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Sample records for leaflet perfusion patterns

  1. Local intense mosaic pattern at site of flail mitral leaflet: report of a new color Doppler sign.

    PubMed

    Khouzam, Rami N; D'Cruz, Ivan A; Minderman, Daniel; Kaiser, Jacqueline

    2005-10-01

    Color flow Doppler has been useful in diagnosing the presence and severity of mitral regurgitation (MR). We noted a hitherto unreported sign of MR due to flail mitral leaflet: intense local mosaic pattern at the site of the flail leaflet. This sign was seen well in 11 of 14 patients (79%) with the two-dimensional echocardiographic features of flail mitral leaflet, all with moderate or severe MR. In 3 other patients, the sign was absent; two of those had flail mitral leaflet with severe MR. No local mosaic pattern was seen on color Doppler in 20 other patients with MR but no flail mitral leaflet. We speculate that the focal intense mosaic color Doppler morphology may have been caused by intrusion of the flail leaflet into the MR stream, or to a Coanda-like effect of the MR jet "adhering" to the flail leaflet. PMID:16194168

  2. Developmental pattern of the right atrioventricular septal valve leaflet and tendinous cords.

    PubMed

    Guzmán, Laura Villavicencio; Mayoral, Pedro Valencia; Valencia, Julio Páez; Pine, Stanislaw Sadowinski; Gómez, Concepción Sánchez

    2010-01-01

    No consensus exists regarding the precise contribution of myocardium and the atrioventricular (AV) cushion mesenchyme to the development of leaflets, tendinous cords (TCs) and papillary muscles. Furthermore, the origin and fate of the myocardium embedded in the immature mesenchyme of the AV cushions at the beginning of AV valvulogenesis is controversial. Some authors have suggested that these cells result from a mesenchyme-to-myocardium transformation. In contrast, other researchers have concluded that they are derived from the myocardial ventricular wall and the interventricular septum (IVS). On the other hand, it has been assumed that the AV mural and septal leaflets have the same pattern of development. However the supporting structures of the two types of leaflets are anatomically different, which could reflect some differences in the pattern of development. We have therefore investigated the morphogenetic processes involved in sculpting and maturation of the right septal leaflet (RSL) and TCs in embryonic and post-hatching chicken hearts. The origin and fate of the myocardium embedded in the immature cushion mesenchyme at the beginning of RSL morphogenesis was also studied. For this purpose, scanning electron microscopic analysis, histological studies and immunohistochemical detection of Nkx2.5 and MEF2C were performed. Our findings indicate that the RSL and TCs present a distinct morphogenetic pattern from that of the mural leaflets. Our results also provide evidence that myocardial recruitment from the IVS, but not mesenchyme-to-myocardium transformation, participates in the development of the muscular region of the TCs adjacent to the IVS. PMID:19899118

  3. Scintigraphic perfusion patterns in patients with diffuse lung disease

    SciTech Connect

    Newman, G.E.; Sullivan, D.C.; Gottschalk, A.; Putman, C.E.

    1982-04-01

    Perfusion scintigrams of 55 patients with radiographic evidence of diffuse lung disease were reviewed. Thirty-nine had acute and/or chronic changes caused by congestive heart failure, and 16 had diffuse reticulonodular disease. A normal or near-normal perfusion pattern was seen in 40/55 (73%), and this finding was equally common in the two groups. The authors conclude that perfusion scintigraphy is useful in excluding pulmonary embolism in patients with radiographic evidence of diffuse, symmetrical lung disease.

  4. Patterns of systolic stress distribution on mitral valve anterior leaflet chordal apparatus. A structural mechanical theoretical analysis.

    PubMed

    Nazari, S; Carli, F; Salvi, S; Banfi, C; Aluffi, A; Mourad, Z; Buniva, P; Rescigno, G

