Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects

BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIM To evaluate the cross-sectional area(CSA) of the median nerve using B-mode ultrasonography(USS) and the presence of peripheral neuropathy(PN) in a cohort of adult diabetic Nigerians.METHODS Demographic and anthropometric data of 85 adult diabetes mellitus(DM) and 85 age-and sex-matched apparently healthy control(HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument(MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile(FLP), fasting blood glucose(FBG) and glycated haemoglobin(HbA1 c) while their MN CSA was evaluated at a point 5 cm proximal to(5 cmCATL) and at the carpal tunnel(CATL) by high-resolution Bmode USS. Data was analysed using SPSS version 22.RESULTS The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5 cmCATL(P < 0.01) and at the CATL(P < 0.01) on both sides. The presence of diabetic peripheral neuropathy(DPN) further increased the MN CSA at the CATL(P < 0.05) but not at 5 cmCATL(P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSION Thickening of the MN CSA at 5 cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at5 cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Food sources of the Manila clam Ruditapes philippinarum in intertidal areas:evidence from stable isotope analysis

Based on stable isotope analysis, we characterized the dietary regime of the Manila clam Ruditapesphilippinarum inhabiting intertidal areas along the Liaodong Peninsula, Northern China. Samples, including particulate organic matter （POM; n=30）, benthic microalgae （BMI; n=30） and R. philippinarum （n=60）, were collected from six sampling sites displaying the same ecological conditions. Of the two primary food sources, POM was more depleted in δ13C （-20.61‰ to -22.89%0） than BMI was （-13.90‰ to -16.66‰）. With respect to 15N, BMI was more enriched （2.90%0 to 4.07%0） than POM was （4.13‰ to 5.12‰）. The δ13C values of R. philippinarum ranged from -18.78‰ to -19.35‰ and the δ15N values from 7.96%0 to 8.63‰, which were intermediate between the POM and BMI values. In a two-source isotope mixing model, we estimated the relative contributions of POM and BMI to the diet ofR. philippinarum to be 74.2% and 25.8%, respectively. We conclude that R. philippinarum feeds mainly on POM, and BMI is also an important supplemental food source in intertidal areas.

Ultrasonographic measurement of median nerve cross-sectional area reference values in a healthy Han population from Guiyang,China

High-resolution ultrasonography was used to analyze the nerve cross-sectional area （CSA） of the median nerve at 7 sites： the wrist crease, pisiform bone, hamate bone, 6 cm proximal to the tip of the wrist crease, proximal forearm （where the nerve enters the pronator teres muscle）, 4 cm proximal to the tip of the medial epicondyle, and mid-humerus （mid-point between elbow crease and axilla） in 200 healthy volunteers from Guiyang, China. Results showed similar CSA values between the left and right sides, but the CSA 6 cm proximal to the tip of the wrist crease, proximal forearm, 4 cm proximal to tip of the medial epicondyle, and mid-humerus in males was greater than that of females. Moreover, CSA values at the wrist crease, pisiform bone, and hamate bone were greater in the middle-aged and old groups when compared to the young group, and correlated with body mass and height. Thus, reference values of median nerve CSA of the upper limbs can facilitate the analysis of abnormal nerve conditions.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

Stable carbon isotopic composition of soil organic matter in the karst areas of Southwest China

This study dealt with the distribution characteristics of soil organic carbon (SOC) and the variation of stable carbon isotopic composition (δ13C values) with depth in six soil profiles, including two soil types and three vegetation forms in the karst areas of Southwest China. The δ13C values of plant-dominant species, leaf litter and soils were measured using the sealed-tube high-temperature combustion method. Soil organic carbon contents of the limestone soil profiles are all above 11.4 g/kg, with the highest value of 71.1 g/kg in the surface soil. However, the contents vary between 2.9 g/kg and 46.0 g/kg in three yellow soil profiles. The difference between the maximum and minimum δ13C values of soil organic matter (SOM) changes from 2.2‰ to 2.9‰ for the three yellow soil profiles. But it changes from 0.8‰ to 1.6‰ for the limestone soil profiles. The contrast research indicated that there existed significant difference in vertical patterns of organic carbon and δ13C values of SOM between yellow soil and limestone soil. This difference may reflect site-specific factors, such as soil type, vegetation form, soil pH value, and clay content, etc., which control the contents of different organic components comprising SOM and soil carbon turnover rates in the profiles. The vertical variation patterns of stable carbon isotope in SOM have a distinct regional character in the karst areas.

