Backflow Region Research Articles

Controllable three-dimensional helical energy backflow in an optical focusing field.

The energy of light generally moves forward along the light propagation direction. However, in recent years, a counter-intuitive effect has been discovered that energy backflow can occur in certain special light fields. Presently, controlling the energy backflow of light for application requirements is becoming a significant challenge. Here we propose a method to generate and control a three-dimensional helical energy backflow (HEB) optical field. By designing an exponential helical conical phase mask, the energy backflow region in a common tightly focused field can be stretched into a three-dimensional helical shape with an ultra-long longitudinal length. The length of the HEB region can be flexibly extended up to 47.6λ by varying the exponential phase index and the initial topological charge. Furthermore, we demonstrate that nanoparticles within the HEB field are subjected to optical pulling forces, thereby drawing the nanoparticles back to the light source. This work presents a new, to the best of our knowledge, approach for the three-dimensional manipulation of the energy backflow field with potential applications in nanoparticle manipulation and detection.

FGM modeling considering preferential diffusion, flame stretch, and non-adiabatic effects for hydrogen-air premixed flame wall flashback

Preferential diffusion plays an important role especially in hydrogen flames. Flame stretch significantly affects the flame structure and induces preferential diffusion. A problematic phenomenon occurring in real combustion devices is flashback, which is influenced by non-adiabatic effects, such as wall heat loss. In this paper, an extended flamelet-generated manifold (FGM) method that explicitly considers the preferential diffusion, flame stretch, and non-adiabatic effects is proposed. In this method, the diffusion terms in the transport equations of scalars, viz. the progress variable, mixture fraction, and enthalpy, are formulated employing non-unity Lewis numbers that are variable in space and different for each chemical species. The applicability of the extended FGM method to hydrogen flames is investigated using two- and three-dimensional numerical simulations of hydrogen-air flame flashback in channel flows. The results of the extended FGM method are compared with those of detailed calculations and other FGM methods. The two-dimensional numerical simulations show that considering both preferential diffusion and flame stretch improves the prediction accuracy of the mixture fraction distribution and flashback speed. The three-dimensional numerical simulations show that the prediction accuracy of the flashback speed, backflow region, and distributions of physical quantities near the flame front is improved by employing the extended FGM method, compared with the FGM method that considers only the heat loss effect. In particular, the extended FGM method successfully reproduced the relationship between the reaction rate and curvature. These results demonstrate the effectiveness of the extended FGM method.Novelty and Significance Statement The novelty of this research is the development of a flamelet-generated mani-fold (FGM) method that explicitly considers preferential diffusion, flame stretch, and non-adiabatic effects. To the best of the authors’ knowledge, no studies have performed numerical simulations of pure hydrogen flames using such an FGM method. The developed FGM method was applied to numerical simula- tions of hydrogen-air premixed flame flashback at an equivalence ratio of 0.5 and reproduced the flashback speed of lean hydrogen-air premixed flame. The applicability of the FGM method to the numerical simulation of hydrogen-air flashback is reported first. This research is significant because the FGM method is one of the most widely used combustion models for premixed combustion, and the development of an accurate FGM method will contribute to the engineering field. The accurate prediction of the flame flashback attempted in this study is particularly important for the development of hydrogen-fueled combustion devices.

Synchronous PIV measurements of a self-powered blood turbine and pump couple for right ventricle support

A blood turbine-pump system (iATVA), resembling a turbocharger was proposed as a mechanical right-heart assist device without external drive power. In this study, the iATVA system is investigated with particular emphasis on the blood turbine flow dynamics. A time-resolved 2D particle image velocimetry (PIV) set-up equipped with a beam splitter and two high speed cameras, allowed simultaneous recordings from both the turbine and pump impellers at 7 different phased-locked instances. The iATVA prototype is 3D printed using an optically clear resin following our earlier PIV protocols. Results showed that magnetically coupled impellers operated synchronously. As the turbine flow rate increased from 1.6 to 2.4 LPM, the rotational speed and relative inlet flow angle increase from 630 to 900 rpm, and 38 to 55% respectively. At the trailing edges, backflow region spanned 3/5 of the total passage outlet flow, and an extra leakage flow was observed at the leading edge. For this early turbine design, approximately, 75% of the turbine blade passage was not contributing to the impulse operation mode. The maximum non-wall shear rate was ~ 2288 s−1 near to the inlet exit, which is significantly lower than the commercial blood pumps, encouraging further research and blood experiments of this novel concept. Experimental results will improve the hydrodynamic design of the turbine impeller and volute regions and will be useful in computational fluid dynamics validation studies of similar passive devices.