    2000-04-01

    Increasing diffusion and complexity of mitral valve repair procedures may prompt an interest in the evaluation of the patterns of stress distribution on the chords, which are, from the structural mechanical point of view, the weakest element of valve apparatus. This theoretical analysis concentrates in particular on the mitral valve anterior leaflet. As is known, the vast majority of the chordae are attached to the anterior leaflet within the coaptation area; during systole they are then necessarily parallel, aligned along the same plane as that of the leaflets' coaptation surface, to which they are attached; moreover the thickness of the chordae increases significantly from the marginal chordae to the more central ones. In normal conditions during systole the progressively wider coaptation surface causes the increasing stress to be supported by an increasing number of progressively thicker chords, which are substantially parallel and aligned on the coaptation surface plane in such a way that they can share the stress between them, according to their thickness; in other words chords form a multifilament functional unit which enrolls elements of increasing thickness in response to the mounting stress. The geometrical modifications of the valve apparatus architecture (annulus dilatation, leaflet retraction, chordal elongation or retraction) often associated with valve insufficiency due to chordal rupture, have the common result of causing, during systole, a radial disarrangement of the direction of most of the secondary chordae which are no longer parallel, aligned on the coaptation surface plane. Due to the negligible elastic module of the valve leaflet, in this new arrangement the various chordae cannot share the stress between themselves as they do in a normal physiological situation; on the contrary the thinner chordae nearer to the free margin are also loaded with the peak systolic stress, thus generating conditions favoring their rupture. It can, therefore, be

  5. Radionuclide cerebral perfusion imaging: Normal pattern

    SciTech Connect

    Goldsmith, S.J.; Stritzke, P.; Losonczy, M.; Vallabhajosula, S.; Holan, V.; DaCosta, M.; Muzinic, M.

    1991-12-31

    Regional cerebral perfusion imaging using a new class of {sup 99m}Tc and {sup 123}I labeled compounds which traverse the blood brain barrier and SPECT imaging technology provides an opportunity to assess this physiologic phenomenon during normal cerebral function and as a manifestation of disease in the central nervous system disease. These applications pose a challenge to the nuclear medicine physician for several reasons: (a) the complex and somewhat unfamiliar functional anatomy, (b) the marked regional differences in regional cerebral perfusion at rest, (c) the lack of understanding of the effect of variations in ambient conditions on regional cerebral perfusion. The difficulties in interpretation are augmented by the display itself. There is frequently no difficulty in differentiating between gray and white matter. However, the frequently used {open_quotes}hot body{close_quotes} color maps, introduce a good deal of contrast, producing displays with apparent interruption in regional cortical perfusion whereas black and white displays provide minimal contrast in the regional cortical activity. The authors sought to define how much variation in regional cerebral perfusion is {open_quotes}allowed{close_quotes} under controlled conditions, to establish a basis to interpret if changes in the environment, psychological interventions, or disease states are accompanied by a measurable change. 2 figs., 1 tab.

  6. Regional ventilation/perfusion mismatch pattern in patient with Swyer James (MacLeod's) syndrome.

    PubMed

    Sager, Sait; Asa, Sertac; Akyel, Reşit; Atahan, Ersan; Kanmaz, Bedii

    2014-09-01

    Swyer James (McLeod's) syndrome (SJMS) is an uncommon disease, which occurs as a result of childhood bronchiolitis obliterans. Patients may not be diagnosed until later in their life. A 46-year-old man underwent ventilation/perfusion scintigraphy for acute onset of dyspnea. The scan showed markedly diminished ventilation and perfusion unilaterally on the right middle and inferior lobes. However, mismatched ventilation-perfusion pattern was shown on the upper right lobe, which was consistent with pulmonary embolism. Unilaterally matched ventilation/perfusion defect can see in SJMS in lung scintigraphy; however, when pulmoner embolism may accompany, scintigraphy should be carefully examined. PMID:25535507

  7. Motility patterns of ex vivo intestine segments depend on perfusion mode

    PubMed Central

    Schreiber, Dominik; Jost, Viktor; Bischof, Michael; Seebach, Kristina; Lammers, Wim JEP; Douglas, Rees; Schäfer, Karl-Herbert

    2014-01-01

    AIM: To evaluate and characterize motility patterns from small intestinal gut segments depending on different perfusion media and pressures. METHODS: Experiments were carried out in a custom designed perfusion chamber system to validate and standardise the perfusion technique used. The perfusion chamber was built with a transparent front wall allowing for optical motility recordings and a custom made fastener to hold the intestinal segments. Experiments with different perfusion and storage media combined with different luminal pressures were carried out to evaluate the effects on rat small intestine motility. Software tools which enable the visualization and characterization of intestinal motility in response to different stimuli were used to evaluate the videotaped experiments. The data collected was presented in so called heatmaps thus providing a concise overview of form and strength of contractility patterns. Furthermore, the effect of different storage media on tissue quality was evaluated. Haematoxylin-Eosin stainings were used to compare tissue quality depending on storage and perfusion mode. RESULTS: Intestinal motility is characterized by different repetitive motility patterns, depending on the actual situation of the gut. Different motility patterns could be recorded and characterized depending on the perfusion pressure and media used. We were able to describe at least three different repetitive patterns of intestinal motility in vitro. Patterns with an oral, anal and oro-anal propagation direction could be recorded. Each type of pattern finalized its movement with or without a subsequent distension of the wavefront. Motility patterns could clearly be distinguished in heatmap diagrams. Furthermore undirected motility could be observed. The quantity of the different patterns varies and is highly dependent on the perfusion medium used. Tissue preservation varies depending on the perfusion medium utilized, therefore media with a simple composition as Tyrode

