The objective of this thesis was to further develop a methodology for surface tension measurement called Axisymmetric Drop Shape Analysisn(ADSA) and to adapt it to studies of lung surfactants, i.e. the material that coats and facilitates the functioning of the lungs of all mammals. The key property of a functioning lung surfactant is its surface tension, which can reach extremely low values. Such values are difficult to measure; but a certain configuration of ADSA, using a constrained sessile drop (ADSA--CSD), is capable of performing such measurements. Clinically, lung surfactant films can be altered from both sides, i.e. from the airspace as well as from the bulk liquid phase that carries the film. Therefore, being able to access the interface from both sides is important. Here, ADSA--CSD was redesigned to be used as a micro film balance allowing access to the interface from both gas- and liquid-side. This allows deposition from the gas side as well as complete exchange of the bulk liquid phase. The new design was used to study lung surfactant inhibition and inhibition reversal. A dynamic compression-relaxation model (CRM) was developed to describe the mechanical properties of lung surfactant films by investigating the response of surface tension to changes in surface area. The model evaluates the quality of lung surfactant preparations -- beyond the minimum surface tension value -- and calculates the film properties, i.e. elasticity, adsorption and relaxation, independent of the compression protocol. The accuracy of the surface tension measurement can depend on drop size. A detailed analysis of drop shapes and accuracy of measured surface tension values was performed using a shape parameter concept. Based on this analysis, the design of ADSA--CSD was optimized to facilitate more accurate measurements. The validity analysis was further extended to the more conventional pendant drop setup (ADSA--PD). An overall upgrade of both hardware and software of ADSA--CSD, together with extensive numerical work, is described and applied to facilitate a more efficient operation. Finally, it is noted that the ADSA--CSD setup developed here can be used for a wide range of colloid and surface chemical applications.

The objective of this thesis was to further develop a methodology for surface tension measurement called Axisymmetric Drop Shape Analysisn(ADSA) and to adapt it to studies of lung surfactants, i.e. the material that coats and facilitates the functioning of the lungs of all mammals. The key property of a functioning lung surfactant is its surface tension, which can reach extremely low values. Such values are difficult to measure; but a certain configuration of ADSA, using a constrained sessile drop (ADSA--CSD), is capable of performing such measurements. Clinically, lung surfactant films can be altered from both sides, i.e. from the airspace as well as from the bulk liquid phase that carries the film. Therefore, being able to access the interface from both sides is important. Here, ADSA--CSD was redesigned to be used as a micro film balance allowing access to the interface from both gas- and liquid-side. This allows deposition from the gas side as well as complete exchange of the bulk liquid phase. The new design was used to study lung surfactant inhibition and inhibition reversal. A dynamic compression-relaxation model (CRM) was developed to describe the mechanical properties of lung surfactant films by investigating the response of surface tension to changes in surface area. The model evaluates the quality of lung surfactant preparations -- beyond the minimum surface tension value -- and calculates the film properties, i.e. elasticity, adsorption and relaxation, independent of the compression protocol. The accuracy of the surface tension measurement can depend on drop size. A detailed analysis of drop shapes and accuracy of measured surface tension values was performed using a shape parameter concept. Based on this analysis, the design of ADSA--CSD was optimized to facilitate more accurate measurements. The validity analysis was further extended to the more conventional pendant drop setup (ADSA--PD). An overall upgrade of both hardware and software of ADSA--CSD, together with extensive numerical work, is described and applied to facilitate a more efficient operation. Finally, it is noted that the ADSA--CSD setup developed here can be used for a wide range of colloid and surface chemical applications.