Numerical investigation on ball-sealers transport and diversion performance in shale gas horizontal well based on semi-resolved CFD-DEM

In the staged multi-cluster fracturing of shale gas horizontal wells, ball sealers are used to ensure uniform fluid distribution among clusters, a strategy that is both cost-effective and operationally beneficial. Despite these advantages, comprehending the ball sealers' dynamics within the wellbore and their plugging behavior at perforations is still challenging. This complexity results in prediction difficulties regarding their diversion efficiency. To address this, our study utilized a semi-resolved CFD-DEM model based on kernel approximation to simulate the behavior of medium-sized ball sealers in single and multiple cluster scenarios. Our findings from a single cluster scenario reveal that the plugging probability is co-determined by velocity gradients in the fluid ingestion area near the perforation, backflow region, and inertial forces of the ball sealers. As the critical flow rate is achieved, the plugging probability negatively correlated with fluid viscosity and displacement, and positively correlated with the perforation flow ratio (PFR), the difference in particle-fluid density, ball sealer’s diameter, and the ball sealer’s offset from the pipeline center. Temporary plugging control efficiency was used to evaluate the flow balance effect among multiple clusters. The results indicate that an increased number of ball sealers enhances the fault tolerance during the temporary plugging process. Nevertheless, excessive ball sealers might undermine the temporary plugging control efficiency, as perforations with lower fluid inflow rates are unexpectedly plugging. Higher differences in fluid injection rates between clusters led to increased efficiency in temporary plugging control. Premature deployment of ball sealers cannot effectively plug perforations with marginally higher fluid inflow rates, but instead accidently plug intermediate clusters with lower fluid inflow rates. These findings offer a theoretical basis for optimizing the design of ball sealers.

Research on substitutability of single-dome versus triple-dome center staged combustor

To investigate the substitutability of the simulation results using the single-dome combustor as the computational domain to the triple-dome combustor, three-dimensional numerical simulations were conducted on both models and the differences in various performances between the two combustors were compared and analyzed. The findings reveal that the simulation results obtained using the single-dome combustor as the computational domain can effectively substitute for those of the triple-dome combustor in terms of critical performance metrics, including velocity distribution in the central cross-section, morphology and size of back-flow regions, total pressure loss coefficient, combustion efficiency, outlet temperature distribution and pollutant emissions. Under takeoff conditions, the flame tube outlet of the single-dome combustor exhibits higher OTDF and RTDF values compared to the triple-dome combustor, with similar radial temperature distribution shapes. Additionally, the NOx emissions of the flame tube outlet are slightly lower in the single-dome combustor compared to the triple-dome combustor, while the Soot emissions are slightly higher. However, both the NOx and Soot emissions are within the same order of magnitude for both combustors. Under idle conditions, both the single-dome and triple-dome combustors show almost zero CO emissions at the flame tube outlet section.

Flame extension length and temperature profile beneath ceiling induced by endwall-attached fire inside compartment with lateral openings

This study experimentally investigated the fire characteristics of endwall-attached fire within the long-narrow compartment, including the flame extension and temperature profile. Experiments were conducted in a reduced scaled compartment featuring multiple lateral openings. Results show that the previous models of flame extension length and temperature rise in the literatures, whether for sidewall fires in tunnels or central fires in compartments with lateral openings, cannot predict the experimental data in this study. A new correlation is proposed for the flame extension length based on non-dimensional heat release rate. The longitudinal temperature profile generated by endwall-attached fires in compartment can be classified into three distinct regions related to the position of the lateral opening: temperature rapid decrease region, temperature slow decrease region, and backflow region at the end of the compartment. A model for the maximum temperature rise and a piecewise equation based on single exponential function for temperature decay profile are proposed, and these equations effectively correlate the experimental data. The findings of this study can deepen the understanding of fire dynamics within similar building structures and have value for the fire hazard assessment.

