Wall Compliance Research Articles

The Influence of Material Properties and Wall Thickness on Predicted Wall Stress in Ascending Aortic Aneurysms: A Finite Element Study.

Finite element analysis (FEA) has been used to predict wall stress in ascending thoracic aortic aneurysm (ATAA) in order to evaluate risk of dissection or rupture. Patient-specific FEA requires detailed information on ATAA geometry, loading conditions, material properties, and wall thickness. Unfortunately, measuring aortic wall thickness and mechanical properties non-invasively poses a significant challenge, necessitating the use of non-patient-specific data in most FE simulations. This study aimed to assess the impact of employing non-patient-specific material properties and wall thickness on ATAA wall stress predictions. FE simulations were performed on 13 ATAA geometries reconstructed from computed tomography angiography (CTA) images. Patient-specific material properties and wall thicknesses were made available from a previous study where uniaxial tensile testing was performed on tissue samples obtained from the same patients. The ATAA wall models were discretised with hexahedral elements and prestressed. For each ATAA model, FE simulations were conducted using patient-specific material properties and wall thicknesses, and group-mean values derived from all tissue samples included in the same experimental study. Literature-based material property and wall thickness were also obtained from the literature and applied to 4 representative cases. Additional FE simulations were performed on these 4 cases by employing group-mean and literature-based wall thicknesses. FE simulations using the group-mean material property produced peak wall stresses comparable to those obtained using patient-specific material properties, with a mean deviation of 7.8%. Peak wall stresses differed by 20.8% and 18.7% in patients with exceptionally stiff or compliant walls, respectively. Comparison to results using literature-based material properties revealed larger discrepancies, ranging from 5.4% to 28.0% (mean 20.1%). Bland-Altman analysis showed significant discrepancies in areas of high wall stress, where wall stress obtained using patient-specific and literature-based properties differed by up to 674kPa, compared to 227kPa between patient-specific and group-mean properties. Regarding wall thickness, using the literature-based value resulted in even larger discrepancies in predicted peak stress, ranging from 24.2% to 30.0% (mean 27.3%). Again, using the group-mean wall thickness offered better predictions with a difference less than 5% in three out of four cases. While peak wall stresses were most affected by the choice of mechanical properties or wall thickness, the overall distribution of wall stress hardly changed. Our study demonstrated the importance of incorporating patient-specific material properties and wall thickness in FEA for risk prediction of aortic dissection or rupture. Our future efforts will focus on developing inverse methods for non-invasive determination of patient-specific wall material parameters and wall thickness.

The Impact of Pneumoperitoneum on Mean Expiratory Flow Rate: Observational Insights from Patients with Healthy Lungs

Background/Objectives: Surgical pneumoperitoneum (PP) significantly impacts volume-controlled ventilation, characterized by reduced respiratory compliance, elevated peak inspiratory pressure, and an accelerated expiratory phase due to an earlier onset of the airway pressure gradient. We hypothesized that this would shorten expiratory time, potentially increasing expiratory flow rate compared to pneumoperitoneum conditions. Calculations were performed to establish correlations between respiratory parameters and the mean increase in expiratory flow rate relative to baseline. Methods: Mechanical ventilation parameters were recorded for 67 patients both pre- and post-PP. Ventilator settings were standardized with a tidal volume of 6 mL/kg, a respiratory rate of 12 breaths per minute, a PEEP of 3 cmH2O, an inspiratory time of 2 s, and an inspiratory-to-expiratory ratio of 1:1.5 (I:E). Results: The application of PP increased both peak inspiratory pressure and mean expiratory flow rate by 28% compared to baseline levels. The elevated intra-abdominal pressure of 20 cmH2O resulted in a 34% reduction in dynamic chest compliance, a 50% increase in elastance, and a 20% increase in airway resistance. The mean expiratory flow rate increments relative to baseline showed a significant negative correlation with elastance (p = 0.0119) and a positive correlation with dynamic compliance (p = 0.0028) and resistance (p = 0.0240). Conclusions: A PP of 20 cmH2O resulted in an increase in the mean expiratory flow rate in the conventional I:E ratio in the volume-ventilated mode. PP reduces lung and chest wall compliance by elevating the diaphragm, compressing the thoracic cavity, and increasing airway pressures. Consequently, the lungs and chest wall stiffen, requiring greater ventilatory effort and accelerating expiratory flow due to increased airway resistance and altered pulmonary mechanics. Prolonging the inspiratory phase through I:E ratio adjustment helps maintain peak inspiratory pressures closer to baseline levels, and this method enhances the safety and efficacy of mechanical ventilation in maintaining optimal respiratory function during laparoscopic surgery.