Climate Evolution Recorded by Organic Carbon Stable I sotope since 5 kaB.P.in Poyang Lake Area, China

Based on the data of organic carbon stable isotope ratios and magnet ic susceptibility, climate evolution in the past 5 kaB.P. in Poyang Lake plain (in Jiangxi Province) has been reconstructed. The results of the research indicate that the climate evolution can be divided into nine stages in the past 5 kaB.P.. Comparisons of different regional environmental records suggest that the intens ity and the temporal spatial changes of monsoon in China mainly controlled the climate evolution.

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis

BACKGROUND Acromioclavicular joint(ACJ)space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis(ACJO).However,the morphology of the ACJ space is irregular because of osteophyte formation,subchondral irregularity,capsular distention,sclerosis,and erosion.Therefore,we created the ACJ cross-sectional area(ACJCSA)as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance(S-MR)imaging that revealed no evidence of ACJO.Oblique coronal,T2-weighted,fat-suppressed SMR images were acquired at the ACJ level from the two groups.We measured the ACJCSA and the ACJ space width(ACJSW)at the ACJ on the S-MR images using our imaging analysis program.The ACJCSA was measured as the cross-sectional area of the ACJ.The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTS The average ACJCSA was 39.88±10.60 mm;in the normal group and 18.80±5.13 mm;in the ACJO group.The mean ACJSW was 3.51±0.58 mm in the normal group and 2.02±0.48 mm in the ACJO group.ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals.Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm^(2),with 91.4%sensitivity and 90.0%specificity.CONCLUSION The optimal ACJSW cutoff score was 2.37 mm,with 88.6%sensitivity and 96.7%specificity.Even though both the ACJCSA and ACJSW were significantly associated with ACJO,the ACJCSA was a more sensitive diagnostic image parameter.

Correlation between current and cross-sectional area of parallel fixed-movable dual electrodes in ESC

Electroslag casting with parallel fixed-movable dual electrodes is a new method for achieving better quality of castings in complex mold cavities.In this work,a mathematical model,y=kx^2+(k+1)x,was established to describe the ideal correlation between the current ratio(y)and the cross-sectional area ratio(x)of the dual electrodes,where k is the filling ratio.Investigation was conducted on the electroslag casting process with dual electrodes of various cross-sectional areas,but at a constant k value.The experimental results indicated that the ideal correlation was obtained at the stable casting stage,and the fitting results were consistent with the experimental results at certain k values.The experimental findings show that better castings can be obtained when the current ratio is greater than 1.536 and the cross-sectional area ratio is greater than 0.5.

Early Holocene climate signals from stable isotope composition of ice wedges in the Chara Basin,northern Transbaikalia,Russia

Stable isotope composition of syngenetic and epigenetic ice wedges, radiocarbon age, and pollen spectra of the surrounding deposits were studied during long term investigations at the "Belyi Klyuch" site on the first(6-8 m height) terrace of the Chara River(720 m.a.s.l.) in northern Transbaikalia to assess climatic conditions during ice-wedge formation. It was revealed that Holocene ice wedges had been formed from 10 to 7.5 ka 14 C BP. The isotope composition(δ^(18)O, δ~2 H) of relict ice wedges is the lightest and amounts-23‰ and-185‰, correspondingly. The isotopic compositions of ice lenses from sandy loam above ice wedges are-15.7‰, and-133‰; of small ice wedge in peat and sand are-15.3‰ and-117.9‰, accordingly.Interpretation of the ice wedge isotope composition has yielded that mean winter temperatures during cold stages of Holocene optimum were lower than today, during warm stages they were close to modern ones. During the coldest stages of Holocene optimum the total annual freezing index varied from-5100 to-5700 ℃ degree days, i.e. 300-600 ℃ degree days colder than during extremely severe modern winters. The total annual thawing index varied from 1300 to 1800 ℃ degree days, which was slightly higher than modern ones.