Application of a new DES model based on Wray-Agarwal turbulence model in flow simulation of a mixed-flow pump

In recent years, it has been demonstrated for many two- and three-dimensional external and internal turbulent flows that the one-equation Wray-Agarwal turbulence model can compute the complex turbulent flow fields with high computational accuracy, excellent computational convergence and efficiency. In this paper, Wray-Agarwal (WA) turbulence model is employed as part of a detached eddy simulation (DES) method to predict the performance of a mixed-flow pump. By comparing the computations with the experimental results, the differences and similarities between the WA-DES model and the Shear Stress Transfer (SST) k-ω model in predicting the internal and external flow characteristics of the pump are analyzed. The results show that both the SST k-ω model and the WA-DES model can reasonably predict the performance of the pump between 0.6 Q and 1.2 Q, where Q is the design flow rate; however, they have their own merits and deficiencies in predicting head and efficiency of the pump at low and high flow rates. For the velocity field in the rotor-stator interaction region, the WA-DES model shows better prediction accuracy since it can accurately predict the large-scale recirculating vortex structure at the inlet of the guide vane. The SST k-ω model over-predicts the separated flow region, which leads to the emergence of a small vortex structure before the backflow region of the pump. Although the turbulent eddy viscosity predicted by the WA-DES model is higher than that of the SST k-ω model and there is small difference in the results for the scale of the tip leakage vortex (TLV) between the two models, the overall simulation results of the WA-DES model for the high turbulent viscosity region and the pressure increase in the impeller are consistent with the SST k-ω model results. The results of this paper demonstrate the potential of WA-DES model for prediction of flows in pumps.

The statistical characteristics and auto-regeneration of backflow in non-Newtonian turbulent pipe flow

The backflow phenomenon in shear-thinning and shear-thickening fluids is investigated in pipe flows at friction Reynolds number Reτ=180 via direct numerical simulations. Conditional average results show that the extreme fluctuation of wall shear stress around the backflow regions is more abrupt under the shear-thinning effect. The statistical characteristics of the backflow at different flow indices from 0.5 to 1.5 show remarkable differences. The probability of the backflow events at the wall increases in both the shear-thinning and the shear-thickening fluids under different mechanisms. The backflow occurs more frequently and exists further away from the wall in the shear-thinning fluids owing to the suppressed near-wall turbulent structures and the laminarization at low flow indices. The increase in the probability of the backflow events in the shear-thickening fluids is caused by increased Q2 and Q4 events in the near-wall region. The variation in the size and the lifespan of the backflow regions with the flow index is very prominent which both increase with the shear-thinning effect and decrease as the flow becomes dilatant. In the weakly turbulent flow of shear-thinning fluid, large backflow regions appear near the leading edge of the turbulent spots where the off-axial turbulent fluctuations are significantly lowered. Observations show the linked evolution between the hairpin vortices and the backflow regions induced underneath the strong spanwise rotations. The backflow follows the auto-regeneration process of the hairpin vortices in a packet which results in coherent streamwise-aligned backflow regions under the hairpin packets confined closer to the wall.

