The mechanism underlying the association between elevated red cell distribution width (RDW) and poor prognosis in variety of diseases is unknown although many researchers consider RDW a marker of inflammation. We hypothesized that RDW directly affects intravascular hemodynamics, interactions between circulating cells and vessel wall, inducing local changes predisposing to atherothrombosis. We applied different human and animal models to verify our hypothesis. Carotid plaques harvested from patients with high RDW had increased expression of genes and proteins associated with accelerated atherosclerosis as compared to subjects with low RDW. In microfluidic channels samples of blood from high RDW subjects showed flow pattern facilitating direct interaction with vessel wall. Flow pattern was also dependent on RDW value in mouse carotid arteries analyzed with Magnetic Resonance Imaging. In different mouse models of elevated RDW accelerated development of atherosclerotic lesions in aortas was observed. Therefore, comprehensive biological, fluid physics and optics studies showed that variation of red blood cells size measured by RDW results in increased interactions between vascular wall and circulating morphotic elements which contribute to vascular pathology.

Background: This study performs an exploratory analysis of current-future sustainability challenges for ocean planning for the regional seas of Catalonia located in the Western Mediterranean (Spain). Methods: To address the challenges we develop an Maritime Spatial Planning (MSP)-oriented geodatabase of maritime activities and deploy three spatial models: 1) an analysis of regional contribution to the 30% protection commitment with Biodiversity Strategy 2030; 2) a spatial Maritime Use Conflict (MUC) analysis to address current and future maritime activities interactions and 3) the StressorGenerator QGIS application to locate current and anticipate future sea areas of highest anthropogenic stress. Results & Conclusions: Results show that the i) study area is one of the most protected sea areas in the Mediterranean (44–51% of sea space protected); ii) anthropogenic stressors are highest in 1–4 nautical miles coastal areas, where maritime activities agglomerate, in the Gulf of Roses and Gulf of Saint Jordi. iii) According to the available datasets commercial fishery is causing highest conflict score inside protected areas. Potential new aquaculture sites are causing highest conflict in Internal Waters and the high potential areas for energy cause comparably low to negligible spatial conflicts with other uses. We discuss the added value of performing regional MSP exercises and define five challenges for regional ocean sustainability, namely: Marine protection beyond percentage, offshore wind energy: a new space demand, crowded coastal areas, multi-level governance of the regional sea and MSP knowledge gaps.

We study the interaction-induced migration of bubbles in shear flow and observe that bubbles suspended in elastoviscoplastic emulsions organize into chains aligned in the flow direction, similarly to particles in viscoelastic fluids. To investigate the driving mechanism, we perform experiments and simulations on bubble pairs, using suspending fluids with different rheological properties. First, we notice that, for all fluids, the interaction type depends on the relative position of the bubbles. If they are aligned in the vorticity direction, then they repel, if not, then they attract each other. The simulations show a similar behavior in Newtonian fluids as in viscoelastic and elastoviscoplastic fluids, as long as the capillary number is sufficiently large. This shows that the interaction-related migration of the bubbles is strongly affected by the bubble deformation. We suggest that the cause of migration is the interaction between the heterogeneous pressure fields around the deformed bubbles, due to capillary pressure.

Purpose: The purpose of this study is to assess the importance of non-Newtonian rheological models on blood flow in the human thoracic aorta. Methods: The pulsatile flow in the aorta is simulated using the models of Casson, Quemada and Walburn-Schneck in addition to a case of fixed (Newtonian) viscosity. The impact of the four rheological models (using constant hematocrit) was assessed with respect to (i) magnitude and deviation of the viscosity relative to a reference value (the Newtonian case); (ii) wall shear stress (WSS) and its time derivative; (iii) common WSS-related indicators, OSI, TAWSS and RRT; (iv) relative volume and surface-based retrograde flow; and (v) the impact of rheological models on the transport of small particles in the thoracic aorta. Results: The time-dependent flow in the thoracic aorta implies relatively large variations in the instantaneous WSS, due to variations in the instantaneous viscosity by as much as an order of magnitude. The largest effect was observed for low shear rates (tens s-1). The different viscosity models had a small impact in terms of time- and spaced-averaged quantities. The significance of the rheological models was clearly demonstrated in the instantaneous WSS, for the space-averaged WSS (about 10%) and the corresponding temporal derivative of WSS (up to 20%). The longer-term accumulated effect of the rheological model was observed for the transport of spherical particles of 2 mm and 2 mm in diameter (density of 1200 kg/m3). Large particles' total residence time in the brachiocephalic artery was 60% longer compared to the smaller particles. For the left common carotid artery, the opposite was observed: the smaller particles resided considerably longer than their larger counterparts. Conclusions: The dependence on the non-Newtonian properties of blood is mostly important at low shear regions (near walls, stagnation regions). Time- and space-averaging parameters of interest reduce the impact of the rheological model and may thereby lead to under-estimation of viscous effects. The rheological model affects the local WSS and its temporal derivative. In addition, the transport of small particles includes the accumulated effect of the blood rheological model as the several forces (e.g., drag, added mass and lift) acting on the particles are viscosity dependent. Mass transport is an essential factor for the development of pathologies in the arterial wall, implying that rheological models are important for assessing such risks.