  8. Pattern of brain blood perfusion in tinnitus patients using technetium-99m SPECT imaging

    PubMed Central

    Mahmoudian, Saeid; Farhadi, Mohammad; Gholami, Saeid; Saddadi, Fariba; Karimian, Ali Reza; Mirzaei, Mohammad; Ghoreyshi, Esmaeel; Ahmadizadeh, Majid; Lenarz, Thomas

    2012-01-01

    Background and Purpose: Tinnitus is associated with an increased activity in central auditory system as demonstrated by neuroimaging studies. Brain perfusion scanning using single photon emission computed tomography (SPECT) was done to understand the pattern of brain blood perfusion of tinnitus subjects and find the areas which are mostly abnormal in these patients. Materials and Methods: A number of 122 patients with tinnitus were enrolled to this cross-sectional study. They underwent SPECT and magnetic resonance imaging (MRI) of brain, and the images were fused to find the regions with abnormal perfusion. Results: SPECT scan results were abnormal in 101 patients (83%). Most patients had bilateral abnormal perfusion (N = 65, 53.3%), and most subjects had abnormality in middle-temporal gyrus (N = 83, 68%) and temporoparietal cortex (N = 46, 37.7%). Patients with multifocal involvement had the least mean age than other 2 groups (patients with no abnormality and unifocal abnormality) (P value = 0.045). Conclusions: Brain blood perfusion pattern differs in patient with tinnitus than others. These patients have brain perfusion abnormality, mostly in auditory gyrus (middle temporal) and associative cortex (temporoparietal cortex). Multifocal abnormalities might be due to more cognitive and emotional brain centers involvement due to tinnitus or more stress and anxiety of tinnitus in the young patients. PMID:23267375

  9. Coronary Flow Impacts Aortic Leaflet Mechanics and Aortic Sinus Hemodynamics

    PubMed Central

    Moore, Brandon L.; Dasi, Lakshmi Prasad

    2016-01-01

    Mechanical stresses on aortic valve leaflets are well-known mediators for initiating processes leading to calcific aortic valve disease. Given that non-coronary leaflets calcify first, it may be hypothesized that coronary flow originating from the ostia significantly influences aortic leaflet mechanics and sinus hemodynamics. High resolution time-resolved particle image velocimetry (PIV) measurements were conducted to map the spatiotemporal characteristics of aortic sinus blood flow and leaflet motion with and without physiological coronary flow in a well-controlled in vitro setup. The in vitro setup consists of a porcine aortic valve mounted in a physiological aorta sinus chamber with dynamically controlled coronary resistance to emulate physiological coronary flow. Results were analyzed using qualitative streak plots illustrating the spatiotemporal complexity of blood flow patterns, and quantitative velocity vector and shear stress contour plots to show differences in the mechanical environments between the coronary and non-coronary sinuses. It is shown that the presence of coronary flow pulls the classical sinus vorticity deeper into the sinus and increases flow velocity near the leaflet base. This creates a beneficial increase in shear stress and washout near the leaflet that is not seen in the non-coronary sinus. Further, leaflet opens approximately 10% farther into the sinus with coronary flow case indicating superior valve opening area. The presence of coronary flow significantly improves leaflet mechanics and sinus hemodynamics in a manner that would reduce low wall shear stress conditions while improving washout at the base of the leaflet. PMID:25636598

  10. Patterns of pulmonary perfusion scans in normal subjects

    SciTech Connect

    Wallace, J.M.; Moser, K.M.; Hartman, M.T.; Ashburn, W.L.