Evaluation and Investigation of Hydraulic Performance Characteristics in an Axial Pump Based on CFD and Acoustic Analysis

In this work, the internal flow behaviour and characteristic pressure fluctuations of an axial pump with varying water conditions are analysed. The impact of tip vortex flow on the pattern of turbulent flow is simulated numerically by the application of the CFD technique and experimentally using an acoustics analysis method. The numerical CFD data are verified with an experimental test model for accuracy and reliability. Based on the results, the difference in pressure in the internal flow and at the surfaces of the blade can be impacted through tip leakage vortex regions, which leads to changes in internal flow. Subsequently, the flow in the clearance and tip leakage vortex regions is changed. Moreover, the results reveal that the suction wall upstream is more unsteady near the surface due to more mixing, secondary flow, and tip leakage vortices. Pressure fluctuation occurs near the tip of the blade, caused by the increasing vortex flow velocity and hence raising the turbulent kinetic energy (TKE). Using different monitoring points at the blade impeller reveals high values of the pulsation amplitude. Owing to the region of clearance backflow under low-water conditions, the axial pump displays larger fluctuations in pressure near the tip blade area. Because the leakage flow leaves the gap at a high flow rate, shear layers are formed quickly between the main flow and the leakage flow. Near the end wall, there is a negative-vorticity-induced vortex. Moreover, as the flow rate increases, the pump’s amplitude decreases along with its main frequency. For the low-water flow, the results reveal that there is an important clearance backflow because the axial pump has large clearance.

The study of heat characteristics for micro pin-fin heat sinks with different structures

Heat flux in electronic devices has increased dramatically with the development of advanced IC technology, facing the demand for effective thermal management technology. Micro pin-fin heat sink (MPFHS) has been demonstrated to be capable of improving the heat transfer capability and suppressing temperature rise effectively. In order to elaborate the discrepancy of heat dissipation of the MPFHS due to the cross-section shapes of pin-fin structures a set of heat sink samples with four different shapes, including the circle-MPFHS, the square-MPFHS, the crisscross- MPFHS, and the octagon-MPFHS, are fabricated with micromachining technology. Then, the thermal characteristics are tested by integrating the heat sinks with a Pt film resistor chip as the heating source, and nucleate boiling phenomenon was observed with a high-speed camera. Results showed that concave corners in pin-fin structures increased the specific surface area, but generated low velocity vortexes in back flow regions, reducing the heat transfer capability. The heat transfer coefficients of the octagon-MPFHS, the crisscross-MPFHS, and the circle- MPFHS was increased by 161.9 %, 152.4%, and 85.7 %, respectively, relative to the square-MPFHS at the flow rate of 147 kg/m2s. The heat transfer coefficients of the octagon-MPFHS, the crisscross-MPFHS, the circle-MPFHS, and the square- MPFHS was increased by 7.27%, 11.32%, 2.56%, and 4.76% when the mass-flow rate was increased from 147 kg/m2s to 295 kg/m2s. The nucleate boiling phenome-non in the crisscross-MPFHS showed periodicity and positive feedback effect, resulting in local dry-out and consequent heat transfer capability deterioration. This study will contribute to the design and modification of MPFHS.

Flow and mass transfer for the adsorption separation of para-xylene in a packed bed by particle-resolved CFD simulations

As the leading polyester product chain, para-xylene (PX) is the most important xylene isomer. In industry, high purity paraxylene is mainly produced by adsorption separation technology. In this study, the PX adsorption process has been investigated by a 3D particle-resolved CFD model. For spherical particle packed beds, the channeling effect, flow stagnation and backflow regions are the main factors leading to non-ideal flow. According to the residence time distribution (RTD) and adsorbent efficiency, the more uniform the flow in the packed bed, the higher the adsorption separation efficiency. Therefore, low feed flow rate and large bed-to-particle diameter ratio (N) are beneficial to the adsorption process. In addition, the effect of particle geometries (trilobe, five-lobe, Raschig ring, four-spoke ring, and six-hole cylindrical) on the flow and adsorption characteristics of the packed bed has been investigated in terms of pressure drop, adsorbed amount and adsorbent efficiency. Internal void particles perpendicular to the flow direction are unfavorable for the adsorption process. The four-spoke ring adsorbent with more surface areas has the largest bed adsorbed amount and exhibits the best adsorption performance. The trilobe adsorbent has the largest adsorbed amount per unit bed pressure drop and is the optimally shaped adsorbent for industrial PX adsorption separation.