The aim of this paper is to assess the association between valve morphology and vortical structures quantitatively and to highlight the influence of valve morphology/orientation on aorta’s susceptibility to shear stress, both proximal and distal. Four-dimensional phase-contrast magnetic resonance imaging (4D PCMRI) data of 6 subjects, 3 with tricuspid aortic valve (TAV) and 3 with functionally bicuspid aortic values (BAV) with right-left coronary leaflet fusion, were processed and analyzed for vorticity and wall shear stress trends. Computational fluid dynamics (CFD) has been used with moving TAV and BAV valve designs in patient-specific aortae to compare with in vivo shear stress data. Vorticity from 4D PCMRI data about the aortic centerline demonstrated that TAVs had a higher number of vortical flow structures than BAVs at peak systole. Coalescing of flow structures was shown to be possible in the arch region of all subjects. Wall shear stress (WSS) distribution from CFD results at the aortic root is predominantly symmetric for TAVs but highly asymmetric for BAVs with the region opposite the raphe (fusion location of underdeveloped leaflets) being subjected to higher WSS. Asymmetry in the size and number of leaflets in BAVs and TAVs significantly influence vortical structures and WSS in the proximal aorta for all valve types and distal aorta for certain valve orientations of BAV. Graphical Abstract: Analysis of vortical structures using 4D PCMRI data (on the left side) and wall shear stress data using CFD (on the right side). [Figure not available: see fulltext.].

A global transient linear stability analysis of the three-dimensional time-dependent flow around an aerofoil undergoing small-amplitude pitching motion is performed using the optimally time-dependent (OTD) framework. The most salient linear instabilities associated with the instantaneous basic state are computed and tracked over time. The resulting OTD modes reflect the variations in the basic state and can be used as predictors of its spatial and temporal evolution, including the formation of a laminar separation bubble and its gradual spanwise modulation via primary global instability, leading to secondary instability and finally rapid breakdown to turbulence. The study confirms and expands upon earlier stability analyses of the same case based on the local properties of spanwise averaged velocity profiles in the bubble that predicted the onset of absolute instability soon followed by rapid breakdown of the separation bubble. The three-dimensional structure of the most unstable OTD mode is extracted, which compares well with both the locally absolutely unstable mode and the evolution of the basic state itself.

Sound generation in human phonation and the underlying fluid–structure–acoustic interaction that describes the sound production mechanism are not fully understood. A previous experimental study, with a silicone made vocal fold model connected to a straight vocal tract pipe of fixed length, showed that vibroacoustic coupling can cause a deviation in the vocal fold vibration frequency. This occurred when the fundamental frequency of the vocal fold motion was close to the lowest acoustic resonance frequency of the pipe. What is not fully understood is how the vibroacoustic coupling is influenced by a varying vocal tract length. Presuming that this effect is a pure coupling of the acoustical effects, a numerical simulation model is established based on the computation of the mechanical-acoustic eigenvalue. With varying pipe lengths, the lowest acoustic resonance frequency was adjusted in the experiments and so in the simulation setup. In doing so, the evolution of the vocal folds’ coupled eigenvalues and eigenmodes is investigated, which confirms the experimental findings. Finally, it was shown that for normal phonation conditions, the mechanical mode is the most efficient vibration pattern whenever the acoustic resonance of the pipe (lowest formant) is far away from the vocal folds’ vibration frequency. Whenever the lowest formant is slightly lower than the mechanical vocal fold eigenfrequency, the coupled vocal fold motion pattern at the formant frequency dominates.