    1981-01-01

    A vital factor conditioning the usage of the pulmonary perfusion (Q) scan in the evaluation of patients suspected of pulmonary embolism is the prevalence of abnormal Q scans in subjects free of cardiopulmonary disease. Because this prevalence has not been well defined, we performed Q scans in 80 nonsmoking subjects 18 to 29 yr of age having no known active cardiopulmonary disease. Each subject underwent a history, physical examination, electrocardiogram, spirometry, and PA chest roentgenogram, followed by a 6-view Q scan. Two subjects in whom a Q defect was suspected underwent a /sup 133/Xe equilibrium-washout ventilation (V) scan. All Q scans were interpreted blindly and independently by 2 experienced readers. Seventy-nine of the 80 Q scans were read as normal. No subject demonstrated a lobar or segmental defect. One of the 80 subjects, who had a mild pectus excavatum, had a left upper lobe subsegmental defect, which was not seen on the V scan. Based on the statistical analysis of these data, no more than 3.68% of normal nonsmoking persons in this age group may have a lobar or segmental Q scan defect and no more than 6.77% may have a subsegmental defect (with 95% confidence). Therefore, our study indicated that Q scan defects, particularly lobar or segmental, are rarely present among normal nonsmokers in this age group.

  11. Bilateral basal Xe-133 retention and ventilation/perfusion patterns in mild and subclinical congestive heart failure

    SciTech Connect

    Lee, H.K.; Skarzynski, J.J.; Spadaro, A. )

    1989-12-01

    The Xe-133 ventilation pattern in congestive heart failure (CHF) was assessed using 24 inpatient ventilation/perfusion studies performed to rule out pulmonary embolism. Patients with histories of CHF, myocardial infarction (MI), and cardiomyopathy were included in the study. Frank pulmonary edema, pulmonary embolism, and other known lung diseases such as chronic obstructive lung disease, tumor, and pneumonia were excluded. Fifteen of the 24 patients had abnormal ventilation scans. Twelve of the 15 showed bilateral basal Xe-133 retention on washout; the remaining 3 showed diffuse, posterior regional retention. On perfusion scans, 14 of the 15 abnormal ventilation patients showed evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, or patchy perfusion, and all of them had a history of CHF or cardiac disease. Nine of the 24 patients had normal ventilation scans, including normal washout patterns. Seven of the nine had normal perfusion (p less than 0.01). Four of the nine normal ventilation patients had a history of cardiac disease or CHF but no recent acute MI. Bilateral basal regional Xe-133 retention, coupled with perfusion scan evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, and patchy perfusion pattern, appears to be a sensitive and characteristic ventilation/perfusion finding in mild or subclinical CHF.

  12. Patterns of disturbed myocardial perfusion in patients with coronary artery disease. Regional myocardial perfusion in angina pectoris

    SciTech Connect

    Selwyn, A.P.; Forse, G.; Fox, K.; Jonathan, A.; Steiner, R.

    1981-07-01

    Fifty patients who presented with angina pectoris were studied to examine the disturbances of regional myocardial perfusion during stress. Each patient underwent 16-point precordial mapping of the ECG during an exercise test, and coronary and left ventricular angiography. Regional myocardial perfusion was assessed using an atrial pacing test and a short-lived radionuclide, krypton-81m. Eleven patients had negative exercise tests and uniform increases in myocardial activity of krypton-81m of 98 +/- 18.0% during pacing. Ten patients performed 30,000-43,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and increases in myocardial activity of krypton-81m to remote and jeopardized myocardium at the onset of pacing. However, further pacing produced a decrease in activity in the affected segment of 68.0 +/- 9.0% accompanied by ST-segment depression and angina. Twelve patients achieved 26,000-32,000 J in positive exercise tests and had significant coronary artery disease. Atrial pacing produced increased activity of krypton-81m to remote myocardium. The jeopardized segment at first showed no change and then a decrease in regional activity of krypton-81m (89.0 +/- 17%) accompanied by ST-segment depression and chest pain. Seventeen patients achieved only 7000-22,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and developed decreases in regional activity of krypton-81m to the affected segment of myocardium starting at the onset of atrial pacing and decreasing by 88 +/- 0 7.0% below control. We conclude that different patterns of disturbed myocardial distribution of krypton-81m are present during stress-induced ischemia in patients with coronary artery disease. There was a close temporal relationship between these disturbances and ST-segment depression.

  13. Charge and aggregation pattern govern the interaction of plasticins with LPS monolayers mimicking the external leaflet of the outer membrane of Gram-negative bacteria.