Simulation of flow past a squirmer confined in a channel at low Reynolds numbers

The two-dimensional lattice Boltzmann method was employed to numerically investigate the flow around a circular squirmer in a channel at low Reynolds numbers. The study thoroughly examined the impact of various factors on flow structures and drag coefficients (C d) of the squirmer, such as the Reynolds number (Re), self-propelled strength (α), squirmer-type factor (β), blockage ratio (B), and orientation angle (θ). Notably, despite the low Reynolds numbers, a change in the orientation angle θ resulted in a lift in the squirmer, consequently affecting its lift coefficient (C l). The simulation findings underscored that a pair of up-down backflow regions are generated on the squirmer’s surface. Interestingly, the locations of these backflow regions varied significantly between the pusher type (β< 0), the neutral squirmer (β= 0), and the puller type (β> 0). These variations were closely tied to the pressure and velocity distributions on the surfaces of the respective squirmers. Furthermore, an increase in α might induce the formation of a new pair of backflow regions near the channel walls and subsequently elevate the C d . On the other hand, alterations in Re did not affect the flow structures but created a negative correlation with C d. Overall, the study unveiled unique dynamic characteristics, offering a contrast to the extensively investigated case of flow past a cylinder.

Magnetic resonance velocity imaging of turbulent gas flow in a packed bed of catalyst support pellets

Compressed sensing magnetic resonance methods have been used to image the time-averaged velocity and turbulent kinetic energy in 3D for turbulent gas flowing through a bed of porous, hollow cylindrical catalyst support pellets. Velocity and turbulent kinetic energy images were acquired at a spatial resolution of 0.70 mm (x) × 0.70 mm (y) × 1.0 mm (z) for particle Reynolds numbers, Rep, of 500, 2500 and 6500 in a bed with a tube-to-particle diameter ratio of 4.7. These data represent the first full-field measurements of turbulent gas flow in packed beds of non-spherical pellets. The resulting images reveal several interesting features of the hydrodynamics in this system. A large degree of flow heterogeneity is observed in the bed, with regions of high-speed fluid observed near the walls and in large voids, and regions of backflow observed in the wake of pellets, between pellets, and within the pellet holes. For increasing Rep, the normalized axial velocity at the wall is found to increase, and the normalized turbulent kinetic energy becomes more homogeneous throughout the bed. The correlation between the turbulent kinetic energy and time-averaged velocity shows that the highest turbulent kinetic energy occurs in regions of intermediate time-averaged velocity. Further, the turbulent kinetic energy profile at the pellet-scale is substantially different from the case of simple channel flow for Rep≥ 2500. Overall, these measurements clearly demonstrate the ability of magnetic resonance methods for acquiring full-field flow data in packed bed systems using commercially-relevant pellets and flow conditions.

Numerical investigation of tip clearance flow in a variable geometry turbine with non-uniform partial clearance

Abstract In variable geometry turbine vanes, tip clearance height and shape vary with the rotation of the vane, which affect the aerodynamic performance significantly. However, these issues are rarely considered in published studies. The current paper investigated the flow field features of transonic variable geometry turbine vanes with non-uniform partial clearance induced by the vane rotating. The results show that: The influence of guide vane rotation on the clearance height and its distribution cannot be ignored. At the same turning angle, the maximum clearance difference is up to 0.79 mm (0.8 % vane height). The height and shape variation of the non-uniform clearance leads to the change in the leakage flow rate, secondary flow structure, and aerodynamic loss of the variable guide vane. Under the combined effect of pressure difference on both sides of the clearance, axial and circumferential non-uniformity of clearance height, the total pressure loss coefficient is up to 9.44 % when the turning angle is −10°. The effect of the pivot on the clearance flow was also analyzed. The pivot increases the pressure in the gap flow field and reduces leakage flow velocity. However, a backflow region appears at the suction side of the pivot, which increases the aerodynamic losses.

