Measurement of airway pressure during high-flow nasal therapy in apnoeic oxygenation: a randomised controlled crossover trial.

It is recognised that high-flow nasal therapy can prevent desaturation during airway management. Studies in spontaneously breathing patients show an almost linear relationship between flow rate and positive airway pressure in the nasopharynx. Positive airway pressure has been suggested as one of the possible mechanisms explaining how high-flow nasal therapy works. However, data on pressures generated by high-flow nasal therapy in apnoeic adults under general anaesthesia are absent. This randomised controlled crossover trial investigated airway pressures generated by different flow rates during high-flow nasal therapy in anaesthetised and paralysed apnoeic patients, comparing pressures with closed and open mouths. Following induction of anaesthesia and neuromuscular blockade, a continuous jaw thrust was used to enable airway patency. Airway pressure was measured in the right main bronchus, the middle of the trachea and the pharynx, using a fibreoptically-placed catheter connected to a pressure transducer. Each measurement was randomised with respect to closed or open mouth and different flow rates. Twenty patients undergoing elective surgery were included (mean (SD) age 38 (18) years, BMI 25.0 (3.3) kg.m-2 , nine women, ASA physical status 1 (35%), 2 (55%), 3 (10%). While closed mouths and increasing flow rates demonstrated non-linear increases in pressure, the pressure increase was negligible with an open mouth. Airway pressures remained below 10 cmH2 O even with closed mouths and flow rates up to 80 l.min-1 ; they were not influenced by catheter position. This study shows an increase in airway pressures with closed mouths that depends on flow rate. The generated pressure is negligible with an open mouth. These data question positive airway pressure as an important mechanism for maintenance of oxygenation during apnoea.

In vitro investigations of red blood cell phase separation in a complex microchannel network.

Microvascular networks feature a complex topology with multiple bifurcating vessels. Nonuniform partitioning (phase separation) of red blood cells (RBCs) occurs at diverging bifurcations, leading to a heterogeneous RBC distribution that ultimately affects the oxygen delivery to living tissues. Our understanding of the mechanisms governing RBC heterogeneity is still limited, especially in large networks where the RBC dynamics can be nonintuitive. In this study, our quantitative data for phase separation were obtained in a complex in vitro network with symmetric bifurcations and 176 microchannels. Our experiments showed that the hematocrit is heterogeneously distributed and confirmed the classical result that the branch with a higher blood fraction received an even higher RBC fraction (classical partitioning). An inversion of this classical phase separation (reverse partitioning) was observed in the case of a skewed hematocrit profile in the parent vessels of bifurcations. In agreement with a recent computational study [P. Balogh and P. Bagchi, Phys. Fluids 30,051902 (2018)], a correlation between the RBC reverse partitioning and the skewness of the hematocrit profile due to sequential converging and diverging bifurcations was reported. A flow threshold below which no RBCs enter a branch was identified. These results highlight the importance of considering the RBC flow history and the local RBC distribution to correctly describe the RBC phase separation in complex networks.

Atmosphere-terrestrial exchange of gaseous elemental mercury: parameterization improvement through direct comparison with measured ecosystem fluxes.

To simulate global mercury (Hg) dynamics in chemical transport models (CTMs), surface-atmosphere exchange of gaseous elemental mercury, Hg0, is often parameterized based on resistance-based dry deposition schemes coupled with a re-emission function, mainly from soils. Despite extensive use of this approach, direct evaluations of this implementation against field observations of net Hg0 exchange are lacking. In this study, we evaluate an existing net exchange parameterization (referred to here as the base model) by comparing modeled fluxes of Hg0 to fluxes measured in the field using micrometeorological techniques. Comparisons were performed in two terrestrial ecosystems: a grassland site in Switzerland and an Arctic tundra site in Alaska, U.S., each including summer and winter seasons. The base model included the dry deposition and soil re-emission parameterizations from Zhang et al. (2003) and the global CTM GEOS-Chem, respectively. Comparisons of modeled and measured Hg0 fluxes showed large discrepancies, particularly in the summer months when the base model overestimated daytime net deposition by approximately 9 and 2 ng m-2 h-1 at the grassland and tundra sites, respectively. In addition, the base model was unable to capture a measured nighttime net Hg0 deposition and wintertime deposition. We conducted a series of sensitivity analyses and recommend that Hg simulations using CTMs: (i) reduce stomatal uptake of Hg0 over grassland and tundra in models by a factor 5-7; (ii) increase nighttime net Hg0 deposition, e.g., by increasing ground and cuticular uptake by reducing the respective resistance terms by factors of 3-4 and 2-4, respectively; and (iii) implement a new soil re-emission parameterization to produce larger daytime emissions and lower nighttime emissions. We also compared leaf Hg0 uptake over the growing season estimated by the dry deposition model against foliar Hg measurements, which revealed good agreement with the measured leaf Hg concentrations after adjusting the base model as suggested above. We conclude that the use of resistance-based models combined with the new soil re-emission flux parameterization is able to reproduce observed diel and seasonal patterns of Hg0 exchange in these ecosystems. This approach can be used to improve model parameterizations for other ecosystems if flux measurements become available.