    PubMed

    Michel, J P; Wang, Y X; Dé, E; Fontaine, P; Goldmann, M; Rosilio, V

    2015-11-01

    Bacterial resistance to antibiotics has become today a major public health issue. In the development of new anti-infectious therapies, antimicrobial peptides appear as promising candidates. However, their mechanisms of action against bacterial membranes are still poorly understood. We describe for the first time the interaction and penetration of plasticins into lipid monolayers and bilayers modeling the two leaflets of the asymmetrical outer membrane of Gram-negative bacteria. The lipid composition of these monolayers mimics that of each leaflet: mixtures of LPS Re 595 mutant and wild type S-form from Salmonella enterica for the external leaflet, and SOPE/SOPG/cardiolipin (80/15/5) for the inner one. The analysis of the interfacial behavior of native (PTCDA1) and modified (PTCDA1-KF) antimicrobial plasticins showed that PTCDA1-KF exhibited better surface properties than its unmodified counterpart. Both peptides could penetrate into the model monolayers at concentrations higher than 0.1 μM. The penetration was particularly enhanced for PTCDA1-KF into the mixed LPS monolayer, due to attractive electrostatic interactions. Grazing X-ray diffraction and atomic force microscopy studies revealed the changes in LPS monolayers organization upon peptide insertion. The interaction of plasticins with liposomes was also monitored by light scattering and circular dichroism techniques. Only the cationic plasticin achieved full disaggregation and structuration in α helices, whereas the native one remained aggregated and unstructured. The main steps of the penetration mechanism of the two plasticins into lipid models of the external leaflet of the outer membrane of Gram-negative bacteria have been established. PMID:26343162

  14. Sleep Deprivation Reveals Altered Brain Perfusion Patterns in Somnambulism

    PubMed Central

    Dang-Vu, Thien Thanh; Zadra, Antonio; Labelle, Marc-Antoine; Petit, Dominique; Soucy, Jean-Paul; Montplaisir, Jacques

    2015-01-01

    Background Despite its high prevalence, relatively little is known about the pathophysiology of somnambulism. Increasing evidence indicates that somnambulism is associated with functional abnormalities during wakefulness and that sleep deprivation constitutes an important drive that facilitates sleepwalking in predisposed patients. Here, we studied the neural mechanisms associated with somnambulism using Single Photon Emission Computed Tomography (SPECT) with 99mTc-Ethylene Cysteinate Dimer (ECD), during wakefulness and after sleep deprivation. Methods Ten adult sleepwalkers and twelve controls with normal sleep were scanned using 99mTc-ECD SPECT in morning wakefulness after a full night of sleep. Eight of the sleepwalkers and nine of the controls were also scanned during wakefulness after a night of total sleep deprivation. Between-group comparisons of regional cerebral blood flow (rCBF) were performed to characterize brain activity patterns during wakefulness in sleepwalkers. Results During wakefulness following a night of total sleep deprivation, rCBF was decreased bilaterally in the inferior temporal gyrus in sleepwalkers compared to controls. Conclusions Functional neural abnormalities can be observed during wakefulness in somnambulism, particularly after sleep deprivation and in the inferior temporal cortex. Sleep deprivation thus not only facilitates the occurrence of sleepwalking episodes, but also uncovers patterns of neural dysfunction that characterize sleepwalkers during wakefulness. PMID:26241047

  15. Assessment of the myocardial perfusion pattern in patients with multivessel coronary artery disease

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Segal, B.L.; Kane, S.A.; Amenta, A.

    1983-11-01

    A total of 42 symptomatic patients with coronary artery disease involving two or three vessels were studied using exercise thallium-201 myocardial scintigraphy. Qualitative analysis of the images predicted multivessel disease in 75% of the patients with two-vessel disease and in 82% of the patients with three-vessel disease. Quantitative analysis of the size of the perfusion defect indicated that approximately 40% of the left ventricular perimeter showed abnormal perfusion pattern during stress in these patients, and there was no significant difference in the size of the defect in patients with two-vessel disease or three-vessel disease (41 +/- 17% vs 42 +/- 14%, respectively, mean +/- SD). The exercise heart rate, exercise ECG response, and severity of narrowing did not correlate with the size of the perfusion defect. Patients with anterior infarction had larger defects in the distribution of the left anterior descending artery than those without infarction. Collaterals offered partial protection during exercise only when they were not jeopardized. This study confirms the value of qualitative analysis of exercise thallium-201 imaging in predicting multivessel disease, and describes a simple method of assessing the extent of perfusion abnormalities during stress in patients with multivessel disease. The results may be important in patient management and prognosis.

