Spontaneous Mode Research Articles

A hovering bubble with a spontaneous horizontal oscillation

Active matters, characterized by multi-mode motions, have been emerging for both engineering and biological applications. Generally, active objects rely on the symmetry-broken structures, compositions, or interfacial activities through a physical or chemical approach. Here, we report an active bubble spontaneously hovering with a horizontal oscillation at the solid/liquid interface by impacting a stationary laser beam into a liquid through a transparent solid cover. This spontaneous oscillation mode of the bubble synchronizes with that of the interfacial temperature and hydrodynamical flow. A physical mechanism is proposed, and the scaling analysis of the oscillation frequency agrees well with experiments in various liquids under different laser powers. Additionally, the bubble trajectory rotates azimuthally, arising from the symmetry breaking of the vortex pair accompanying the oscillation. Moreover, the double pendulum of oscillation bubbles has been demonstrated, achieving a preferable oscillation direction in a controllable way. These findings would not only advance our understanding of active matters but also shed light on the bubble-mediated technological applications, such as microrobots and drug deliveries.

Performance of newly developed add-on devices on aerosol delivery in noninvasive ventilated subjects

Background: Several techniques had been developed to generate aerosolized medications during noninvasive ventilation (NIV) using variable inhalation methods. This study hypothesized that large spacers were more efficient significantly than small spacers and adapters during NIV. Objective: The main objective of this study was to compare the performance of newly developed spacers with standard T-piece in NIV chronic obstructive pulmonary disease (COPD) subjects. Methods: Sixty COPD subjects requiring NIV were included in this study. A dual-limb circuit was used, and the mode of ventilator was set in spontaneous volume-controlled mode. Dual-limb ventilation circuit, consists of inspiratory-limb and expiratory-limb, is pressure and volume controlled in response to subject expiration providing relatively high resistance to expiratory flow. Two experimental sets were evaluated: the first was introducing two preliminary pressurized metered-dose inhalers (pMDI) puffs before the nebulization of 1 ml of a respirable solution of salbutamol by vibrating mesh nebulizer (VMN) using Minimhal and Combihaler. The second was to only nebulize 1 ml of salbutamol respirable solution by VMN using Combihaler, Minimhal, and standard T-piece. Two urine samples were collected after aerosol delivery: urine sample after 30 min. (USAL0.5) as an indicator of lung deposition and all urine pooled 24 h (USAL24) post-inhalation as an indicator of systemic absorption. The amount of salbutamol extracted from urine samples was assayed by high-performance liquid chromatography. Results: Minimhal + pMDI + VMN delivered a higher percentage of salbutamol 30 min post-inhalation than Minimhal + VMN (p < 0.001). Also, Combihaler + pMDI + VMN delivered a higher percentage of salbutamol 30 min post-inhalation than Combihaler + VMN (p < 0.001). Combihaler + VMN delivered a higher percentage of salbutamol 30 min and 24 h post-inhalation than both Minimhal + VMN and T-piece + VMN (p < 0.001). Standard T-piece delivered the lowest aerosol amount delivered to the lung compared to both spacers (p < 0.05). Conclusions: Introducing two pMDI puffs significantly improved aerosol delivery by both spacers. Combihaler significantly improves aerosol delivery more than Minimhal.

Time to adequate weight gain and predictors among low-birth-weight preterm neonates at Neonatal Intensive Care Unit of hospitals in Bahir-Dar