Genetic studies of lung disease in Cystic Fibrosis are faced with the challenge of identifying a severity measure that accounts for chronic disease progression and mortality attrition. Further, combining analyses across studies requires common phenotypes that are robust to study design and patient ascertainment. This thesis uses data from the North American Cystic Fibrosis Modifier Consortium (Canadian Consortium for CF Genetic Studies (CGS), Johns Hopkins University Twins and Siblings Study (TSS), and University of North Carolina/Case Western Reserve University Gene Modifier Study (GMS)), to calculate two novel phenotypes using age-specific CF percentile values of FEV1 (Forced Expiratory Volume in 1 second), with adjustment for CF age-specific mortality. The normalized residual, mortality adjusted (NoRMA) was designed for population based samples, while KNoRMA, using Kulich percentiles, is robust to sample ascertainment; both account for the effects of age-related disease progression and mortality attrition. NoRMA was computed for 2122 patients representing the Canadian CF population. KNoRMA was computed for these 2122 patients and also 1137 extreme phenotype patients in the GMS study and 1323 patients from multiple CF sib families in the TSS study. Phenotype was distributed in all three samples in a manner consistent with ascertainment differences, reflecting the lung disease severity of each individual in the underlying population. The new phenotype was highly correlated with the previously recommended mixed model phenotype1; 2, but computationally much easier and suited to studies with limited follow up time. As an example of its use, KNoRMA was used to test the association between locus variants in a previously published candidate gene, Transforming Growth Factor β1(TGFβ1), and lung function in CF, in an attempt to provide insight into discrepant results in the literature. A disease progression and mortality adjusted phenotype reduces the need for stratification or additional covariates, increasing statistical power and avoiding possible interpolation distortions.

This thesis examined associations between ecological indicators of residential radon and fine particulate matter air pollution (PM2.5) and lung cancer mortality using data from the American Cancer Society Cancer Prevention Study-II (CPS-II) prospective cohort. Nearly 1.2 million CPS-II participants were recruited in 1982. Mean county-level residential radon concentrations were linked to study participants according to ZIP code information at enrollment (mean (SD) = 53.5 (38.0) Bq/m3). Cox proportional hazards regression models were used to obtain adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for lung cancer mortality associated with radon. After necessary exclusions, a total of 811,961 participants in 2,754 counties were retained for analysis. A significant positive linear trend was observed between categories of radon concentrations and lung cancer mortality (p = 0.02). A 15% (95% CI 1 - 31%) increase in the risk of lung cancer mortality was observed per each 100 Bq/m3 radon. Radon was also positively associated with chronic obstructive pulmonary disease mortality (HR per each 100 Bq/m3 = 1.13, 95% CI 1.05 - 1.21). No clear associations were observed between radon and non-respiratory mortality. In lifelong never smokers (n = 188,699), each 10 µg/m3 increase in mean metropolitan statistical area PM2.5 concentrations was associated with a 15-27% increase in the risk of lung cancer death which strengthened among individuals with a history of asthma or any prevalent chronic lung disease at enrollment (p for interaction < 0.05). There was no association between PM2.5 and mortality from non-malignant respiratory disease. In conclusion, this thesis observed significant positive associations between ecological indicators of residential radon and PM2.5 concentrations and lung cancer mortality. These findings further support efforts to reduce radon concentrations in homes to the lowest possible level and strengthens the evidence that ambient concentrations of PM2.5 measured in recent decades are associated with small but measurable increases in lung cancer mortality. Further research is needed to better understand possible complex inter-relationships between environmental risk factors, chronic lung disease, and lung cancer.

No description available.

El cáncer de pulmón no célula pequeña es la neoplasia más frecuente en la actualidad en los países industrializados, siendo la primera causa de mortalidad por cáncer en el varón. Su incidencia continúa aumentando progresivamente, y su tratamiento, pese a los esfuerzos de investigación de los últimos años, sigue siendo poco efectivo en la mayor parte de los casos, situándose la supervivencia global a los cinco años alrededor del 13%. La alta tasa de recaída, incluso en estadios iniciales susceptibles de cirugías radicales, justifica el interés de estudiar marcadores pronósticos de supervivencia y recaída. Esto nos ayudaría a distinguir grupos de riesgo, cuyo interés radica en ayudarnos a conocer la necesidad y efecto de los tratamientos adyuvantes, con quimioterapia y radioterapia así como abrir la puerta a posibles nuevas armas terapéuticas. Dada la alta incidencia de