Physiological effects and safety of bed verticalization in patients with acute respiratory distress syndrome

BackgroundTrunk inclination in patients with Acute Respiratory Distress Syndrome (ARDS) in the supine position has gained scientific interest due to its effects on respiratory physiology, including mechanics, oxygenation, ventilation distribution, and efficiency. Changing from flat supine to semi-recumbent increases driving pressure due to decreased respiratory system compliance. Positional adjustments also deteriorate ventilatory efficiency for CO2 removal, particularly in COVID-19-associated ARDS (C-ARDS), indicating likely lung parenchyma overdistension. Tilting the trunk reduces chest wall compliance and, to a lesser extent, lung compliance and transpulmonary driving pressure, with significant hemodynamic and gas exchange implications.MethodsA prospective, pilot physiological study was conducted on early ARDS patients in two ICUs at CHU Clermont-Ferrand, France. The protocol involved 30-min step gradual verticalization from a 30° semi-seated position (baseline) to different levels of inclination (0°, 30°, 60°, and 90°), before returning to the baseline position. Measurements included tidal volume, positive end-expiratory pressure (PEEP), esophageal pressures, and pulmonary artery catheter data. The primary endpoint was the variation in transpulmonary driving pressure through the verticalization procedure.ResultsFrom May 2020 through January 2021, 30 patients were included. Transpulmonary driving pressure increased slightly from baseline (median and interquartile range [IQR], 9 [5–11] cmH2O) to the 90° position (10 [7–14] cmH2O; P < 10–2 for the overall effect of position in mixed model). End-expiratory lung volume increased with verticalization, in parallel to decreases in alveolar strain and increased arterial oxygenation. Verticalization was associated with decreased cardiac output and stroke volume, and increased norepinephrine doses and serum lactate levels, prompting interruption of the procedure in two patients. There were no other adverse events such as falls or equipment accidental removals.ConclusionsVerticalization to 90° is feasible in ARDS patients, improving EELV and oxygenation up to 30°, likely due to alveolar recruitment and blood flow redistribution. However, there is a risk of overdistension and hemodynamic instability beyond 30°, necessitating individualized bed angles based on clinical situations.Trial registration ClinicalTrials.gov registration number NCT04371016, April 24, 2020.

Optimization of Entropy generation on peristaltic flow of nanofluid having compliant walls by RSM: Sensitivity analysis

In this study the mathematical model of entropy generation of peristaltic flow of nanofluid is developed under the assumption of long wavelength and low Reynolds number. The simplified coupled partial differential equation is solved by a well know analytical technique Homotopy Perturbation Method. The mathematical equation for entropy generation of nanofluid is utilized to find entropy generation behavior. The numerical results obtained by using Homotopy Perturbation Method are used to develop the correlation between input parameters and output responses by using Response Surface Methodology (RSM). The residual graph is plotted to show the validity of developed correlation. The high values of R-Square and Adj-R Square also show the best fit of developed correlation. Finally, sensitivity analysis is performed, and the obtained results are plotted for temperature and entropy generation against various pertinent parameters. It is concluded that the input thermophoresis parameter is most sensitive for entropy generation and the sensitivity of input parameter Grashof number is zero.

Numerical study on nanofluidic transport mechanism in Ellis flow within curved channel comprising compliant walls subjected to peristaltic activity

Peristaltic movement of fluid flows has significant applications in biomedical engineering, medicine, human physiology, etc. Specifically, it is very useful to understand and cure the very common intestinal diseases in human beings. A number of theoretical and empirical models are used to analyze peristaltic movement. In this work, the peristaltic movement of nanofluid is modeled with a non-Newtonian Ellis fluid model in a curved channel with compliant wall properties. The effects of Brownian motion, thermophoresis, and nonlinear radiations are considered in the heat transfer for better thermal analysis. The mathematical modeling of the physical problem yields the nonlinear partial differential equations with boundary conditions. First, the governing partial differential equations are non-dimensionalized, and then the resultant system is simplified by using the assumptions of a small Reynolds number and long wavelength. Then the obtained boundary value problem of differential equations is solved with the built-in Mathematica command NDSolve. The accuracy and reliability of the adopted procedure are verified by comparing the computed results with the reported literature. The impacts of the pertinent parameters (Brownian motion, thermal radiation, mixed convection, and thermophoresis phenomenon) on thermal energy, velocity, concentration, heat transfer rate, and stress at the lower wall are analyzed both in qualitative and quantitative manners. This study revealed some interesting facts, such as the peristaltic-driven motion of nanoliquid is strongly influenced by wall properties (i.e., wall elasticity, mass density, and wall damping). In addition, the flow experienced more resistance in the case of larger wall damping, but larger wall elasticity and mass density provide favorable movement for fluid motion. In addition, mixed convection plays a vital role in heat transfer and nanoparticle concentration in the curved domain. In addition, the curved channel walls have a higher stress factor than straight-plane channels. The results of the current study are very useful to understand many biological phenomena, such as the peristaltic movement of liquid during dialysis, food movement through the intestine, etc.