Weight gain in low birth-weight babies remains a challenge to the management of the neonatal period in low and middle-income countries like Ethiopia. Therefore, this study aimed to determine the time to adequate weight gain and its predictors among low-birth-weight preterm neonates admitted to neonatal intensive care unit of public hospitals in Bahir Dar City. An institution-based retrospective follow-up study was conducted from March 4 to April 3, 2023, using three years of data. About 344 low-birth-weight preterm babies were recruited and followed up until 28 days of age. Model goodness-of-fit was checked by Cox Snell residuals test. The Cox-Proportional Hazards Model was used to assess predictors of weight gain with a statistically significant level of P-value < 0.05. The median weight gain time was 15 days with an overall incidence density rate of 6.3 per 100 person-day of observation (95% CI 0.055, 0.071). Absence of medical problems of mothers (AHR: 1.63, 95% CI 1.015, 4.614), spontaneous vaginal mode of delivery (AHR: 1.53, 95% CI 1.028, 2.593), and long duration of labor (AHR: 3.18, 95% CI 1.579, 6.413) were significant predictors. The time of adequate weight gain was long. Early detection and management of significant predictors is recommended.

Dénètem Touam Bona, Fugitive, where are you running?

Fugitive, Where are you Running? is a collection of essays, most of which were previously published in French, by writer, philosopher and curator Dénètem Touam Bona. The author's inclination to straddle geographic and conceptual lines is reflected in the scope, exuberance and poetic verve of the volume. The first three chapters ('Return of the Maroni', 'The Art of the Fugue', 'Manhunt') lay the conceptual foundation by foregrounding categories of marronage, fugitivity and fugue. The fugitive slave is presented as the figure that haunts the establishment of capitalist modernity and the only possible 'line of flight' from it. The fugue is the art of subtle evasion from the prisons of racialised capitalism and an alternative to the triumphalist politics of armed liberation struggles. Touam Bona proposes an impressionistic, rhapsodic and allegorical travel through the various incarnations of the maroon community - with its spontaneous and horizontal modes of organisation and accretion - and capitalism's death drive to surveil and suppress them. The following two chapters track the iterations and repression of fugitivity in the present, by engaging with technologies of migrant surveillance at the border ('Heroic Land', which mixes critique and fiction) and the space of Mayotte, a French department in the heart of the Indian Ocean, increasingly securitised and excised from the histories of flux that characterise this region ('The Impossibility of an Island'). The sixth chapter ('Cosmo-poetics of the Refuge') returns to the book's central theme of the maroon rebellion, connecting it to Afro-diasporic spirituality and performance. The final extended chapter ('Liana Dreaming') turns to environmental concerns, by foregrounding the figure of the liana as the point of resistance to colonial penetration and weapon of maroon resistance. In Caribbean cultures, the liana and the vine bring together collective bodies and communities. Against colonial tropes of taming, erasure and penetration, the power of the forest itself generates plant-induced visions of unsubmission.

Intercultural dialogue on ecopedagogy between Daoism and Naess’ ecosophy: Comparing and integrating Chinese and Western ecological wisdom

Dialogues between ecological wisdom across the East and the West contribute to generating unorthodox education, improving cross-cultural ecopedagogical praxis, and reinforcing education for sustainable development (ESD). In this article, Chinese Daoism and Norwegian Naessian ecosophy are compared and integrated to form an intercultural ecopedagogy. Indigenous Daoist wisdom entails profound ecopedagogical implications in learning from nature, human-nature reciprocity, and spontaneous, altruistic, and harmonious modes of action. Moreover, the cosmo-metaphysical notion of qi (氣) implies an alternative ecopedagogy that may empower learners to consolidate psychosomatic learning and embody human-nature oneness. Correspondingly, Arne Naess’ life philosophy promotes ecocentric living and education that underline experiential relations, non-violent symbiosis, and activeness in sensing and feeling. Naess’ postulation on subjective aesthetical identification with nature can be seen as one sensible complement to objective scientific knowledge of the ecosystem, facilitating individuals’ holistic and personally meaningful formation of be(com)ing ecocitizens. The reciprocity of Lao Zhuang’s and Naess’ ecological wisdom is argued to shed new light on theories and practices of ecopedagogy and combat dualism and anthropocentrism cross-culturally and innovatively.