Hemodynamic Characterization of Peripheral Arterio-venous Malformations.

Peripheral arterio-venous malformations (pAVMs) are congenital vascular anomalies that require treatment, due to their severe clinical consequences. The complexity of lesions often leads to misdiagnosis and ill-planned treatments. To improve disease management, we developed a computational model to quantify the hemodynamic effects of key angioarchitectural features of pAVMs. Hemodynamic results were used to predict the transport of contrast agent (CA), which allowed us to compare our findings to digital subtraction angiography (DSA) recordings of patients. The model is based on typical pAVM morphologies and a generic vessel network that represents realistic vascular feeding and draining components related to lesions. A lumped-parameter description of the vessel network was employed to compute blood pressure and flow rates. CA-transport was determined by coupling the model to a 1D advection-diffusion equation. Results show that the extent of hemodynamic effects of pAVMs, such as arterial steal and venous hypertension, strongly depends on the lesion type and its vascular architecture. Dimensions of shunting vessels strongly influence hemodynamic parameters. Our results underline the importance of the dynamics of CA-transport in diagnostic DSA images. In this context, we identified a set of temporal CA-transport parameters, which are indicative of the presence and specific morphology of pAVMs.

Hemodynamic performance of Edwards Intuity valve in a compliant aortic root model.

Numerous designs of bioprosthetic valves exist. The sutureless surgical valve is a newer design concept which combines elements of the transcatheter valve technology with surgical valves. This design aims at shorter and easier implantation. It was the aim of this study to perform hemodynamic and kinematic measurements for this type of valves to serve as a baseline for following studies which investigate the effect of the aortic root on the valve performance. To this end, the Edwards Intuity aortic valve was investigated in a new in vitro flow loop mimicking the left heart. The valve was implanted in a transparent, compliant aortic root model, and the valve kinematics was investigated using a high speed camera together with synchronized hemodynamic measurements of pressures and flows. The valve closure was asynchronous (one by one leaflet), and the valve started to close before the deceleration of the fluid. The aortic root model showed a dilation of the sinuses which was different to the ascending aorta, and the annulus was found to move towards the left ventricle during diastole and towards the aorta during systole.

Quantitative analysis of benign paroxysmal positional vertigo fatigue under canalithiasis conditions.

In our daily life, small flows in the semicircular canals (SCCs) of the inner ear displace a sensory structure called the cupula which mediates the transduction of head angular velocities to afferent signals. We consider a dysfunction of the SCCs known as canalithiasis. Under this condition, small debris particles disturb the flow in the SCCs and can cause benign paroxysmal positional vertigo (BPPV), arguably the most common form of vertigo in humans. The diagnosis of BPPV is mainly based on the analysis of typical eye movements (positional nystagmus) following provocative head maneuvers that are known to lead to vertigo in BPPV patients. These eye movements are triggered by the vestibulo-ocular reflex, and their velocity provides an indirect measurement of the cupula displacement. An attenuation of the vertigo and the nystagmus is often observed when the provocative maneuver is repeated. This attenuation is known as BPPV fatigue. It was not quantitatively described so far, and the mechanisms causing it remain unknown. We quantify fatigue by eye velocity measurements and propose a fluid dynamic interpretation of our results based on a computational model for the fluid-particle dynamics of a SCC with canalithiasis. Our model suggests that the particles may not go back to their initial position after a first head maneuver such that a second head maneuver leads to different particle trajectories causing smaller cupula displacements.

A meshless boundary method for Stokes flows with particles: application to canalithiasis.

We propose to couple the method of fundamental solutions (MFS) to the force coupling method (FCM). The resulting method is an efficient, easy to program, meshless method for flows at low Reynolds numbers with finite-size particles. In such an approach, the flow domain is extended across the solid particle phase, and the flow is approximated by a superposition of singular Stokeslets positioned outside the flow domain and finite-size multipoles collocated with the particle. To improve the efficiency of the coupling, we propose new MFS quadratures for the computation of the volume integrals required for the FCM. These are exact and do not require the expensive evaluation of Stokeslets. The proposed method has been developed in the context of investigations of the fluid dynamics of canalithiasis, that is, a pathological condition of the semicircular canals of the inner ear. Numerical examples are presented to illustrate the applicability of the method.

Mercury distribution across 14 U.S. Forests. Part I: spatial patterns of concentrations in biomass, litter, and soils.