Study on the Energy Loss Characteristics of Shaft Tubular Pump Device under Stall Conditions Based on the Entropy Production Method

This study aimed to reveal the energy loss characteristics of each part of the shaft tubular pump device (STPD) under stall conditions. Numerical simulations were conducted by using the SST k-ω turbulence model with curvature correction, and the reliability of the simulation results was verified by a model test. The entropy production method was used to evaluate and visualize the energy loss. The results show that turbulent entropy production (TEP) is the main source of energy loss in each component of the STPD, and the TEP increases significantly with the deterioration of stall. The energy loss in the impeller is mainly concentrated near the shroud and hub, while in the guide vanes it is mainly concentrated near the shroud and suction surface of the blades. In addition, with the deterioration of stall, the energy loss in the inlet of the impeller and guide vanes increases significantly. Influenced by the backflow from the impeller, there is a significant amount of energy loss at the outlet segment of the inlet passage, and the location of the high-energy-loss region is consistent with the backflow region. Affected by the flow separation vortex at the tail of the guide vanes, the energy loss in the outlet passage is mainly concentrated at the inlet segment.

Effect of flow rate ratio and positioning on a lighthouse tip ECMO return cannula.

Extracorporeal membrane oxygenation is a life-saving support therapy in the case of cardiopulmonary refractory failure. Its use is associated to complications due to the presence of artificial surfaces and supraphysiological stress conditions. Thus, knowledge of the fluid structures associated to each component can give insight into sources of blood damage. In this study, an experimentally validated numerical study of a conventional lighthouse tip cannula in return configuration was carried out to characterize the flow structures using water or a Newtonian blood analog with different flow rate ratios and cannula positioning and their influence on hemolysis. The results showed that strong shear layers developed where the jets from the side holes met the co-flow. Stationary backflow regions at the vessel wall were also present downstream of the cannula. In the tilted case, the recirculation was much more pronounced on the wide side and almost absent on the narrow side. Small vortical backflow structures developed at the side holes which behaved like obstacles to the co-flow, creating pairs of counter-rotating vortices, which induced locally higher risk of hemolysis. However, global hemolysis index did not show significant deviations. Across the examined flow rate ratios, the holes on the narrow side consistently reinfused a larger fraction of fluid. A radial force developed in the tilted case in a direction so as to recenter the cannula in the vessel.

Backflow structures in turbulent pipe flows at low to moderate Reynolds numbers

The statistical characteristics and the evolution of the backflow structures are investigated in wall-bounded flows at Reynolds numbers up to $Re_{\tau }=1000$ . The backflow is caused by the joining of large-scale high- and low-speed structures in the vicinity of the wall and is formed at the tail tip of the low-speed structure. The distribution density of the backflow structures and the percentage area of the backflow region on the wall both increase with the Reynolds number. The backflow structures have an average lifespan of 8 wall units which is found to be slightly longer in the pipe than the channel, and they are convected downstream at the average velocities of the buffer region of approximately 10 wall units, similar to Cardesa et al. (J. Fluid Mech., vol. 880, 2019, R3). The backflow structures occasionally split and merge, and can form detached from the wall. Evidence shows that the split, merged and wall-detached backflow structures are caused by the near-wall structures. The split backflow structures are on average, larger and more spanwise-elongated which are split due to the spanwise shearing of the near-wall streaks. A backflow structure is formed detached from the wall when the trailing end of its carrier low-speed structure ‘sits’ on the near-wall high-speed streaks. The wall-detached backflow structures tend to become wall-attached by approaching the wall when undergoing a similar life cycle to the normal backflow of growth and decay with spanwise elongation because the backflow region at the tail of the low-speed structure is continuously pressed down to the wall by the high-speed structure driven by persistent vortical structures in the buffer region.