Correlation analysis of central venous pressure and Intra-thoracic pressures in Acute Respiratory Distress Syndrome mechanical ventilated patients, a pilot Study

Abstract Background Positive end expiratory pressure can affect measurement of central venous pressure through increased intrathoracic pressure. However, when positive end expiratory pressure (PEEP) is applied, central venous pressure and pleural pressure often increases more than right atrial pressure, so that transmural right atrial pressure (true filling pressure) decreases. Aim of the study Primary end point was to recognizing correlation coefficient between mean CVP and intra- thoracic pressures on volume-controlled mode and spontaneous modes on same population of mechanically ventilated ARDS patients. The secondary end point is to compare the correlation coefficient R during both modes with parameters of ventilatory settings. Patient and Methods A cohort observational prospective study was done enrolling single group of patients with acute respiratory distress syndrome, who necessitate mechanical ventilation more than two days after connection to ventilators, the study was performed with demonstration of central venous pressure in cmH2O upon application of needed PEEP. Central venous catheter inserted for measuring CVP were processed in accordance with the standard guidelines. Results There were statistically significant differences between control and support group regarding the PEEP, Plateau pressure, mean CVP and mean airway pressure MAP. The data were higher in control than support group with p-value &amp;lt;0.001, 0.002 and 0.004, respectively. There was statistically significant positive correlation between R and CVP in the control group with p &amp;lt; 0.001 and r = 0.918. There was statistically significant positive correlation between R and ΔPIT in support group with p 0.001 and r = 0.926. The correlation between CVP and R among the control group was R = 0.028 + 0.032 * CVP with p-value &amp;lt;0.001, whereas the correlation between ΔPIT and R among the support group was R = 0.465 + 0.020 * ΔPIT with p-value = 0.022 Conclusion The relation between hemodynamics change of central venous pressures and intrathoracic pressure is new independent marker for evaluating ARDS mechanically ventilated patients. Values of R correlation are different in controlled mode relative to spontaneous mode during ARDS ventilated patients.

New perspective into the interaction behavior explore of Nano-berberine with alpha-lactalbumin in the presence of beta-lactoglobulin: Multi-spectroscopic and molecular dynamic investigations

The present study was focus on the interaction of alpha lactalbumin (α-LA) and Nano-berberine (Nano-Ber) in the absence and presence of beta lactoglobulin (β-LG) as binary and ternary systems by the exertion of different spectroscopic techniques, conductometry, β-galactosidase activity, and molecular simulation measurements. The outcomes of fluorescence quenching clarified the dominance of static quenching mechanism throughout the interaction of α-LA-Nano-Ber and (α-LA-β-LG) Nano-Ber complexes and also determined the KSV values to be (4.68±0.05) × 104 and (5.18±0.06) × 104 M−1, respectively. The measured thermodynamic parameters exhibited the participation of electrostatic forces in the binding interaction of α-LA and α-LA-β-LG complex with Nano-Ber. Moreover, the negative value of ΔG0 represents the spontaneous mode of this binding process in both systems. Synchronous fluorescence and resonance light scattering data demonstrated the impact of β-LG attendance on altering the interaction behavior of α-LA and Nano-Ber. The changes in the secondary structure of both proteins were affirmed by circular dichroism spectroscopy (CD) technique. According to the displayed β-galactosidase activity in the Michaelis-Menten plot of both binary and ternary systems, a greater Vmax refers to the stronger affinity of lactose and lactose hydrolysis that can be effective on the lactose intolerance regarding dairy products. Additionally, molecular dynamic simulations were employed to simulate the atomic-level interactions and explore the stability and conformational changes of protein-Nano Ber complexes over time. The results of these comprehensive biophysical investigations shed light on the binding characteristics, structural alterations, and dynamic behavior of Nano-Ber upon interaction with α-lactalbumin in the absence and presence of β-lactoglobulin as the binary and ternary systems. This study reveals the Nano-Ber role in the protein–protein interaction behavior and provides valuable insights into the potential applications of α-lactalbumin in the design of functional food formulations and drug delivery systems

Pulsed field ablation in patients with cardiac implantable electronic devices: an ex vivo assessment of safety.

