that the fractal nature of pulmonary blood flow distribution is not altered by changes in overall flow.

Animals↗

Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease.

BACKGROUND: Coronary arteriography is considered the "gold standard" for evaluating the severity of a coronary stenosis. Because the resistance to blood flow through a stenotic lesion depends on a number of lesion characteristics, the physiological significance of coronary lesions of intermediate severity is often difficult to determine from angiography alone. This study of patients with coronary artery disease seeks to determine the relation between myocardial blood flow and flow reserve measured by positron emission tomography (PET) and the percent area stenosis on quantitative coronary arteriography. METHODS AND RESULTS: We studied 28 subjects: 18 patients with coronary artery disease (66 +/- 8 years) and 10 age-matched healthy volunteers (64 +/- 13 years) with dynamic N-13 ammonia PET imaging at rest and after dipyridamole (0.56 mg/kg). The percent cross-sectional area stenosis was quantified on the coronary arteriograms as described by Brown et al. In the 18 patients, a total of 41 non-infarct-related coronary vessels were analyzed. Myocardial blood flows in normal regions of patients with coronary artery disease were not different than those in healthy volunteers, both at rest and after dipyridamole. As a result, the myocardial flow reserve was also similar in both groups (2.4 +/- 0.4 versus 2.6 +/- 0.7, respectively; P = NS). Quantitative PET estimates of hyperemic blood flow (r = .81, P < .00001), flow reserve (r = .78, P < .00001), and an index of the "minimal coronary resistance" (r = .78, P < .00001) were inversely and nonlinearly correlated with the percent area stenosis on angiography. Of note, PET estimates of myocardial flow reserve successfully differentiated coronary lesions of intermediate severity (50% to 70% and 70% to 90%; 2.4 +/- 0.4 versus 1.8 +/- 0.5, respectively; P = .04). CONCLUSIONS: In patients with coronary artery disease, non-invasive measurements of myocardial blood flow and flow reserve by PET are inversely and nonlinearly related to stenosis severity as defined by quantitative angiography. Importantly, coronary lesions of intermediate severity have a differential flow reserve that decreases as stenosis increases that can be detected noninvasively by PET, thus allowing better definition of the functional importance of known coronary stenosis.

Aged↗

Effects of atrial natriuretic peptide on transmural blood flow and reactive hyperemia in the presence of flow-limiting coronary stenosis in the awake dog: evidence for dilation of the intramural vasculature.

The effects of atrial natriuretic peptide (ANP) on transmural myocardial blood flow distribution and the reactive hyperemic response in the presence and absence of flow-limiting coronary stenosis were examined in chronically instrumented conscious dogs. Ten-second coronary occlusion without subsequent flow restriction resulted in marked reactive hyperemic responses (Doppler flow probes), mean flow debt repayment was 481 +/- 55%. When the 10-second coronary occlusions were followed by a 20-second partial restriction that allowed normal preocclusion coronary inflow, the subsequent reactive hyperemia was significantly augmented, mean flow debt repayment was 938 +/- 91% (p less than 0.05). Pretreatment with ANP (3 micrograms/kg) did not alter the flow debt repayment after a 10-second occlusion without restriction (474 +/- 30%, NS) but attenuated the augmentation of reactive hyperemia resulting from the 20-second inflow restriction, flow debt repayment (613 +/- 66%, NS). Regional myocardial blood flow to the ischemic region was measured during restricted inflow after a 10-second coronary occlusion before and after ANP pretreatment. Before ANP, subendocardial flow decreased (0.54 +/- 0.04 ml/min/g) and subepicardial flow significantly increased (1.03 +/- 0.12 ml/min/g) when compared with the nonischemic zone (subendocardial, 1.03 +/- 0.09 ml/min/g; subepicardial, 0.87 +/- 0.09 ml/min/g, p less than 0.05), indicating maldistribution of the restricted inflow. The resultant subendocardial-to-subepicardial ratio in the ischemic region was significantly decreased when compared with the nonischemic region (0.56 +/- 0.03 vs. 1.18 +/- 0.04, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Measurement of flow through perfused bronchial segments: optimization of flow head resistance.

Techniques for measuring flow, for example through perfused bronchial segments, frequently use a flow head as the sensing device. The sensitivity of these instruments to changes in airway resistance is dependent on the flow head resistance. This study aims to quantify the effect of flow head resistance on sensitivity and flow, allowing optimization of flow head resistance. A mathematical model of the perfused bronchial segment preparation was constructed and used to explore the effect of flow head resistance on sensitivity. The model's assumptions were experimentally tested using segments of pig bronchus, perfused through the lumen with Krebs solution. The model suggests a complex relationship between flow head resistance and sensitivity that has a distinct maximum when approximately half of the total resistance is present in the flow head. Furthermore, the maximum sensitivity was found to be proportional to the resting flow. Regression between experimentally derived sensitivities and modelled predictions was linear, with a correlation coefficient of 0.93. We have defined the optimum recording conditions for study of flow through isolated bronchial segments.

Acetylcholine↗

Pulmonary venous flow pattern in various grades of mitral regurgitation and the effect of mitral surgery on flows in severe regurgitation.