  16. Patterns of postictal cerebral perfusion in idiopathic generalized epilepsy: a multi-delay multi-parametric arterial spin labelling perfusion MRI study

    PubMed Central

    Chen, Guangxiang; Lei, Du; Ren, Jiechuan; Zuo, Panli; Suo, Xueling; Wang, Danny J. J.; Wang, Meiyun; Zhou, Dong; Gong, Qiyong

    2016-01-01

    The cerebral haemodynamic status of idiopathic generalized epilepsy (IGE) is a very complicated process. Little attention has been paid to cerebral blood flow (CBF) alterations in IGE detected by arterial spin labelling (ASL) perfusion magnetic resonance imaging (MRI). However, the selection of an optimal delay time is difficult for single-delay ASL. Multi-delay multi-parametric ASL perfusion MRI overcomes the limitations of single-delay ASL. We applied multi-delay multi-parametric ASL perfusion MRI to investigate the patterns of postictal cerebral perfusion in IGE patients with absence seizures. A total of 21 IGE patients with absence seizures and 24 healthy control subjects were enrolled. IGE patients exhibited prolonged arterial transit time (ATT) in the left superior temporal gyrus. The mean CBF of IGE patients was significantly increased in the left middle temporal gyrus, left parahippocampal gyrus and left fusiform gyrus. Prolonged ATT in the left superior temporal gyrus was negatively correlated with the age at onset in IGE patients. This study demonstrated that cortical dysfunction in the temporal lobe and fusiform gyrus may be related to epileptic activity in IGE patients with absence seizures. This information can play an important role in elucidating the pathophysiological mechanism of IGE from a cerebral haemodynamic perspective. PMID:27374369

  17. Association between retinal hemorrhagic pattern and macular perfusion status in eyes with acute branch retinal vein occlusion

    PubMed Central

    Muraoka, Yuki; Uji, Akihito; Tsujikawa, Akitaka; Murakami, Tomoaki; Ooto, Sotaro; Suzuma, Kiyoshi; Takahashi, Ayako; Iida, Yuto; Miwa, Yuko; Hata, Masayuki; Yoshimura, Nagahisa

    2016-01-01

    This prospective study included 63 eyes with acute branch retinal vein occlusion (BRVO) to evaluate the retinal hemorrhagic patterns at the posterior poles and explore their clinical relevance in macular perfusion differentiation. Retinal hemorrhagic patterns and macular perfusion status were evaluated via fundus photography and fluorescein angiography, respectively. Macular perfusion was judged as nonischemic in 30, ischemic in 28, and undeterminable in 5 among the 63 eyes. Predominant hemorrhagic patterns were flame-shaped in 39 (67.2%) and non-flame-shaped in 19 (32.8%) eyes. All 39 eyes with a flame-shaped hemorrhage showed a nonischemic macula. Of the 19 eyes classified as having a non-flame-shaped hemorrhage, 13 (68.4%) had an ischemic macula and 6 (31.6%) had a nonischemic macula (P < 0.001). Parallelism in eyes with a flame-shaped hemorrhage was higher than in those with a non-flame-shaped hemorrhage (P < 0.001), and in those with a nonischemic macula versus those with an ischemic macula (P < 0.001). The area under the curve for parallelism was 0.975 (P < 0.001), suggesting an accurate diagnostic parameter for macular perfusion differentiation. In conclusion, we objectively evaluated retinal hemorrhagic patterns at the posterior pole in BRVO using the parallelism method, which was useful in differentiating macular perfusion status. PMID:27334338

  18. Optimal Design of Aortic Leaflet Prosthesis

    NASA Technical Reports Server (NTRS)

    Ghista, Dhanjoo N.; Reul, Helmut; Ray, Gautam; Chandran, K. B.

    1978-01-01

    The design criteria for an optimum prosthetic-aortic leaflet valve are a smooth washout in the valve cusps, minimal leaflet stress, minimal transmembrane pressure for the valve to open, an adequate lifetime (for a given blood-compatible leaflet material's fatigue data). A rigorous design analysis is presented to obtain the prosthetic tri-leaflet aortic valve leaflet's optimum design parameters. Four alternative optimum leaflet geometries are obtained to satisfy the criteria of a smooth washout and minimal leaflet stress. The leaflet thicknesses of these four optimum designs are determined by satisfying the two remaining design criteria for minimal transmembrane opening pressure and adequate fatigue lifetime, which are formulated in terms of the elastic and fatigue properties of the selected leaflet material - Avcothane-51 (of the Avco-Everett Co. of Massachusetts). Prosthetic valves are fabricated on the basis of the optimum analysis and the resulting detailed engineering drawings of the designs are also presented in the paper.