Pulse field ablation (PFA) is a novel catheter ablation technology with potential safety benefits due to its tissue selectivity. It has the potential to directly damage or interact with the functionality of cardiac implantable electronic devices (CIEDs) in the form of electromagnetic interference (EMI). The aim of our study was to assess the impact of PFA on CIEDs. PFA lesions (45 per CIED) were applied from the Farapulse system to CIEDs (< 5 cm from the lead tip and < 15 cm from the generator). All devices were checked before and after PFA application for proper sensing and pacing functionality as well as for integrity of shock circuits in ICDs using a heart simulator. Moreover, devices were then interrogated for any spontaneous reprogramming, mode switching or other EMI effects. In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1980 PFA applications. There was no change in device settings, functionality and electrical parameters, and there was no macroscopic damage to the devices. The risk of damage to the electric components or leads on a patient-based analysis is 0/44 (95% CI 0-8%) and on a PFA pulse-based analysis is 0/1980 (95% CI 0-0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition but not tachycardia detection. Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In vivo studies are needed to confirm our findings.

Reduction of relative intensity noise in a diamond Raman laser

The relative intensity noise (RIN) characteristics of a continuous-wave diamond Raman laser are investigated for the first time. The results reveal the parasitic stimulated Brillouin scattering (SBS) that usually occurred with higher-order spatial modes in the diamond Raman resonator is a pivotal factor impacting the Raman longitudinal modes and deteriorating the RIN level. The diamond Raman laser automatically switches to single-longitudinal-mode operation and the RIN level is significantly decreased in the frequency range of 200 Hz to 1 MHz after the parasitic SBS is effectively suppressed through inserting a spatial aperture or a χ(2) nonlinear crystal into the cavity. Due to the introduction of additional nonlinear loss to the high intensity Raman fluctuations and the non-lasing spontaneous Raman modes, the χ(2) nonlinear crystal enables better performance in the RIN-level reduction compared to the spatial aperture which can only achieve SBS inhibition. The RIN reduction routes are well suited for various crystalline Raman media to achieve high power and low intensity noise laser at different wavelengths.

Asymmetric nucleation processes in spontaneous mode switch of active matter

Flocking and vortical are two typical motion modes in active matter. Although it is known that the two modes can spontaneously switch between each other in a finite-size system, the switching dynamics remain elusive. In this work, by computer simulation of a two-dimensional Vicsek-like system with 1000 particles, we find from the perspective of the classical nucleation theory that the forward and backward switching dynamics are asymmetric: going from flocking to vortical is a one-step nucleation process, while the opposite is a two-step nucleation process, with the system staying in a metastable state before reaching the final flocking state.

Estimating patient spontaneous breathing effort in mechanical ventilation using a b-splines function approach

Background:Patient work of breathing is a key clinical metric strongly to guide patient care and weaning from mechanical ventilation (MV). Measurement requires added equipment, well-trained clinicians, or/and extra interventions. This study combines a spontaneous breathing effort model using b-spline functions with a nonlinear, predictive MV digital-twin model to monitor patient effort in real-time. Methods:Data from 22 patients for two assisted spontaneous breathing MV modes, NAVA (neurally adjusted ventilatory assist) and PSV (pressure support ventilation), are employed. The patient effort function estimates a pleural pressure Pˆp surrogate of muscular work of breathing induced pressure. To ensure identifiability Pˆp is identified with a negative constraint level of 75%. Estimated patient effort is compared to electrical activity of the diaphragm (EAdi) signals from the NAVA naso-gastric tude, airway pressure, and tidal volume (VT) as well as physiological and clinical expectations. Results:Pˆp generalizes well across the digital twin model and MV modes in comparison to the original single compartment lung model. Strong neuro-muscular correlations are identified with Pˆp compared to EAdi, VT, and airway pressure in NAVA. They are lower in PSV, as expected, as pressure delivery is not a function of EAdi in this MV mode, while the uncontrolled variable VT shows a stronger association with Pˆp than EAdi. Conclusion:The digital twin model relates patient-specific induced breathing effort, modeled as Pˆp, as well as or better than EAdi in both assisted breathing MV modes. Results differ between NAVA and PSV modes due to the poorer patient–ventilator interaction typical in PSV. The ability to estimate patient work of breathing allows non-invasive, real-time quantification of ventilator unloading, heretofore not possible without extra sensors or maneuvers, to help guide weaning or changes in MV settings for assisted spontaneous breathing (ASB) MV modes.