Exposed Cross-section of the Archaean Lower Crustin the Shanxi-Hebei-Inner Mongolia Border Region:Problems and Prospects

The Archaean lower crust represented by granulite facies rocks, which is rare in China, is found to be exposed in the Shanxi-Hebei-Inner Mongolia border region. Studies of the regional structure and deformation and metamorphism of the region indicate that there occurred at least two phases of deformation and metamorphism in the region. Early-phase nearly E-W-directed deformational structure is well preserved in the Zhangjiakou-Xuanhua area. Observations of the features of the geological structure from north to south (in the Hengshan metamorphic terrain) have revealed a possible exposed cross-section through the Archaean lower crust. The structure was superimposed by a NE-SW-trending high-temperature ductile shear zone in the Datong area in the late phase, thus reworking the Archaean sequence.

Insights into the long-term stability of landslide dams on the eastern margin of the Tibetan Plateau, China——A case study of the Diexi area

Landslide dams,especially long-term stable landslide dams,have been recognized as important contributors to regional geomorphological evolution.Here,the Diexi area,a long-term stable dam-prone area located in upstream of the Minjiang River on the eastern Tibetan Plateau,was adopted to reveal reasons that landslide dams are concentrated in this area and maintain long-term stability via detailed field investigations,landslide dam sampling,unmanned aerial vehicle(UAV)images,and digital surface models(DSM).The results show the controlling factors that the slopes are prone to sliding and rock mass structure deterioration including lithological combination mode,slope structure,topographic conditions,a series of NNE-trending radial fissures and hydrological conditions.Fault activities,which have caused many earthquakes,are the main inducing factor.Landslide dams are prone to occurrence in the Diexi area owing to the combined effect of the narrow channels,the large landslide dam volume and the rock fragments.The river flow,and the landslide dam volume,material,structure,and parameters control the stability of landslide dams.The landslide dam consists of various sizes of boulders and all landslide dams exhibit an obvious inverse grading sequence,and this size combination could consume most of the flow energy,and consequently protect the dam from incision.Additionally,a total of seven knickpoints were formed by landslide dams,and the longitudinal gradient upstream of every landslide dam was found to decrease by the action of knickpoint.In the eastern margin of the Tibetan Plateau,there are numerous landslide dams existed for hundreds or thousands of years.Studies on the long-term stable landslide dams in the Diexi area could provide experience for studying similar kinds of landslide dams in this region.

长庆气区关停气井挖潜措施技术与展望

长庆气区天然气资源丰富,天然气田均为低渗—致密气田,主要以致密气为主。随着气田开发深入,存在气区关停井、低产井“存量大、分布广、复产难”实际问题,为气区的长期效益稳产带来艰巨挑战。文章通过开展长庆气区关停井措施挖潜实践及应用评价,结合气井动静态特征,分析气井关停的形成原因及技术难点,优选挖潜措施类型,优化工艺参数,强化效果评价,初步形成了“储层挖潜、井筒治理、地面配套”三大评价挖潜措施工艺技术系列,实施挖潜井1497口,累计增气超50×10^(8) m^(3),成效显著。随着长庆气区天然气勘探开发不断推进,气藏“埋藏深、储层薄、单井产量低、水气比高”特点更加突出,还需进一步开展老层剩余储量挖潜、层间储量动用、井筒复杂处理、积液停产井快速复产及综合治理、地面工艺技术配套等技术攻关,以实现气田气井挖潜措施工艺关键技术的迭代升级,更好支撑长庆气区的稳产及长远发展目标。长庆气田老井措施挖潜及增产技术体系的建立,助力了长庆气区的增储上产,为长庆气区稳固国内战略大气区地位及长期发展提供了较好的参考及借鉴。

黄河南岸灌区玉米根系吸水来源研究

【目的】明晰玉米根系吸水来源。【方法】采用液态水稳定氢氧同位素技术,通过监测黄河南岸灌区上、中、下游灌域的分层土壤水和玉米根系土壤水中的氢氧稳定同位素组成,结合直观图法和MIXSIAR模型确定玉米根系吸水来源,分析各供给水源的贡献比例。【结果】拔节期玉米生长较快,需水量较大,灌区上、中、下游干旱程度不同,导致玉米根系主要吸水深度也不同。上游主要吸收0~20 cm土层的土壤水,其水源贡献率为38.1%,20~40cm土层贡献率为23.7%;中游主要吸收20~40 cm土层的土壤水,贡献率为43.6%,0~20 cm土层贡献率为27.4%;下游主要吸收20~40 cm土层的土壤水,贡献率为63%,0~20 cm土层贡献率为20%。【结论】干旱环境下玉米会改变根系吸水深度,整个生育期内玉米根系吸水深度由浅入深再变浅;且玉米对各潜在水源的利用比例与其根系吸水深度以及不同水源对土壤水的补给密切相关。