A study of thermal and nonlinear radiative aspects in peristalsis of Cu–H2O through compliant wall conduits

A study of thermal and nonlinear radiative aspects in peristalsis of Cu–H2O through compliant wall conduits

AnXplore: a comprehensive fluid-structure interaction study of 101 intracranial aneurysms.

Advances in computational fluid dynamics continuously extend the comprehension of aneurysm growth and rupture, intending to assist physicians in devising effective treatment strategies. While most studies have first modelled intracranial aneurysm walls as fully rigid with a focus on understanding blood flow characteristics, some researchers further introduced Fluid-Structure Interaction (FSI) and reported notable haemodynamic alterations for a few aneurysm cases when considering wall compliance. In this work, we explore further this research direction by studying 101 intracranial sidewall aneurysms, emphasizing the differences between rigid and deformable-wall simulations. The proposed dataset along with simulation parameters are shared for the sake of reproducibility. A wide range of haemodynamic patterns has been statistically analyzed with a particular focus on the impact of the wall modelling choice. Notable deviations in flow characteristics and commonly employed risk indicators are reported, particularly with near-dome blood recirculations being significantly impacted by the pulsating dynamics of the walls. This leads to substantial fluctuations in the sac-averaged oscillatory shear index, ranging from -36% to +674% of the standard rigid-wall value. Going a step further, haemodynamics obtained when simulating a flow-diverter stent modelled in conjunction with FSI are showcased for the first time, revealing a 73% increase in systolic sac-average velocity for the compliant-wall setting compared to its rigid counterpart. This last finding demonstrates the decisive impact that FSI modelling can have in predicting treatment outcomes.

Synchronized shock wave and compliant wall interactions: Experimental characterization and aeroelastic modeling

The static and dynamic interaction of a normal shock wave (upstream Mach number 1.35) with a compliant wall is characterized experimentally by schlieren visualizations and an optical displacement sensor. Depending on the location of the shock wave along the compliant wall, three different regimes of interaction are found: large-amplitude synchronized regime, small-amplitude synchronized regime and unsynchronized regime. The regime of large-amplitude synchronized oscillations is found for shock locations close to the mid-point of the compliant wall along the streamwise direction; at this location, the coupled system locks to the second vibration frequency of the structure. Three regimes of small-amplitude synchronized oscillations are found depending on the shock position. When the shock is located upstream the center of the compliant wall, the shock may oscillate either periodically at the frequency of the first vibration mode or quasi-periodically with highest amplitudes at the three frequencies of the vibration modes. When the shock is located downstream the center of the compliant wall, the shock oscillates periodically at the frequency of the third vibration mode. Finally, close to the trailing edge of the compliant wall, the shock oscillation is not synchronized with the compliant wall which oscillates with a very small amplitude. An empirical model is proposed to investigate the energy exchange between the flow and the compliant wall during the limit cycle oscillations. A negative aerodynamic damping – and, hence, the possibility of a limit cycle – is observed when a sufficiently extended separation is considered in the model for the pressure distribution at the wall.

Respiratory and chest wall mechanics in very preterm infants.

Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.