Coherent Phase Change in Interstitial Solutions: A Hierarchy of Instabilities.

Metal hydrides or lithium ion battery electrodes can take the form of interstitial solid solutions with a miscibility gap. This work discusses theory approaches for locating, in temperature-composition space, coherent phase transformations during the charging/discharging of such systems and for identifying the associated transformation mechanisms. The focus is on the simplest scenario, where instabilities derive from the thermodynamics of the bulk phase alone, considering strain energy as the foremost consequence of coherency and admitting for stress relaxation at free surfaces. The extension of the approach to include capillarity is demonstrated by an example. The analysis rests on constrained equilibrium phase diagrams that are informed by geometry- and dimensionality-specific mechanical boundary conditions and on elastic instabilities-again geometry-specific-as implied by the theory of open-system elasticity. It is demonstrated that some scenarios afford the analysis of chemical stability to be based entirely on a linear stability analysis of the mechanical equilibrium, which provides closed-form solutions in a straightforward manner. Attention is on the impact of the system geometry (infinitely extended or of finite size) and on the chemical (closed or open system) and mechanical (incoherent or coherent) boundary conditions. Transformation mechanism maps are suggested for documenting the findings. The maps reveal a hierarchy of instabilities, which depend strongly on each of the above characteristics. Specifically, realistic, finite-sized systems differ qualitatively from idealized systems of infinite extension. Among the transformation mechanisms exposed by the analysis are a uniform switchover to the other phase when the open system reaches its chemical spinodal, practical coherent nucleation, as well as chemo-elastically coupled spontaneous buckling modes, which may take the form of either, single-phase or dual-phasestates.

Rapid Design of an ICU Ventilator: An Approach Based on Smart Switching of Compressed Air-Oxygen.

Breathing support is provided by regulating volume or pressure of lungs using ventilators. Due to COVID-19 pandemic, there was a sudden shortage of resuscitating devices such as ventilators. Additionally, ventilators being one of the primary critical care devices are also very costly. In order to address this situation, a number of low-cost designs have been proposed, however, many of these lack either an efficient control system or a hardware comparable to a standard ICU ventilator. In this regard, this article presents a comprehensive cost-effective solution that covers all aspects of the ventilator design (named as NED-Vent) such as hardware/pneumatic assembly, electronic design, user interface and control system. The proposed design works on compressed air-oxygen switching via proportional valves to produce basic volume and pressure modes as well as their derivatives such as assist ventilation, intermittent ventilation and spontaneous modes. The NED-Vent also features an interactive single-knob-single-touch user interface along with an automated mechanism for adjusting air-oxygen ratio in breathing gas mixture as an improvement on existing designs. The pressure regulated control is based on two mathematical models of human lungs with dynamic lung parameters estimated using machine learning approach. Additionally, the controller is tuned to optimized stability using Jury's Test and Ziegler-Nichols methods. The obtained results of breath profile are validated for the employed mathematical models (SLSC & SLMC) as well as the tuning methods in compliance with the tolerances provided by international standards.