alteraciones en la vía de p53 en el cáncer de pulmón no célula pequeña, y su probable valor pronóstico, nuestra hipótesis es que existen alteraciones en los niveles de expresión de los miRNAs directamente regulados por p53, así como en los reguladores intermedios de la función de p53, con posible valor pronóstico en recaída y supervivencia de pacientes operados de cáncer de pulmón no célula pequeña o no microcítico(CPNCP). Tratamos pues de identificar el papel que juegan los miRNAs como marcadores útiles en el pronóstico del CPNCP en estadios iniciales, tras cirugía radical. De forma más específica determinar el posible papel pronóstico en recaída y en supervivencia de los miRNAs de la familia de miR-34: miR-34a, miR-34b y miR-34c, cuya transcripción es activada por p53. También definir el posible papel pronóstico en recaída y en supervivencia de los miRNAs miR-16 y miR-143, cuyos niveles finales en la célula, están modulados por p53. Así como, conocer si existen posibles interacciones entre miR-34a, miR-34b, miR-34c, miR-16 y miR-143 a nivel pronóstico. Para ello, hemos planteado un estudio retrospectivo, con las muestras de tejido tumoral y normal pareado de 70 pacientes, diagnosticados y tratado, de cáncer de pulmón no microcítico estadios I-III, entre Febrero de 1996 y Septiembre de 2002, en el Hospital Clínic de Barcelona. Se realizaron la extracción y cuantificación de RNA. Determinación de los niveles de los microRNAs mencionados. Determinación del estado de metilación de la región promotora del gen MIR34A. Determinación de la presencia de mutaciones de P53 entre los exones 5-8. Tras estos estudios los resultado obtenidos se han publicado en dos artículos. El primero de ellos en la revista “Carcinogenesis” y el segundo en la revista “Journal of Surgical Oncology”. En el primer artículo, titulado “miR-34a as a prognostic marker of relapse in surgically resected non-small-cell lung cancer”, relacionamos los niveles de miR-34a con la recaída tumoral, estableciendo tres grupos en función de esta tasa de recaída: el grupo con niveles bajos de miR34a, con un 67% de recaída, los que tenían niveles altos, con un 43% de recaída y los que tenían los niveles más altos con un 0% de recaída. Además, en el análisis univariado para riesgo de recaída, el estado mutacional de P53, los niveles de miR-34a y el estadio IA vs el resto, se correlacionaron con probabilidad de recaída. Se realizaron dos análisis mutilvariados, incluyendo o no el estado mutacional de P53, permaneciendo en ambos análisis la expresión de miR-34a, como factor independiente para recaída tumoral. Se observó que los pacientes con mutaciones de P53 presentaban una media de expresión de miR-34a más baja. Se observó que el subgrupo de pacientes en el que los niveles de expresión de miR-34a baja coincidían con presencia de mutaciones de P53, presentaban una alta tasa de recaída. En los pacientes sin mutaciones de de P53, existe una diferencia significativa en los niveles de expresión de miR-34a entre los pacientes que presentaban la región promotora de MIR34A metilada vs los que no. Por todo esto, encontramos que miR-34a se demuestra como un nuevo marcador biológico con significación en el pronóstico de la recaída de pacientes sometidos a cirugía del CPNCP, abriendo la posibilidad de una futura herramienta en el algoritmo de decisiones terapéuticas. En el segundo artículo, titulado “Prognostic Implications of miR-16 Expression Levels in Resected Non-Small-Cell Lung Cancer”, desde la hipótesis de que P53 activa la transcripción de la familia de miRNAs de miR-34 y regula la maduración de miR-16 y miR143, se estudiaron los niveles de expresión de miR-143 y miR-16 en el tejido normal y tumoral pareado de cada paciente de la serie, antes mencionada, de 70 pacientes. Así los pacientes se clasificaron de acuerdo a los niveles de expresión de miR-16(alto, normal y bajo). Aquellos pacientes con niveles normales tuvieron la mejor evolución, mientras que aquellos con niveles más altos tuvieron la peor. La supervivencia libre de enfermedad (SLE) era de 22,4 meses para los pacientes con niveles altos de miR-16, 71,8 meses para los de niveles normales y de 55,8 meses para los de niveles bajos. La supervivencia global (SG) fue de 23,9 meses para los que tenían niveles altos de miR-16, de 97,6 meses para los que tenían niveles normales y 63,5 meses para aquellos con niveles bajos. No se observó correlación entre los niveles de miR-143 y la evolución clínica de los pacientes. El análisis multivariado mostró a miR-16 como factor pronóstico independiente de SLE Y SG. En un análisis secundario, examinamos la correlación potencial entre la expresión de miR-16 y miR-34a y el estado mutacional de P53.No hubo correlación entre el estado mutacional de P53 y miR-16, pero si se observó una interacción entre miR-16 y miR-34a. En los pacientes con niveles altos de miR-34a, se observaron diferencias entre SLE Y SG, de acuerdo a los niveles de expresión de miR-16, mientras que en los pacientes con niveles bajos de miR-34a presentaban un pobre pronóstico, independientemente de los niveles de expresión de miR-16. Estos resultados nos indican el posible valor pronóstico de miR-16 en pacientes intervenidos de CPNCP, además del posible sinergismo entre miR-34a y miR16. / Non