INTRAOPERATIVE FASCIAL TRACTION FOR TREATMENT OF W2 AND W3 VENTRAL HERNIAS

Abstract Background Component separation techniques are increasingly employed in abdominal wall reconstruction surgery. The use of adjuvant techniques, such as intraoperative vertical dynamic fascial traction, enhances the compliance of the abdominal wall. This facilitates closure of the abdominal wall using less disruptive techniques without compromising effective treatment. Our aim is to retrospective review our results regarding the effectiveness and complication rate of intraoperative fascial traction for the treatment of complex ventral hernias. Method Conducted a retrospective analysis of 10 patients who underwent surgery using intraoperative fascial traction for W2 and W3 ventral hernias. Results Preoperatively, fascial distances measured ranged from 55 cm to 145 cm, with the majority of patients (70%) having a fascial distance greater than 10 cm. Most patients received other adjuvant treatments (nine cases with botulinum toxin injection and one with pre-operative progressive pneumoperitoneum). Posterior component techniques were employed in 40% of patients (half with W2 hernias and the other half with W3 hernias). The complication rate was 10%, with one case of hemorrhage requiring percutaneous embolization. During the average 6-month follow-up period (ranging from 1 to 17 months), one recurrence was observed. Conclusion Intraoperative fascial traction is a feasible and safe adjuvant technique for abdominal wall reconstruction. The use of adjuvants in complex abdominal wall hernia surgery may, in some patients, downstage the hernia, thereby avoiding the need for component separation techniques. This approach enables tension-free closure of the abdominal wall in a less invasive manner.

The origin of intraluminal pressure waves in gastrointestinal tract.

The gastrointestinal (GI) peristalsis is an involuntary wave-like contraction of the GI wall that helps to propagate food along the tract. Many GI diseases, e.g., gastroparesis, are known to cause motility disorders in which the physiological contractile patterns of the wall get disrupted. Therefore, to understand the pathophysiology of these diseases, it is necessary to understand the mechanism of GI motility. We present a coupled electromechanical model to describe the mechanism of GI motility and the transduction pathway of cellular electrical activities into mechanical deformation and the generation of intraluminal pressure (IP) waves in the GI tract. The proposed model consolidates a smooth muscle cell (SMC) model, an actin-myosin interaction model, a hyperelastic constitutive model, and a Windkessel model to construct a coupled model that can describe the origin of peristaltic contractions in the intestine. The key input to the model is external electrical stimuli, which are converted into mechanical contractile waves in the wall. The model recreated experimental observations efficiently and was able to establish a relationship between change in luminal volume and pressure with the compliance of the GI wall and the peripheral resistance to bolus flow. The proposed model will help us understand the GI tract's function in physiological and pathophysiological conditions.

Reactive control of velocity fluctuations using an active deformable surface and real-time PIV

This study demonstrates an experimental realization of turbulence control strategies previously explored by Choi et al. (J. Fluid Mech., vol. 262, 1994, pp. 75–110) through numerical simulations. To conduct the experiments, a deformable surface with a streamwise array of 16 independently controlled actuators was developed. A real-time particle image velocimetry (RT-PIV) system was also created for flow measurements. The objective of the control strategy was to target the sweep and ejection motions of the vortex shedding from a spherical cap placed in a laminar boundary layer. Reactive control strategies consisted of wall-normal surface deformations that opposed or complied with the wall-normal (v) or streamwise (u) velocity fluctuations obtained from the RT-PIV. The results showed two primary outcomes of the control approach. Firstly, it effectively hindered the advancement of sweep motions towards the wall. Secondly, it disrupted the periodic shedding of vortices. The v-control with opposing wall motions and u-control with compliant wall motions exhibited strong inhibition of sweep motions, while the v-control with compliant and u-control with opposing wall motions showed weaker inhibition. All reactive control cases resulted in the disruption of vortex shedding. In some instances, this disruption was accompanied by increased turbulent kinetic energy due to the generation of additional flow motions. However, the v-control with opposing wall motions significantly reduced the vortex-shedding energy while maintaining total turbulent kinetic energy close to or below that of the unforced flow. Overall, the experiments show the effectiveness of reactive control strategies in mitigating sweep motions and disrupting vortical structures, offering insights for developing reactive control strategies.

Transient energy growth in channel flow with compliant walls

Transient energy growth in channel flow with compliant walls

Computational Investigation of Vessel Injury Due to Catheter Tracking During Transcatheter Aortic Valve Replacement.