Results from a systematic investigation of mercury (Hg) concentrations across 14 forest sites in the United States show highest concentrations in litter layers, strongly enriched in Hg compared to aboveground tissues and indicative of substantial postdepositional sorption of Hg. Soil Hg concentrations were lower than in litter, with highest concentrations in surface soils. Aboveground tissues showed no detectable spatial patterns, likely due to 17 different tree species present across sites. Litter and soil Hg concentrations positively correlated with carbon (C), latitude, precipitation, and clay (in soil), which together explained up to 94% of concentration variability. We observed strong latitudinal increases in Hg in soils and litter, in contrast to inverse latitudinal gradients of atmospheric deposition measures. Soil and litter Hg concentrations were closely linked to C contents, consistent with well-known associations between organic matter and Hg, and we propose that C also shapes distribution of Hg in forests at continental scales. The consistent link between C and Hg distribution may reflect a long-term legacy whereby old, C-rich soil and litter layers sequester atmospheric Hg depositions over long time periods. Based on a multiregression model, we present a distribution map of Hg concentrations in surface soils of the United States.

Summertime elemental mercury exchange of temperate grasslands on an ecosystem-scale.

In order to estimate the air-surface mercury exchange of grasslands in temperate climate regions, fluxes of gaseous elemental mercury (GEM) were measured at two sites in Switzerland and one in Austria during summer 2006. Two classic micrometeorological methods (aerodynamic and modified Bowen ratio) have been applied to estimate net GEM exchange rates and to determine the response of the GEM flux to changes in environmental conditions (e.g. heavy rain, summer ozone) on an ecosystem-scale. Both methods proved to be appropriate to estimate fluxes on time scales of a few hours and longer. Average dry deposition rates up to 4.3 ng m-2 h-1 and mean deposition velocities up to 0.10 cm s-1 were measured, which indicates that during the active vegetation period temperate grasslands are a small net sink for atmospheric mercury. With increasing ozone concentrations depletion of GEM was observed, but could not be quantified from the flux signal. Night-time deposition fluxes of GEM were measured and seem to be the result of mercury co-deposition with condensing water. Effects of grass cuts could also be observed, but were of minor magnitude.

Mercury accumulation in grass and forb species as a function of atmospheric carbon dioxide concentrations and mercury exposures in air and soil.

The goal of this study was to investigate the potential for atmospheric Hg degrees uptake by grassland species as a function of different air and soil Hg exposures, and to specifically test how increasing atmospheric CO(2) concentrations may influence foliar Hg concentrations. Four common tallgrass prairie species were germinated and grown for 7 months in environmentally controlled chambers using two different atmospheric elemental mercury (Hg major; 3.7+/-2.0 and 10.2+/-3.5 ng m(-3)), soil Hg (<0.01 and 0.15+/-0.08 micro g g(-1)), and atmospheric carbon dioxide (CO(2)) (390+/-18, 598+/-22 micro mol mol(-1)) exposures. Species used included two C4 grasses and two C3 forbs. Elevated CO(2) concentrations led to lower foliar Hg concentrations in plants exposed to low (i.e., ambient) air Hg degrees concentrations, but no CO(2) effect was apparent at higher air Hg degrees exposure. The observed CO(2) effect suggests that leaf Hg uptake might be controlled by leaf physiological processes such as stomatal conductance which is typically reduced under elevated CO(2). Foliar tissue exposed to elevated air Hg degrees concentrations had higher concentrations than those exposed to low air Hg degrees , but only when also exposed to elevated CO(2). The relationships for foliar Hg concentrations at different atmospheric CO(2) and Hg degrees exposures indicate that these species may have a limited capacity for Hg storage; at ambient CO(2) concentrations all Hg absorption sites in leaves may have been saturated while at elevated CO(2) when stomatal conductance was reduced saturation may have been reached only at higher concentrations of atmospheric Hg degrees . Foliar Hg concentrations were not correlated to soil Hg exposures, except for one of the four species (Rudbeckia hirta). Higher soil Hg concentrations resulted in high root Hg concentrations and considerably increased the percentage of total plant Hg allocated to roots. The large shifts in Hg allocation patterns-notably under soil conditions only slightly above natural background levels-indicate a potentially strong role of plants in belowground Hg transformation and cycling processes.

Increasing CO2 accelerates root growth and enhances water acquisition during early stages of development in Larrea tridentata.

• Stimulation of root growth under elevated CO2 has been hypothesized to enhance soil water uptake under water-limiting conditions. The objectives of this study were to quantify the effects of rising CO2 on root development and soil water uptake in Larrea tridentata and to quantify root proliferation into small water patches. • Seedling communities of L. tridentata were grown in rhizotrons under controlled environmental conditions at three CO2 concentrations (280, 360, and 600 µl l-1 ). Patches of water were applied to small areas of the root systems in the rhizotrons and to L. tridentata shrubs in the field. • Rising CO2 significantly stimulated root length production, but only in the lower half of the soil profile. Stimulation of root production led to faster depletion of soil water. Neither mature shrubs nor seedlings responded to water-enriched soil patches via root proliferation. • The results of our study indicate that rising CO2 may accelerate seedling root growth in L. tridentata, could lead to proportionally greater investment of roots in deeper soil layers and may enhance water acquisition.