small cell lung cancer is more common today, in industrialized countries and is the leading cause of cancer death in men. Its incidence continues to increase gradually, and their treatment, despite the research efforts of recent years, it remains ineffective in most cases, putting the overall survival at five years about 13%. The high rate of relapse, even in early stages susceptible to radical surgery, justifies the interest in studying prognostic markers of survival and relapse. This would help us distinguish risk groups, whose interest lies in helping to meet the need and effect of adjuvant treatment with chemotherapy and radiotherapy as well as opening the door to possible new therapeutic tools. Given the high incidence of alterations in the p53 pathway in non small cell lung cancer, and likely its prognostic role, our hypothesis is that there are alterations in the expression levels of miRNAs directly regulated by p53, as well as in intermediate regulators of p53 function with potential prognostic value on relapse and survival of patients undergoing non small cell lung cancer (NSCLC). Then, we try to identify the role of miRNAs as useful markers for the prognosis of NSCLC in initial stages, after radical surgery. More specifically determine the possible prognostic role in relapse and survival of the family miRNAs miR-34: miR-34a, miR-34b and miR-34c, whose transcription is activated by p53. Also define the possible prognostic role in relapse and survival of the miRNAs miR-16 and miR-143, whose final levels in the cell are modulated by p53. And, determine whether there are possible interactions between miR-34a, miR-34b, miR-34c, miR-16 and miR-143 as regards prognosis. To do this, we have proposed a retrospective study, with the tumor tissue and paired normal in 70 patients, diagnosed and treated of non small cell lung cancer stages I-III, between February 1996 and September 2002, at the Hospital Clínic, in Barcelona. We performed RNA extraction and quantification. Determining levels of microRNAs mentioned. Determining the status of methylation of the promoter region of the gene MIR34A. Determining the presence of p53 mutations between exons 5-8. Following, the results obtained from these studies have been published in two articles. The first in the journal "Carcinogenesis" and the second in the "Journal of Surgical Oncology." In the first article, entitled "miR-34a as a Prognostic marker of relapse in surgically resected non-small-cell lung cancer", we relate the levels of miR-34a with the tumor relapse, establishing three groups according to the rate of relapse: the group with low levels of miR34a, with 67% relapse, those with high levels, with 43% relapse and those with the highest levels with a 0% relapse. Furthermore, in univariate analysis for risk of relapse, the mutational status of p53, the levels of miR-34a and stage IA vs the rest, were correlated with likelihood of relapse. Two multivariate analyzes were performed, including or not the P53 mutational status, remaining in both analyzes the expression of miR-34a, as an independent factor for tumor relapse. It was observed that patients with p53 mutations had a mean expression of miR-34a lower. It was noted that the subgroup of patients in which the expression levels of miR-34a low coincided with the presence of p53 mutations, had a high rate of relapse. In patients without mutations of p53, there is a significant difference in expression levels of miR-34a between the patients with the methylated promoter region MIR34A vs. those without. For all this, we found that miR-34a is shown as a novel biomarker with prognostic significance in patients relapsed NSCLC undergoing surgery, opening the possibility of a future tool in the therapeutic decision algorithm. In the second article, entitled "Prognostic Implications of miR-16 Expression Levels in Resected Non-Small-Cell Lung Cancer", from the hypothesis that p53 activates transcription of the family of miRNAs miR-34 and regulates the maturation of miR-16 to miR-143, we studied the expression levels of miR-143 and miR-16 in the paired normal and tumor tissue of each patient in the series, mentioned above, in 70 patients. So patients were classified according to the expression levels of miR-16 (high, normal and low). Patients with normal levels had the best clinical course, while those with higher levels had the worst. The disease-free survival (DFS) was 22.4 months for patients with high levels of miR-16, 71.8 months for normal levels of 55.8 months for low levels. Overall survival (OS) was 23.9 months for those with high levels of miR-16, from 97.6 months for those with normal levels and 63.5 months for those with low levels. No correlation was observed between the levels of miR-143 and the clinical course of patients. Multivariate analysis showed miR-16 as an independent prognostic factor for DFS and OS. In a secondary analysis, we examined the potential correlation between the expression of miR-16 and miR-34a and the mutational status of P53. There was no correlation between p53 mutational status and miR-16, but observed an interaction between miR-16 and miR-34a. In patients with high levels of miR-34a, there were differences between DFS and OS, according to the expression levels of miR-16, whereas in patients with low levels of miR-34a had a poor prognosis, regardless of expression levels of miR-16. These results indicate the possible prognostic value of miR-16 in patients operated for NSCLC, as well as possible synergism between miR-34a and miR16