OBJECTIVE: Firstly, to describe pulmonary venous flow patterns in various grades of mitral regurgitation and secondly, to determine effect of mitral valve surgery on these flows. DESIGN: Descriptive study for the first objective and open randomised intervention for the second objective. SETTING: Mater Misericordiae Hospital Heart Unit, Nairobi (1996-1997). PATIENTS: Thirty eight consecutive patients referred to the unit with various grades of mitral regurgitation from any cause. INTERVENTION: Sixteen patients with severe mitral valve regurgitation underwent mitral valve surgery. MAIN OUTCOME MEASURES: Peak forward flow systolic velocity and peak forward flow diastolic velocity plus their velocity time integrals (VTI). Atrial contraction peak reverse flow velocity and its VTI. RESULTS: Seventy eight per cent of patients with mild (2+) mitral regurgitation (MR) had normal pulmonary venous flow. All patients with moderate (3+) MR had blunted forward systolic flow. Eighty eight per cent of patients with severe (4+) MR had reversal of the normally forward systolic flow. For the patients who had mitral valve surgery, reversed systolic flow of severe MR converted to blunted flow in 12 out of 14 patients. CONCLUSION: Pulmonary venous flow by Doppler echocardiography has potential of being a useful additional index in the grading of MR.

Adolescent↗

Diurnal and seasonal variability in the radial distribution of sap flow: predicting total stem flow in Pinus taeda trees.

We monitored the radial distribution of sap flux density (v; g H2O m(-2) s(-1)) in the sapwood of six plantation-grown Pinus taeda L. trees during wet and dry soil periods. Mean basal diameter of the 32-year-old trees was 33.3 cm. For all trees, the radial distribution of sap flow in the base of the stem (i.e., radial profile) was Gaussian in shape. Sap flow occurred maximally in the outer 4 cm of sapwood, comprising 50-60% of total stem flow (F), and decreased toward the center, with the innermost 4 cm of sapwood (11-15 cm) comprising less than 10% of F. The percent of flow occurring in the outer 4 cm of sapwood was stable with time (average CV < 10%); however, the percentage of flow occurring in the remaining sapwood was more variable over time (average CV > 40%). Diurnally, the radial profile changed predictably with time and with total stem flow. Seasonally, the radial profile became less steep as the soil water content (theta) declined from 0.38 to 0.21. Throughout the season, daytime sap flow also decreased as theta decreased; however, nighttime sap flow (an estimate of stored water use) remained relatively constant. As a result, the percentage of stored water use increased as theta declined. Time series analysis of 15-min values of F, theta, photosynthetically active radiation (PAR) and vapor pressure deficit (D) showed that F lagged behind D by 0-15 min and behind PAR by 15-30 min. Diurnally, the relationship between F and D was much stronger than the relationship between F and PAR, whereas no relationship was found between F and theta. An autoregressive moving average (ARIMA) model estimated that 97% of the variability in F could be predicted by D alone. Although total sap flow in all trees responded similarly to D, we show that the radial distribution of sap flow comprising total flow could change temporally, both on daily and seasonal scales.

Circadian Rhythm↗

Tissue blood flow and blood flow distribution after administration of dextran 70, dihydroergotamine and their combination. A study in dogs using the radioactive microsphere technique.

The radioactive microsphere technique was used to measure tissue blood flow after administration of dextran 70 and dihydroergotamine, both separate and in combination, in normotensive dogs. Dextran 70 increased cardiac, output and tissue blood flow to most organs. Unchanged blood flow after dextran 70 to CNS, liver (hepatic artery blood flow), adrenals, genitals, uterus and lungs (bronchial artery and arteriovenous shunts) was found. Dihydroergotamine administration did not alter cardiac output. Tissue blood flow to pancreas and thyroid was reduced and CNS-tissue blood flow increased. Heart tissue blood flow was unaffected. When dihydroergotamine was given after dextran 70 had been infused, tissue blood flow returned to baseline values--except for pancreas and thyroid, where tissue blood flow was reduced, and CNS-tissue, where blood flow was increased. When dextran 70 was infused after dihydroergotamine, cardiac output and tissue blood flow remained mainly unchanged.

Animals↗

Turbine flow sensor for volume-flow rate verification in MR.

A turbine flow sensor for MR flow experiments has been evaluated using reference volume-flow rate measurements obtained using an electromagnetic (EM) flow meter measurements and simultaneous phase contrast (PC) MR acquisitions. After calibration, the device was found to have accuracy (compared with the EM flow meter), linearity, and precision of better than +/- 1%, +/- 3.5%, 3.5%, respectively, in constant flow mode (0 to 30 ml s-1). The frequency response of the flow sensor was flat (within +/- 10%) up to 13.9 Hz. Volume-flow rate measurements on constant and simulated physiologic flow waveforms were in close agreement with both the electromagnetic (EM) flow meter and the gated MR PC estimates.

Calibration↗

Regurgitant flow field characteristics of the St. Jude bileaflet mechanical heart valve under physiologic pulsatile flow using particle image velocimetry.

The regurgitant flow fields of clinically used mechanical heart valves have been traditionally studied in vitro using flow visualization, ultrasound techniques, and laser Doppler velocimetry under steady and pulsatile flow. Detailed investigation of the forward and regurgitant flow fields of these valves can elucidate a valve's propensity for blood element damage, thrombus formation, or cavitation. Advances in particle image velocimetry (PIV) have allowed its use in the study of the flow fields of prosthetic valves. Unlike other flow field diagnostic systems, recent work using PIV has been able to relate particular regurgitant flow field characteristics of the Bjork-Shiley Monostrut valve to a propensity for cavitation. In this study, the regurgitant flow field of the St. Jude Medical bileaflet mechanical heart valve was assessed using PIV under physiologic pulsatile flow conditions. Data collected at selected time points prior to and after valve closure demonstrated the typical regurgitant jet flow patterns associated with the St. Jude valve, and indicated the formation of a strong regurgitant jet, in the B-datum plane, along with twin vortices near the leaflets. Estimated ensemble-average viscous shear rates suggested little potential for hemolysis when the hinge jets collided. However, the vortex motion near the occluder tips potentially provides a low-pressure environment for cavitation.

Blood Flow Velocity↗