Farmland Transfer Mode and Livelihood Capital Endowment Impacts on Income Inequality: Rural Survey Data of Hubei Province, China

Studying the impact of different farmland transfer modes on farmers’ income inequality can help understand the reasons for the income gap between farmers. Based on this, we use field survey data and OLS regression, quantile idea and Shapley decomposition to analyse the impact of farmland transfer on farmers’ income inequality. The results show that the influence of farmers’ spontaneous mode on the increase in farmers’ income is better than that of the market-led mode and government-led mode. The market-led and government-led transfer modes also significantly enhance the positive impact of livelihood capital on farmers’ income. The higher the level of natural, material, labour and social capital of farmers, the more favourable the effect on income, while the financial capital is more beneficial to high-income farmers. As for the restraining effect of the transfer modes on the income gap, the farmers’ spontaneous mode is the best, the government-led mode is the second, and the market-led mode is the worst. Further research shows that the transfer mode greatly impacts the income inequality of middle-income and low-income farmers. There are significant differences in the effects of livelihood capital on farmers’ income inequality in different transfer modes. Therefore, on the premise of following farmers’ willingness, the government should play a leading role in further standardizing the farmland transfer market and improving the household income of low-income and middle-income farmers.

Creativity and consciousness in motion: The roundtrip of "mindful" and "mindless" processes in embodied creativity.

In this opinion paper, we make a journey across different accounts of creativity that emphasize either the mindful, conscious and cognitive expression of creativity, or its mindless, unconscious and sensorimotor expression. We try to go beyond dichotomy, putting creativity in motion and outlining its embodied and enactive features. Based on the assumption that no creative act is purely conscious or purely unconscious, our discussion on creativity relies on the distinction of three types of creativity that complementarily contribute to the creative process through shifts in the activation of their substrates in the brain: the deliberate, spontaneous and flow types of creativity. The latter is a hybrid and embodied type, in which movement and physical activity meet creativity. We then focus on the most fascinating contribution of unconscious processes and mind wandering to spontaneous and flow modes of creativity, exploring what happens when the individual apparently takes a break from a deliberate and effortful search for solutions and the creative process progresses through an incubation phase. This phase and the overall creative process can be facilitated by physical activity which, depending on its features and context, can disengage the cognitive control network and free the mind from filters that constrain cognitive processes or, conversely, can engage attentional control on sensorimotor and cognitive task components in a mindful way. Lastly, we focus on the unique features of the outer natural environment of physical activity and of the inner environment during mindful movements that can restore capacities and boost creativity.

A Numerical Study on the Ignition and Flame Propagation for Locally Stratified Methanol/n-Heptane Dual-Fuel Mixtures

ABSTRACT Flame propagation under thermal and compositional stratifications is relevant to a wide range of applications in combustion devices. In this work, numerical studies are conducted to investigate the multi-stage ignition process and flame propagation in the stratified methanol/n-heptane-air dual-fuel mixture under engine-like conditions. Firstly, the effects of the initial gas temperature of the oxidizer (TOX) and fuel stream on the ignition process and combustion modes are investigated. The results show that TOX affects the early-stage ignition, and a fuel-rich stabilization mode is observed at low temperatures. For example, at 800 K, both cool and hot flames are initiated at the regions close to the most reactive mixture fraction, . A transition from the fuel-lean to fuel-rich and then back to the fuel-lean regions in the mixture fraction space is observed at higher temperatures. Then, hot flames propagate into the methanol/air premixture, forming quasi-steady hot-flame fronts in the fuel-rich regions at TOX = 800 and 900 K owing to the lack of oxygen and low adiabatic flame temperatures. At 1000 K, another flame front propagates into the n-heptane/air mixtures owing to enhanced reaction rate at higher local temperatures. By increasing TOX, a balance owing to the gas expansion is observed at 1020 K, and a spontaneous ignition mode appears at temperatures above 1050 K owing to the high reactivity and early ignition of the methanol/air premixture. Secondly, the effect of compositional stratification on the ignition and flame structures is investigated. Compared with the double flame structure under thermal and compositional stratification conditions, only a single flame structure is observed for those cases with uniform temperatures. A high temperature in the fuel stream region accelerates the decomposition of n-heptane, resulting in the complete consumption of oxygen.