Catheter reaction forces during transcatheter valve replacement (TAVR) may result in injury to the vessel or plaque rupture, triggering distal embolization or thrombosis. In vitro test methods represent the arterial wall using synthetic proxies to determine catheter reaction forces during tracking, but whether they can account for reaction forces within the compliant aortic wall tissue in vivo is unknown. Moreover, the role of plaque inclusions is not well understood. Computational approaches have predicted the impact of TAVR positioning, migration, and leaflet distortion, but have not yet been applied to investigate aortic wall reaction forces and stresses during catheter tracking. In this study, we investigate the role that catheter design and aorta and plaque mechanical properties have on the risk of plaque rupture during TAVR catheter delivery. We report that, for trackability testing, a rigid test model provides a reasonable estimation of the peak reaction forces experienced during catheter tracking within compliant vessels. We investigated the risk of rupture of both the aortic tissue and calcified plaques. We report that there was no risk of diseased aortic tissue rupture based on an accepted aortic tissue stress threshold (4.2MPa). However, we report that both the aortic and plaque tissue exceed a rupture stress threshold (300kPa) with and without the presence of stiff and soft plaque inclusions. We also highlight the potential risks associated with shorter catheter tips during catheter tracking and demonstrate that increasing the contact surface will reduce peak contact pressures experienced in the tissue.

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

IntroductionCompliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations.Materials and MethodsA post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow MRI data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed.ResultsIncreased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively.ConclusionThis study suggests that by minimising graft length and matching its compliance to the native aorta whilst aligning with surgical requirements, the risk of LV hypertrophy may be reduced. This provides evidence that compliance-matching grafts may enhance patient outcomes.

Macroscopic and stable gas film obtained by superhydrophobic step and its drag reduction performance

Drag reduction technology has a promising application in marine fields and has drawn much interest in scientific fields. Superhydrophobic surface has been proven to be effective in drag reduction due to thin film of gas adsorbed on surface because of its low friction drag and large slip length. Here, macroscopic and stable gas film was observed when water flowed over superhydrophobic surface with step without additional gas injection under laminar flow and turbulent flow. Superhydrophobic surface was prepared with contact angle more than 150° and roll-off angle nearly 0°. Macroscopic gas film could maintain under laminar flow and turbulent flow and keep up to 80% after 1 h water flowing with optimized parameters of step, showing different morphological deformations under different velocities and Reynolds numbers. Compared with untreated hydrophilic surface, superhydrophobic surface with step exhibited good drag reduction performance with maximum drag reduction rate 20% under laminar flow and turbulent flow, after optimizing of height of step and distance between steps. Mechanisms of gas film drag reduction were the ultra-low skin friction drag force between liquid–gas interface, large slip length on liquid–gas interface, and flexible gas film surface acted like compliant wall. Gas film of millimeter scale was much larger than thickness of boundary layer and reduced turbulence intensity near wall. This work provides a new way to obtain macroscopic gas film and analyze liquid–gas interface.

Experimental modal testing of growing thin ice

Current practices for assessing the thickness of growing ice include drilling and coring. This is inherently risky and motivates the use of a stand-off method. Laser Doppler vibrometry is a potential technique, however, the interpretation of vibrometer signals must be informed by a physical understanding of ice subjected to mechanical vibrations. The vibrational response of growing, thin ice is largely unknown. For thick ice, adequate predictions for the vibrational response assumes ice behaves as an elastic plate. It is hypothesized that thin ice responds in a fashion somewhere between an elastic membrane and an elastic plate. A modal test of thin ice growing within an insulated plastic basin was conducted over the course of two tests. The resulting dataset spans a range of ice thicknesses from 8 to 45 mm. Examination of Bode and Nyquist plots showed that the two lowest observable ice resonances, as measured at the center of the ice sheet, exhibit a dependence on ice thickness distinctly different from a fixed elastic plate loaded by a half-space of water. Preliminary finite-element analysis calculations indicates that the basin wall compliance is a significant factor in modifying the ice resonance versus thickness relationship.

Influence of the chest wall on respiratory function at birth in near-term lambs.

