High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study

One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis

Linear Analysis of Dispersive Waves in Bubbly Flows Based on Averaged Equations

One-dimensional linear dispersive waves in water flows containing a number of small spherical air bubbles are analytically studied on the basis of a set of averaged equations recently derived by the present authors. The set of equations consists of the conservation laws for gas and liquid phases and the equation of motion of bubble wall. In addition to the volume-averaged pressure in each phase, the surface-averaged liquid pressure at the bubble wall is incorporated. The compressibility of water is taken into account as well as that of gas in bubbles, and a model of virtual mass force is included, although the Reynolds stress, viscosity, heat conductivity, and the phase change across the bubble wall are disregarded. The results are summarized as follows: (i) the waves are decomposed into the fast mode, slow mode, and convection mode (void wave). (ii) In the uniform flows, the three modes stably exist for all real wave numbers. (iii) In the limit of infinitesimal void fraction, the explicit representation of the elementary solution is obtained. (iv) The instability does not appear in the range where the present averaged equations are applicable