Lung cancer (LC) is often diagnosed at advanced stage and as a result, survival rates are low. Recent studies describe exhaled breath and exhaled breath condensate (EBC) as a potential non-invasive method of sampling the airways for assessing inflammation of the respiratory system, and possibly for the early detection of LC. It was hypothesised that higher concentrations of markers and protein will be present in the EBC of LC patients compared to those of normal controls and healthy smokers, and may aid in assessing lung status. Methods: The gaseous phase of breath was investigated for volatile organic compound (VOC) patterns using an electronic nose (eNose) system, in addition to off-line measurements of carbon monoxide (CO) and nitric oxide (NO) levels. The aqueous phase, EBC, was collected during tidal breathing through a glass collection device cooled to 4??C by ice. Nitrite/nitrate (NOx) and pH levels were determined by a fluorescent modification of the Griess method, and silicon chip sensor pH meter, respectively. Protein levels in EBC were examined with a bicinchoninic acid (BCA) assay, silver staining and PAGE techniques, while the levels of tumour markers, CYFRA 21-1 and CEA, were quantified by enzyme-linked immunosorbent assays (ELISA). Results: The eNose machine was not able to produce characteristic VOC profiles from exhaled breath unique to each study group, while no significant difference was observed for mean NOx concentrations in the LC group when compared to other subjects (p=0.8824). Higher protein levels were found in the EBC of LC patient compared to normal controls (p=0.0204), with subsequent measurements of elevated CEA levels observed in the LC group when compared to non-smokers and smokers (p=0.023). Conclusion: This study showed that protein can be detected in the exhaled breath condensate of patients, with a significantly elevated amount in the samples from newly diagnosed LC patients. The mechanism for these differences remains to be determined but may be related to inflammatory changes within the airway, such as vascular protein leakage and release of mediators. Future work may aim to identify the upregulated proteins, and focus on proteomics and tissue microarrays to explore candidate proteins.

This research develops a detailed, anatomically-based model of the human pulmonary circulatory system from the large scale arterial and venous vessels, to the microcirculatory alveolar-capillary unit. Flow is modelled through these networks enabling structure-function simulations to be conducted to increase our understanding of this complex system.Voronoi meshing is applied in a novel technique to represent the three-dimensional structure of the alveoli, and the corresponding capillary plexus intimately wrapped over the alveolar surface. This technique is used to create the alveolar-capillary structure of a single alveolar sac, closely representing the geometry measured in anatomical studies.A Poiseuille type flow solution technique is implemented within the capillary geometry. The solution procedure incorporates calculations of red and white blood cell transit time frequencies. Novel predictions of regional microcirculatory blood cell transit in the anatomically-realistic alveolar-capillary model compare well with experimental measures.An anatomically-based finite element model of the arterial and venous vessels, down to the level of their accompanying respiratory bronchioles, is created using a combination of imaging and computational algorithms, which includes generation of supernumerary vessels. Large arterial and venous vessels and lobar geometries are derived from multi-detector row x-ray computed tomography (MDCT) scans. From these MDCT vessel end points a volume-filling branching algorithm is used to generate the remaining blood vessels that accompany the airways into the MDCT-derived host volume. An empirically-based algorithm generates supernumerary blood vessels - unaccompanied by airways that branch to supply the closest parenchymal tissue. This new approach produces a model of pulmonary vascular geometry that is far more anatomically-realistic than previous models in the literature.A reduced form of the Navier-Stokes equations are solved within the vascular geometries to yield pressure, radius, and velocity distributions. Inclusion of a gravitational term in the governing equations allows application of the model in investigating the relative effects of gravity, structure, and posture on regional perfusion.Gravity is shown to have a lesser influence on blood flow distribution than suggested by earlier experimental studies, and by comparison between different model solutions the magnitude of the gravitational flow gradient is predicted. This study clearly demonstrates the significant role that symmetric vascular branching has in determining the distribution of blood flow. The influence of branching geometry is revealed by solution in symmetric, human, and ovine vascular models.