Development of a non-invasive ventilator for emergency and beyond

The SARS-CoV-2 pandemic led to the development and implementation of emergency ventilators owing to the shortage of ventilators globally. Using invasive ventilators for patient intubation has medical experts concerned about increasing mortality. Early intervention with oxygen and respiratory therapy reduces the need for intubation, increases survival rates, and reduces the stress of critical care ventilators in hospitals. This study explores the capabilities of an easy-to-build and accessible non-invasive ventilator during an emergency and the practical implementation of the ventilator beyond the scope of the emergency. The proposed system consists of a high-pressure turbine integrated with a microcontroller and pressure and flow sensors assembled in a portable design. The non-invasive pressure support system is tested with a single-chamber high-precision lung simulator capable of simulating multiple lung diseases. The system is operated in a spontaneous pressure support mode as a Bi-level Ventilator for varying degrees of pressure level and lung conditions. The proposed study implements two most commonly adapted non-invasive patient circuits, i.e., single passive limb leak circuit and single limb active circuit. Both circuits are tested with and without leakage compensation. Two clinically accepted ventilation modes, i.e., pressure support and volume-assured pressure support ventilation, are presented. The results demonstrate the feasibility of using this type of device for non-invasive respiratory support and highlight the need for further testing to assess its safety and effectiveness in various clinical settings.

MECHANISMS OF NATURAL MITOCHONDRIAL TRANSFER IN HEALTH AND IN CANCER

This review discusses issues related to mitochondrial dynamics. It also highlights mechanisms allowing these organelles to transcend cell boundaries and transfer between mammalian cells. Mitochondria play a key role in energy generation and cellular physiological processes. These organelles are highly dynamic; they constantly change their morphology, cellular location, and distribution in response to cellular stress.&#x0D; In recent years, the phenomenon of mitochondrial transfer has attracted significant attention and interest from biologists and medical investigators. Intercellular mitochondrial transfer occurs in a different way, including tunneling nanotubes (TNTs), extracellular vesicles (EVS), and gap junction channels (GJCs). According to research on intercellular mitochondrial transfer in physiological and pathological environments, mitochondrial transfer has great potential for maintaining body homeostasis and regulating pathological processes. Recent evidence also suggests, that cell-free mitochondria release into blood under normal and pathological conditions (stress, trauma). They were found as circulating extracellular mitochondria in blood samples from mica and humans. Multiple research groups have developed artificial mitochondrial transfer/transplantation (AMT/T) methods that transfer healthy mitochondria into damaged cells and recover cellular function. This paper reviews intercellular spontaneous mitochondrial transfer modes, mechanisms, and the latest methods of AMT/T. Furthermore, potential application value and mechanism of AMT/T in disease treatment (including malignant neoplasms) are also discussed.

Effects of three spontaneous ventilation modes on respiratory drive and muscle effort in COVID-19 pneumonia patients