渭北黄土台塬区水库水下岸坡稳定形态预测模型研究

黄土地区水库塌岸预测仍以卡丘金法等经验图解法为主,此类方法预测结果的准确性取决于对岸坡剖面形态的准确描述。为了提高黄土地区水库塌岸宽度预测的准确性,选取渭北黄土台塬区选择典型水库进行现场调查,对原河道岸坡形态与蓄水后岸坡形态进行对比分析,在此基础上建立了水下岸坡形态预测模型。结果表明,渭北黄土台塬区水库岸坡塌岸稳定后,水上岸坡呈直立状,高度可达30 m以上,水下岸坡呈曲线形,受水深和岸坡高度共同影响,塌落物可能露出水面。在此基础上基于对数螺线方程建立了水下岸坡形态预测模型,并与经典图解法所用直线型岸坡进行对比,误差分析结果表明采用对数螺线方程进行水下岸坡形态预测时堆积体积误差为4.50%~39.70%,均值为12.64%,而直线型岸坡的预测误差为25.75%~124.69%,均值为75.69%。即采用对数螺线方程可以更好的测水下岸坡形态及水下堆积量。相关研究成果对黄土台塬区水库塌岸预测方法的改进,以及黄河流域的渭北黄土台塬区的环境保护与高质量发展具有实际意义。

促进农村低收入人口稳定增收机制优化:逻辑建构与实证分析

全面建设社会主义现代化国家,实现全体人民共同富裕,最艰巨最繁重的任务仍然在农村,最大的短板仍然是低收入人口。历史分析农村居民收入变化及低收入人口阶段性特征,基于村域视角,依据内源发展理论和可行能力理论,建构促进农村低收入人口稳定增收的“村域空间融合、经济要素整合和政策支持聚合”逻辑分析框架,选取江西农村980户低收入人口调查数据,实证分析促进农村低收入人口稳定增收的具体驱动因素、作用机制及异质性特征,并从注重区际联合和资源整合、推动经济要素高效配置和强化支持政策有效供给等方面给出优化策略。

宁夏干旱风沙区不同季节柠条锦鸡儿水分利用特征研究

柠条锦鸡儿是宁夏干旱风沙区生态重建的主要树种,为明确宁夏干旱风沙区不同季节柠条锦鸡儿在干旱严苛环境条件下的用水策略,该研究采用稳定同位素技术,通过测定柠条锦鸡儿可利用的水源和枝条木质部水分的同位素特征比率,应用IsoSource模型,从定性和定量角度出发,对比研究不同季节柠条锦鸡儿主要利用水分来源及各水源的贡献率,同时结合土壤水分的补给特征,综合分析柠条锦鸡儿应对干旱严苛环境的适应机制。结果表明:在0~60 cm土层,不同季节柠条锦鸡儿土壤含水量差异显著,雨季的土壤含水量均值为14.66%,而旱季的土壤含水量仅为9.69%。在80~200 cm土层,不同季节柠条锦鸡儿土壤含水量差异不显著。不同季节柠条锦鸡儿各水分来源贡献率均不同。在雨季,雨水的贡献率高达93.00%,而土壤水分贡献率仅为7.00%。在旱季,80~200 cm土层的土壤水,水分贡献率达到64.10%,0~60 cm土层土壤水分有部分利用。可见,一定降雨事件影响浅层土壤水分含量,对深层土壤水分影响不显著。不同季节柠条用水策略与各土层土壤含水量的高低有直接关系。雨季,柠条锦鸡儿利用雨水;旱季,柠条锦鸡儿主要利用深层土壤水分,对浅层水分也有一定利用。柠条锦鸡儿在不同季节能通过转化不同水源利用来应对干旱严苛的环境,从而维持自身生长。