This research develops a detailed, anatomically-based model of the human pulmonary circulatory system from the large scale arterial and venous vessels, to the microcirculatory alveolar-capillary unit. Flow is modelled through these networks enabling structure-function simulations to be conducted to increase our understanding of this complex system.Voronoi meshing is applied in a novel technique to represent the three-dimensional structure of the alveoli, and the corresponding capillary plexus intimately wrapped over the alveolar surface. This technique is used to create the alveolar-capillary structure of a single alveolar sac, closely representing the geometry measured in anatomical studies.A Poiseuille type flow solution technique is implemented within the capillary geometry. The solution procedure incorporates calculations of red and white blood cell transit time frequencies. Novel predictions of regional microcirculatory blood cell transit in the anatomically-realistic alveolar-capillary model compare well with experimental measures.An anatomically-based finite element model of the arterial and venous vessels, down to the level of their accompanying respiratory bronchioles, is created using a combination of imaging and computational algorithms, which includes generation of supernumerary vessels. Large arterial and venous vessels and lobar geometries are derived from multi-detector row x-ray computed tomography (MDCT) scans. From these MDCT vessel end points a volume-filling branching algorithm is used to generate the remaining blood vessels that accompany the airways into the MDCT-derived host volume. An empirically-based algorithm generates supernumerary blood vessels - unaccompanied by airways that branch to supply the closest parenchymal tissue. This new approach produces a model of pulmonary vascular geometry that is far more anatomically-realistic than previous models in the literature.A reduced form of the Navier-Stokes equations are solved within the vascular geometries to yield pressure, radius, and velocity distributions. Inclusion of a gravitational term in the governing equations allows application of the model in investigating the relative effects of gravity, structure, and posture on regional perfusion.Gravity is shown to have a lesser influence on blood flow distribution than suggested by earlier experimental studies, and by comparison between different model solutions the magnitude of the gravitational flow gradient is predicted. This study clearly demonstrates the significant role that symmetric vascular branching has in determining the distribution of blood flow. The influence of branching geometry is revealed by solution in symmetric, human, and ovine vascular models.

This research develops a detailed, anatomically-based model of the human pulmonary circulatory system from the large scale arterial and venous vessels, to the microcirculatory alveolar-capillary unit. Flow is modelled through these networks enabling structure-function simulations to be conducted to increase our understanding of this complex system.Voronoi meshing is applied in a novel technique to represent the three-dimensional structure of the alveoli, and the corresponding capillary plexus intimately wrapped over the alveolar surface. This technique is used to create the alveolar-capillary structure of a single alveolar sac, closely representing the geometry measured in anatomical studies.A Poiseuille type flow solution technique is implemented within the capillary geometry. The solution procedure incorporates calculations of red and white blood cell transit time frequencies. Novel predictions of regional microcirculatory blood cell transit in the anatomically-realistic alveolar-capillary model compare well with experimental measures.An anatomically-based finite element model of the arterial and venous vessels, down to the level of their accompanying respiratory bronchioles, is created using a combination of imaging and computational algorithms, which includes generation of supernumerary vessels. Large arterial and venous vessels and lobar geometries are derived from multi-detector row x-ray computed tomography (MDCT) scans. From these MDCT vessel end points a volume-filling branching algorithm is used to generate the remaining blood vessels that accompany the airways into the MDCT-derived host volume. An empirically-based algorithm generates supernumerary blood vessels - unaccompanied by airways that branch to supply the closest parenchymal tissue. This new approach produces a model of pulmonary vascular geometry that is far more anatomically-realistic than previous models in the literature.A reduced form of the Navier-Stokes equations are solved within the vascular geometries to yield pressure, radius, and velocity distributions. Inclusion of a gravitational term in the governing equations allows application of the model in investigating the relative effects of gravity, structure, and posture on regional perfusion.Gravity is shown to have a lesser influence on blood flow distribution than suggested by earlier experimental studies, and by comparison between different model solutions the magnitude of the gravitational flow gradient is predicted. This study clearly demonstrates the significant role that symmetric vascular branching has in determining the distribution of blood flow. The influence of branching geometry is revealed by solution in symmetric, human, and ovine vascular models.