Airway liquid is cleared into lung tissue after birth, which becomes edematous and forces the chest wall to expand to accommodate both the cleared liquid and incoming air. This study investigated how changing chest wall mechanics affects respiratory function after birth in near-term lambs with different airway liquid volumes. Surgically instrumented near-term lambs (139 ± 2 days) were randomized into Control (n = 7) or Elevated Liquid (EL; n = 6) groups. Control lambs had lung liquid drained to simulate expected volumes following vaginal delivery. EL lambs had airway liquid drained and 30 mL/kg liquid returned to simulate expected airway liquid volumes after elective cesarean section. Lambs were delivered, transferred to a Perspex box, and ventilated (30 min). Pressure in the box was adjusted to apply positive (7-8 cmH2O above atmospheric pressure) or negative (7-8 cmH2O below atmospheric pressure) pressures for 30 min before pressures were reversed. External negative pressures expanded the chest wall, reduced chest wall compliance (CCW) and increased lung compliance (CL) in Control and EL lambs. External positive pressures compressed the chest wall, increased CCW and reduced CL in Control and EL lambs. External negative pressure improved pulmonary oxygen exchange, reducing the alveolar-arterial difference in oxygen (AaDO2) by 69 mmHg (95% CI [13, 125]; P = 0.016) in Control lambs and by 300 mmHg (95% CI [233, 367]; P < 0.001) in EL lambs. In contrast, external positive pressures impaired pulmonary gas exchange, increasing the AaDO2 by 179 mmHg (95% CI [73, 285]; P = 0.002) in Control and by 215 mmHg (95% CI [89, 343]; P < 0.001) in EL lambs. The application of external thoracic pressures influences respiratory function after birth.NEW & NOTEWORTHY This study investigated how changes in chest wall mechanics influence respiratory function after birth. Our data indicate that the application of continuous external subatmospheric pressure greatly improves respiratory function in near-term lambs with respiratory distress, whereas external positive pressures impair respiratory function. Our findings indicate that, during neonatal resuscitation at birth, the forces applied to the chest wall should not be ignored as they can have a major impact on neonatal respiratory function.

Effect of pharyngeal wall compliance on passive collapsibility of retropalatal airway in patients with obstructive sleep apnea

AbstractObjectiveTo evaluate the pharyngeal compliance of patients with obstructive sleep apnea with complete muscle relaxation. And to study the relationship between the pharyngeal wall compliance and the mechanical load of the retropalatal airway.MethodsThe static mechanical load of the retropalatal pharynx was determined by critical closing pressure (Pcrit) of the segment during general anesthesia in 30 patients. The size/dimensions of the pharynx were measured while intraluminal pressure was controlled at 3–20 cmH2O.ResultsA total of 30 participants (age: 37.6 ± 7.6 years, 27 males) were studied. The mean apnea‐hypopnea index was 51.6 ± 23.9 events/h. The retropalatal mean Pcrit was 12.68 ± 4.13 cmH2O. There was a significant difference in the length of the obstruction segment (F = 26.028, p &lt; 0.001) among groups with different pharyngeal collapsibility. The correlation between the mechanical load of retropalatal airway and pharyngeal compliance in the level of the hard palate (r = −0.448, p = 0.015) and the uvula level (r = −0.462, p = 0.026) were significant.ConclusionsIncreased retropalatal mechanical loads were related to abnormal passive compliance of the pharyngeal wall. The contribution of each pharyngeal wall to airway collapse was varied.

Morphological features of biological and tissue-engineered vascular patches remodeling: results of tests on a sheep model

One of the ways to reconstruct the arterial wall is endarterectomy with a vascular patch. The use of vascular wall prostheses made from existing materials can lead to complications with the need for reoperation. The search for new materials for the manufacture of vascular patches that have optimal compatibility with the vessel wall is still relevant.Aim: To study the dynamics and compare the morphological features of remodeling of tissue-engineered vascular patches from silk fibroin (SF) and biological xenopericardium (XP) flaps implanted into the wall of the sheep carotid artery.Material and Methods. Matrices from a 15% SF solution (n = 2) were prepared by electrospinning. For comparison, bovine pericardial flaps were used (n = 2). Vascular patches were implanted into the wall of the carotid artery in sheep for 2 and 6 months. A histological examination of explanted samples of vascular patches, scanning electron microscopy and confocal microscopy with specific immunofluorescent staining of the preparations were performed.Results. Based on the implanted SF-patch, neointima and neoadventitia were formed. After 2 months of implantation, the SFmatrix retained its structure; after 6 months, there were signs of moderate biodegradation of the material with the replacement of the vessel wall with its own tissue. There were no areas of calcification or massive inflammation. After 6 months, neointimal hyperplasia was detected in the projection of the implanted SF-patch. Based on the implanted XP-flap, neointima and neoadventitia were also formed. After 2 months, delamination of the implanted XP was revealed. After 6 months, neointimal hyperplasia was found in the projection of the XP-patch.Conclusion. Remodeling of the SF-patches and XP-flaps implanted into the wall of the sheep carotid artery followed the formation of a three-layer structure resembling the architecture of the vessel’s own wall, with signs of moderate biodegradation of the material. Neointimal hyperplasia is explained by insufficient compliance of the arterial wall and the patch and requires improvement in the composition of the implanted matrix.