  19. Document of the Month: German Propaganda Leaflets

    ERIC Educational Resources Information Center

    Byers, CeCe; Alexander, Mary

    1978-01-01

    Excerpts from two propaganda leaflets distributed by Germany during World War I to demoralize American soldiers. Teaching suggestions encourage students to examine the leaflets' tone, guess who the authors might have been, and analyze the leaflets as examples of a propaganda technique. (AV)

  20. Cortical electrical stimulation alters erythrocyte perfusion pattern in the cerebral capillary network of the rat.

    PubMed

    Schulte, M L; Wood, J D; Hudetz, A G

    2003-02-14

    The effect of direct cortical electrical stimulation on the pattern of erythrocyte perfusion in the capillary network of the rat cerebral cortex was studied by fluorescence intravital video-microscopy. The movement of fluorescently labeled red blood cells (FRBCs) in individual capillaries 50-70 microm subsurface in the dorsal somatosensory cortex was visualized using a closed cranial window. Cortical stimulation electrodes were placed on opposite sides of the window. FRBC velocity (mm/s) and supply rate (cells/s) were measured in 51 capillaries from six rats before and during electrical stimulation of increasing intensities (15-s trains of 3-Hz, 3-ms, 0.5-5.0-mA, square pulses). FRBC velocity, supply rate, and the instantaneous capillary erythrocyte content (lineal cell density, LCD, cells/mm) increased with the stimulation current and reached maxima of 110, 160 and 33% above control, respectively. Capillaries with low resting velocity showed a greater response than those with high resting velocity. The fraction of capillaries in which FRBC velocity increased was not constant, but increased with the stimulation current, as did the magnitude of the velocity change in these capillaries. A few capillaries showed a negative FRBC velocity response at stimulations <4 mA. These results suggest that a robust rise in the fraction of responding (engaged) capillaries and a smaller rise in the capillary LCD contribute to neuronal activation-induced cortical hyperemia. Thus, capillary engagement and erythrocyte recruitment appear to represent important components of the cortical functional hyperemic response. These results provide insight into some of the specific hemodynamic changes associated with functional hyperemia occurring at the capillary level. PMID:12560113

  1. Rapid casting of patterned vascular networks for perfusable engineered three-dimensional tissues

    NASA Astrophysics Data System (ADS)

    Miller, Jordan S.; Stevens, Kelly R.; Yang, Michael T.; Baker, Brendon M.; Nguyen, Duc-Huy T.; Cohen, Daniel M.; Toro, Esteban; Chen, Alice A.; Galie, Peter A.; Yu, Xiang; Chaturvedi, Ritika; Bhatia, Sangeeta N.; Chen, Christopher S.

    2012-09-01

    In the absence of perfusable vascular networks, three-dimensional (3D) engineered tissues densely populated with cells quickly develop a necrotic core. Yet the lack of a general approach to rapidly construct such networks remains a major challenge for 3D tissue culture. Here, we printed rigid 3D filament networks of carbohydrate glass, and used them as a cytocompatible sacrificial template in engineered tissues containing living cells to generate cylindrical networks that could be lined with endothelial cells and perfused with blood under high-pressure pulsatile flow. Because this simple vascular casting approach allows independent control of network geometry, endothelialization and extravascular tissue, it is compatible with a wide variety of cell types, synthetic and natural extracellular matrices, and crosslinking strategies. We also demonstrated that the perfused vascular channels sustained the metabolic function of primary rat hepatocytes in engineered tissue constructs that otherwise exhibited suppressed function in their core.

  2. Longitudinal Changes in Tumor Perfusion Pattern during the Radiation Therapy Course and its Clinical Impact in Cervical Cancer

    SciTech Connect

    Mayr, Nina A.; Wang, Jian Z.; Zhang, Dongqing; Grecula, John C.; Lo, Simon S.; Jaroura, David; Montebello, Joseph; Zhang Hualin; Li, Kaile; Lu, Lanchun; Huang Zhibin; Fowler, Jeffery M.; Wu, Dee H.; Knopp, Michael V.; Yuh, William T.C.