BackgroundHigh drive and high effort during spontaneous breathing can generate patient self-inflicted lung injury (P-SILI) due to uncontrolled high transpulmonary and transvascular pressures, with deterioration of respiratory failure. P-SILI has been demonstrated in experimental studies and supported in recent computational models. Different treatment strategies have been proposed according to the phenotype of elastance of the respiratory system (Ers) for patients with COVID-19. This study aimed to investigate the effect of three spontaneous ventilation modes on respiratory drive and muscle effort in clinical practice and their relationship with different phenotypes. This was achieved by obtaining the following respiratory signals: airway pressure (Paw), flow (V´) and volume (V) and calculating muscle pressure (Pmus).MethodsA physiologic observational study of a series of cases in a university medical-surgical ICU involving 11 mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing was conducted. Three spontaneous ventilation modes were evaluated in each of the patients: pressure support ventilation (PSV), airway pressure release ventilation (APRV), and BiLevel positive airway pressure ventilation (BIPAP). Pmus was calculated through the equation of motion. For this purpose, we acquired the signals of Paw, V´ and V directly from the data transmission protocol of the ventilator (Dräger). The main physiological measurements were calculation of the respiratory drive (P0.1), muscle effort through the ΔPmus, pressure‒time product (PTP/min) and work of breathing of the patient in joules multiplied by respiratory frequency (WOBp, J/min).ResultsTen mechanically ventilated patients with COVID-19 pneumonia at the initiation of spontaneous breathing were evaluated. Our results showed similar high drive and muscle effort in each of the spontaneous ventilatory modes tested, without significant differences between them: median (IQR): P0.1 6.28 (4.92–7.44) cm H2O, ∆Pmus 13.48 (11.09–17.81) cm H2O, PTP 166.29 (124.02–253.33) cm H2O*sec/min, and WOBp 12.76 (7.46–18.04) J/min. High drive and effort were found in patients even with low Ers. There was a significant relationship between respiratory drive and WOBp and Ers, though the coefficient of variation widely varied.ConclusionsIn our study, none of the spontaneous ventilatory methods tested succeeded in reducing high respiratory drive or muscle effort, regardless of the Ers, with subsequent risk of P-SILI.

Estimation of transpulmonary driving pressure during synchronized mechanical ventilation using a single lower assist maneuver (LAM) in rabbits: a comparison to measurements made with an esophageal balloon

BackgroundMechanical ventilation is applied to unload the respiratory muscles, but knowledge about transpulmonary driving pressure (ΔPL) is important to minimize lung injury. We propose a method to estimate ΔPL during neurally synchronized assisted ventilation, with a simple intervention of lowering the assist for one breath (“lower assist maneuver”, LAM).MethodsIn 24 rabbits breathing spontaneously with imposed loads, titrations of increasing assist were performed, with two neurally synchronized modes: neurally adjusted ventilatory assist (NAVA) and neurally triggered pressure support (NPS). Two single LAM breaths (not sequentially, but independently) were performed at each level of assist by acutely setting the assist to zero cm H2O (NPS) or NAVA level 0 cm H2O/uV (NAVA) for one breath. NPS and NAVA titrations were followed by titrations in controlled-modes (volume control, VC and pressure control, PC), under neuro-muscular blockade. Breaths from the NAVA/NPS titrations were matched (for flow and volume) to VC or PC. Throughout all runs, we measured diaphragm electrical activity (Edi) and esophageal pressure (PES). We measured ΔPL during the spontaneous modes (PL_PES) and controlled mechanical ventilation (CMV) modes (PL_CMV) with the esophageal balloon. From the LAMs, we derived an estimation of ΔPL (“PL_LAM”) using a correction factor (ratio of volume during the LAM and volume during assist) and compared it to measured ΔPL during passive (VC or PC) and spontaneous breathing (NAVA or NPS). A requirement for the LAM was similar Edi to the assisted breath.ResultsAll animals successfully underwent titrations and LAMs for NPS/NAVA. One thousand seven-hundred ninety-two (1792) breaths were matched to passive ventilation titrations (matched Vt, r = 0.99). PL_LAM demonstrated strong correlation with PL_CMV (r = 0.83), and PL_PES (r = 0.77). Bland–Altman analysis revealed little difference between the predicted PL_LAM and measured PL_CMV (Bias = 0.49 cm H2O and 1.96SD = 3.09 cm H2O). For PL_PES, the bias was 2.2 cm H2O and 1.96SD was 3.4 cm H2O. Analysis of Edi and PES at peak Edi showed progressively increasing uncoupling with increasing assist.ConclusionDuring synchronized mechanical ventilation, a LAM breath allows for estimations of transpulmonary driving pressure, without measuring PES, and follows a mathematical transfer function to describe respiratory muscle unloading during synchronized assist.