全球典型热带雨林的微波散射特征建模与验证

使用大面积且均匀的自然目标进行微波散射计的定标检验,有助于客观评价微波遥感的观测精度。热带雨林具有相对稳定的植被覆盖条件,可减小地表异质性对仪器测量的影响,是微波仪器定标评价的常用目标。利用2019年1月1日—2021年12月31日Met Op-B(the second meteorological operational satellite)卫星ASCAT(advanced scatterometer)散射计的观测数据,提出平均值、标准差与相对标准差联合的雨林目标稳定区优选算法,确定亚马逊雨林、刚果雨林和东南亚雨林的稳定区域,对稳定区内目标的自身特性开展包括季节、入射角和方位角影响建模。建模时综合考虑模型误差和时序变化,将目标特性与仪器波动导致的后向散射系数变化分离。结果表明:亚马逊雨林和刚果雨林稳定区的白天数据具有较低的模型误差和波动较小的变化趋势,适用于多星散射计的定标稳定性检验。基于亚马逊雨林和刚果雨林稳定区的白天数据模型,对Met Op-C卫星的ASCAT观测数据进行定标稳定性检验和分析,检验结果表明:Met Op-C卫星ASCAT散射计的观测数据略有波动,但变化幅度小于0.05 d B,定标稳定性较好。

贺兰山东麓子产区马瑟兰葡萄酒产地识别研究

目的:以宁夏贺兰山东麓不同子产区马瑟兰单品葡萄酒为研究对象,明确葡萄酒中碳、氧稳定同位素分馏特征,探讨碳、氧稳定同位素及矿物元素在小尺度区域葡萄酒产地识别中的可行性。方法:采集红寺堡、青铜峡、永宁、贺兰和镇北堡5个子产区马瑟兰单品葡萄酒样品45份,监测分析葡萄酒中矿物元素含量及δ^(13)C、δ^(18)O值,采用Fisher线性判别分析方法,构建基于稳定同位素、矿物元素的葡萄酒产地判别模型。结果:碳、氧稳定同位素在葡萄酒发酵过程中存在明显的分馏,总δ^(13)C>乙醇δ^(13)C>甘油δ^(13)C,三者表现出一定的同源性;δ^(18)O大小依次为葡萄汁δ^(18)O>葡萄酒中δ^(18)O>水中δ^(18)O。As、B、K、Li、Mn、Ni、Pb、Rb、Sb、Sr、Ti、Cs元素在部分产区间存在显著差异(P<0.05),δ^(13)C、δ^(18)O及Ba、Ca等13种矿物元素在不同产区间不存在显著差异(P>0.05)。基于碳、氧稳定同位素构建的葡萄酒产地判别模型的正确判别率仅为40%,基于矿物元素以及碳、氧稳定同位素结合矿物元素的正确判别率均为95.6%。结论:矿物元素可有效区分不同子产区的葡萄酒样品的有效指标,但碳、氧稳定同位素不能作为小尺度区域葡萄酒产地判别的有效指标。

基于δ^(13)C估算水分利用效率的2种模型比较——以峨眉山雷洞坪植物为例

【目的】通过对基于碳稳定同位素值(δ^(13)C)估算水分利用效率(iWUE)的2种模型(是否考虑叶肉导度,gm)之间差异的研究,有助于进一步理解gm对植物iWUE的影响。【方法】选择峨眉山雷洞坪针阔混交林中不同生长型植物,采集了48个物种的117个叶片样品,通过测定其叶片δ^(13)C,对比了早期估算iWUE模型(iWUEsim模型,将gm看作无穷大)与包含gm效应的iWUE模型(iWUEmes模型)之间的iWUE差异(iWUE_(difference)),以及这种差异随植物生长型变化的趋势。【结果】结果显示,iWUEsim的平均值(42.23±1.33μmol·mol^(-1))显著高于iWUEmes的平均值(28.10±0.65μmol·mol^(-1)),高估比例为3.64%~72.11%(平均49.58%±1.30%)。不同生长型植物的iWUEsim均显著大于iWUEmes,其中草本植物高估比例3.64%~48.00%(平均29.20%±5.16%),灌木高估比例13.68%~67.73%(平均48.44%±1.83%),乔木高估比例32.04%~72.11%(平均54.08%±1.47%)。此外,叶片功能性状对iWUE_(difference)有显著影响,相比于叶片厚度、叶片干物质含量和单位质量叶片氮含量,单位面积叶片氮含量和比叶重是影响iWUE_(difference)变化的主要因素。【结论】将gm看作无穷大会造成对基于δ^(13)C估算的iWUE的高估,未来估算植物iWUE时应考虑gm的影响。

Modeling Blood Flow in Veins of Uniform Properties (Giraffe Jugular Vein)

This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.