The behaviour of collapsed or stenotic vessels in the human body can be studied by means of simplified geometries like a collapsible tube. The objective of this work is to determine the value of the buckling critical pressure of a collapsible tube by employing Landau’s theory of phase transition. The methodology is based on the implementation of an experimentally validated 3D numerical model of a collapsible tube. The buckling critical pressure is estimated for different values of geometric parameters of the system by treating the relation between the intramural pressure and the area of the central cross-section as the order parameter function of the system. The results show the dependence of the buckling critical pressures on the geometric parameters of a collapsible tube. General non-dimensional equations for the buckling critical pressures are derived. The advantage of this method is that it does not require any geometric assumption, but it is solely based on the observation that the buckling of a collapsible tube can be treated as a second-order phase transition. The investigated geometric and elastic parameters are sensible for biomedical application, with particular interest to the study of the bronchial tree under pathophysiological conditions like asthma.

This Special Issue comprises original research and reviews articles in the research area of computational biofluid dynamics, fluid–structure interaction, and acoustic phenomena of relevance to confined, unsteady, transitional, or turbulent fluid flow scenarios in the human body. The selected papers in this issue represent several trends in biofluid mechanics. The scope of the papers ranges from extending numerical methodology for handling the interaction between the flow and the vessel (fluid–structure interactions, FSI) to using computational tools to guide intervention in clinical situations.

In the optic of a more sustainable society, research and development of highly efficient fluid machines represent a fundamental process to satisfy the rapidly growing energy needs of the modern world. Radial turbines are characterized by higher efficiencies for a larger range of inflow conditions compared to axial turbines. Due to this favorable characteristic, they find their natural application in turbocharger systems, where the flow is inherently unsteady due to the engine reciprocating. In a turbocharged engine, to exploit the residual energy contained in the exhaust gases, the radial turbine is fed by the exhaust gases from the cylinders of the engine. The particular inflow conditions to which a turbocharger turbine is exposed, i.e. pulsating flow and high gas temperatures, make the turbocharger turbine a unique example in the turbomachinery field. Indeed, pulsating flow causes performance deviations from quasi-steady to pulsating flow conditions, while heat transfer deteriorates the turbine performance. Modeling correctly these phenomena is essential to enhance turbocharger-engine matching. The problem is further complicated since, due to the geometrical diversity of the different parts of the system, each component represents a stand-alone problem both in terms of flow characteristics and design optimization. In this thesis, high-fidelity numerical simulations are used to characterize the performance of a single-entry radial turbine applied in a commercial 4-cylinder engine for a passenger car under engine-like conditions. By treating the hot-side system as a stand-alone device, parametrization of the pulse shape imposed as inlet boundary conditions has let to highlight specific trends of the system response to pulse amplitude and frequency variations. Reduced-order models to predict the deviations of the turbine performance from quasi-steady to pulsating flow conditions are developed. At first, a simple algebraic model demonstrates the proportionality between the intensity of the deviations and the normalized reduced frequency. Then, a neural network model is demonstrated to accurately predict the unsteady turbine performance given a limited number of training data. Lastly, a gradient-based optimization method is developed to identify the optimum working conditions, in terms of pulse shape, to maximize the power output of the turbine. High-fidelity LES simulations are used to improve the understanding of flow physics. The flow at the rotor blade experiences different characteristics between continuous and pulsating flow conditions. In particular, large separations and secondary flows develop on both the pressure and suction sides of the blade as a consequence of the large range of relative inflow angles the blade is exposed to. Such secondary flows are addressed as the main cause of the drop of the isentropic efficiency from continuous to pulsating flow conditions.