Study on the non-premixed combustion characteristics and exergy analysis of H2/Air in vase-shaped micro combustor

The micro thermophotovoltaic system (MTPV) based on H2/Air combustion has the advantages of high energy density, long-lasting and small-scaled. However, there are still some challenges in combustion stability and safety due to short residence time, large heat dissipation, and flashback. For this reason, a non-premixed micro-combustor with tangential inlet and vase shape is proposed in this paper. The tangential inlet can replace the swirler to form a swirling flow and the vase-shaped channel is designed as a gradual expansion and shrinking tube. The effects of the tangential inlet, equivalence inlet velocity, and key parameters of structure on non-premixed combustion characteristics were numerically studied. The energy transfer path and exergy efficiency were analyzed. The results showed that the vase-shaped micro combustor has a higher blow out limit, and much greater exergy and exergy efficiency than the conventional combustor. With the increase of equivalence inlet velocity, the exergy increases while the exergy efficiency greatly decreases. With the decrease in tangential inlet size, the flame temperature and exergy decreased while the exergy efficiency increased significantly. The tangential inlet can promote the mixing effect in the back-flow region, but the exergy and exergy efficiency decrease. The blow out limit increases with the increase of R3/R1 (maximum channel radius/inlet-1 radius) while the efficiency greatly decreases.

Multiphase Flow Hemodynamic Evaluation of Vertebral Artery Stenosis Lesions and Plaque Stability.

Atherosclerosis is one of the main causes of vertebral artery stenosis, which reduces blood supply to the posterior circulation, resulting in cerebral infarction or death. To investigate stenosis rates and locations on the development of vertebral artery plaques. Stenosis models with varying degrees and positions of stenosis were established. The stenosis area was comprehensively analyzed using multiphase flow numerical simulation. Wall shear stress (WSS), blood flow velocity, and red blood cell (RBC) volume fraction were calculated. Blood flow velocity in 30-70% stenosis of each segment tended to increase significantly higher than normal. Downstream of 50% stenosis exhibited turbulent flow; downstream of 70% displayed reflux. Severe stenosis increases the WSS and distribution area. The mixed area of high and low WSS appeared downstream of the stenosis. The RBC volume fraction at the stenosis increased (maximum value: 0.487 at 70% stenosis in the V4), which was 1.08 times the normal volume fraction. Turbulent and backflow regions exhibited complex RBC volume fraction distributions. Flow velocity, WSS, and RBC volume fraction at the stenosis increase with stenosis severity, increasing plaque shedding. Narrow downstream spoiler and reflux areas possess low WSS and high erythrocyte volume fractions, accelerating plaque growth.

The Effectiveness of Fluoroscopy-Guided Manual Lymph Drainage as Part of Decongestive Lymphatic Therapy on the Superficial Lymphatic Architecture in Patients with Breast Cancer-Related Lymphoedema: A Randomised Controlled Trial

The objective of this trial was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD), as part of decongestive lymphatic therapy (DLT), on the superficial lymphatic architecture in patients with chronic mild to moderate breast cancer-related lymphoedema (BCRL). This trial was a multicentre, double-blind, randomised controlled trial involving 194 participants with BCRL. Participants were randomised into (1) DLT with fluoroscopy-guided MLD (intervention group), (2) DLT with traditional MLD (control group), or (3) DLT with placebo MLD (placebo group). Superficial lymphatic architecture was evaluated as a secondary outcome, visualised by ICG lymphofluoroscopy at the baseline (B0), post-intensive (P), and post-maintenance phases (P6). Variables were (1) number of efferent superficial lymphatic vessels leaving the dermal backflow region, (2) total dermal backflow score, and (3) number of superficial lymph nodes. The traditional MLD group showed a significant decrease in the number of efferent superficial lymphatic vessels at P (p = 0.026), and of the total dermal backflow score at P6 (p = 0.042). The fluoroscopy-guided MLD and placebo group showed significant decreases in the total dermal backflow score at P (p < 0.001 and p = 0.044, respectively) and at P6 (p < 0.001 and p = 0.007, respectively); the placebo MLD group showed a significant decrease in the total number of lymph nodes at P (p = 0.008). However, there were no significant between-group differences for the changes in these variables. In conclusion, based on lymphatic architecture outcomes, the added value of MLD, in addition to the other parts of DLT, could not be demonstrated in patients with chronic mild to moderate BCRL.