Venovenous extracorporeal membrane oxygenation (ECMO) can be performed with two single lumen cannulas (SLCs) or one dual-lumen cannula (DLC) where low recirculation fraction (Rf) is a key performance criterion. DLCs are widely believed to have lower Rf , though these have not been directly compared. Similarly, correct positioning is considered critical although its impact is unclear. We aimed to compare two common bi-caval DLC designs and quantify R f in several positions. Two different commercially available DLCs were sectioned, measured, reconstructed, scaled to 27Fr and simulated in our previously published patient-averaged computational model of the right atrium (RA) and venae cavae at 2–6 L/min. One DLC was then used to simulate ± 30° and ± 60° rotation and ± 4 cm insertion depth. Both designs had low Rf (< 7%) and similar SVC/IVC drainage fractions and pressure drops. Both cannula reinfusion ports created a high-velocity jet and high shear stresses in the cannula (> 413 Pa) and RA (> 52 Pa) even at low flow rates. Caval pressures were abnormally high (16.2–23.9 mmHg) at low flow rates. Rotation did not significantly impact Rf . Short insertion depth increased Rf (> 31%) for all flow rates whilst long insertion only increased Rf at 6 L/min (24%). Our results show that DLCs have lower Rf compared to SLCs at moderate-high flow rates (> 4 L/min), but high shear stresses. Obstruction from DLCs increases caval pressures at low flow rates, a potential reason for increased intracranial hemorrhages. Cannula rotation does not impact Rf though correct insertion depth is critical.

Background: : Increasingly, computational fluid dynamics (CFD) is helping explore the impact of variables like: cannula design/size/position/flow rate and patient physiology on venovenous (VV) extracorporeal membrane oxygenation (ECMO). Here we use a CFD model to determine what role cardiac output (CO) plays and to analyse return cannula dynamics. Methods: : Using a patient-averaged model of the right atrium and venae cava, we virtually inserted a 19Fr return cannula and a 25Fr drainage cannula. Running large eddy simulations, we assessed cardiac output at: 3.5–6.5 L/min and ECMO flow rate at: 2–6 L/min. We analysed recirculation fraction (Rf), time-averaged wall shear stress (TAWSS), pressure, velocity, and turbulent kinetic energy (TKE) and extracorporeal flow fraction (EFF = ECMO flow rate/CO). Results: : Increased ECMO flow rate and decreased CO (high EFF) led to increased Rf (R = 0.98, log fit). Negative pressures developed in the venae cavae at low CO and high ECMO flow (high CR). Mean return cannula TAWSS was >10 Pa for all ECMO flow rates, with majority of the flow exiting the tip (94.0–95.8 %). Conclusions: : Our results underpin the strong impact of CO on VV ECMO. A simple metric like EFF, once supported by clinical data, might help predict Rf for a patient at a given ECMO flow rate. The return cannula imparts high shear stresses on the blood, largely a result of the internal diameter.

Introduction: Extracorporeal membrane oxygenation is a lifesaving treatment for patients with refractory acute respiratory, circulatory, or combined cardiopulmonary failure. The patient is cannulated with one or two cannulae for drainage and reinfusion of blood. Blood is drained from the patient, pumped through a membrane lung for oxygenation and then returned back to the patient.Efficacy of the treatment depends on correct cannula positioning and interactions between drainage and reinfusion cannula.Methods: An experimental setup was built to study the isolated drainage performance of a 24 Fr rigid model of a blunt and lighthouse tip cannula both when centered and when tilted towards the vessel wall. Particle image velocimetry was used to investigate the flow field with water as the fluid medium.Results: The blunt tip cannula induced higher levels of shear stresses for similar flow configuration, when compared to the lighthouse design. Moreover, in the lighthouse design, side-holes furthest from the tip (proximal holes) drained the highest fraction of the total  flow. Results did not change significantly when the cannula was tilted towards the vessel wall.

Extracorporeal life support (ECLS) includes life-saving support in severe acute cardiac and/or pulmonary failure. In the past 20 years, centrifugal pumps have become the primary choice to deliver the required blood flow. Pumps of various designs, with different approved operating ranges, are today available to clinicians. The use of centrifugal pumps in the low flow condition has been shown to increase hemolytic and thrombogenic risks of the treatment. Further, low flow operation has been associated with retrograde flow at the pump inlet. In this study, experimental and numerical methods have been applied to investigate the operating conditions and fluid dynamical mechanisms leading to reverse flow (or backflow) at the inlet. Reverse flow was predominantly observed in pumps having a top shroud covering the impeller blades, showing a relation between pump geometry and backflow. The shroud divides the pump volume above the impeller into two regions, separating the swirling reverse flow migrating toward the upper pump volute from the main flow, reducing the dissipation of the vortical structures, and allowing the swirling reverse flow to reach further in the pump inlet. At the inlet, backflow was observed as stable recirculation areas at the side of the pump inlet.