    2010-06-01

    Purpose: To study the temporal changes of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion patterns during the radiation therapy (RT) course and their influence on local control and survival in cervical cancer. Methods and Materials: DCE-MRI was performed in 98 patients with Stage IB{sub 2}-IVA cervical cancer before RT (pre-RT) and during early RT (20-25 Gy) and mid-RT (45-50 Gy). Signal intensity (SI) from the DCE-MRI time-SI curve was derived for each tumor voxel. The poorly perfused low-DCE tumor subregions were quantified as lower 10th percentiles of SI (SI10). Local control, disease-specific survival, and overall survival were correlated with DCE parameters at pre-RT, early RT, and mid-RT. Median follow-up was 4.9 (range, 0.2-9.0) years. Results: Patients (16/98) with initial pre-RT high DCE (SI10 >=2.1) had 100% 5-year local control, 81% disease-specific survival, and 81% overall survival, compared with only 79%, 61%, and 55%, respectively, in patients with pre-RT low DCE. Conversion from pre-RT low DCE to high DCE in early RT (28/82 patients) was associated with higher local control, disease-specific survival, and overall survival (93%, 74%, and 67%, respectively). In comparison with all other groups, outcome was worst in patients with persistently low DCE from pre-RT throughout the mid-RT phase (66%, 44%, and 43%; p = 0.003, 0.003, and 0.020; respectively). Conclusion: Longitudinal tumor perfusion changes during RT correlate with treatment outcome. Persistently low perfusion in pre-RT, early RT, and mid-RT indicates a high risk of treatment failure, whereas outcome is favorable in patients with initially high perfusion or subsequent improvements of initially low perfusion. These findings likely reflect reoxygenation and may have potential for noninvasive monitoring of intra-treatment radio-responsiveness and for guiding adaptive therapy.

  3. Patients’ views on electronic patient information leaflets

    PubMed Central

    2015-01-01

    Background: Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future. Objective: To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version. Methods: The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15). Results: The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients. Conclusion: Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet. PMID:27382423

  4. Pattern of Hemodynamic Impairment in Multiple Sclerosis: Dynamic Susceptibility Contrast Perfusion MR Imaging at 3.0 T

    PubMed Central

    Adhya, Sumita; Johnson, Glyn; Herbert, Joseph; Jaggi, Hina; Babb, James S.; Grossman, Robert I.; Inglese, Matilde

    2006-01-01

    This study aimed to determine regional pattern of tissue perfusion in the normal-appearing white matter (NAWM) of patients with primary-progressive (PP), relapsing-remitting (RR) multiple sclerosis (MS) and healthy controls, and to investigate the association between perfusion abnormalities and clinical disability. Using dynamic susceptibility contrast (DSC) perfusion MRI at 3 Tesla, we studied twenty-two patients with clinically definite MS, eleven with PP-MS and eleven with RR-MS and eleven age- and gender-matched healthy volunteers. The MRI protocol included axial dual-echo, dynamic susceptibility contrast enhanced (DSC) T2*-weighted and post-contrast T1-weighted images. Absolute cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the periventricular, frontal, occipital NAWM, and in the splenium of the corpus callosum. Compared to controls, CBF and CBV were significantly lower in all NAWM regions in both PP-MS patients (p values from <0.0001 to 0.001) and RR-MS (p values from <0.0001 to 0.020). Compared to RR-MS, PP-MS patients showed significantly lower CBF in the periventricular NAWM (p= 0.002) and lower CBV in the periventricular and frontal NAWM (p values: 0.0029 and 0.022). EDSS was significantly correlated with the periventricular CBF (r=−0.48, p=0.0016) and with the periventricular and frontal CBV (r=−0.42, p=0.015; r=−0.35, p=0.038, respectively). This study suggests that the hemodynamic abnormalities of NAWM have clinical relevance in patients with MS. DSC perfusion MRI might provide a relevant objective measure of disease activity and treatment efficacy. PMID:16996280

  5. Resting cerebral glucose metabolism and perfusion patterns in women with posttraumatic stress disorder related to sexual assault.

    PubMed

    Kim, Shin-Young; Chung, Young-Ki; Kim, Bom Sahn; Lee, Su Jin; Yoon, Joon-Kee; An, Young-Sil

    2012-03-31

    In the literature, numerous trials using neuroimaging techniques have investigated brain function in patients with post-traumatic stress disorder (PTSD). However, the contrasting results showed that improvements, including in the study design, were required to reach consistent and convincing conclusions. This study evaluated the functional neuroimaging pattern of resting cerebral blood flow and glucose metabolism in patients with PTSD related to sexual assault. Twelve patients were enrolled for both brain single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose positron emission tomography (PET) investigations. All data were analyzed with statistical parametric mapping 2 (SPM2). The PTSD patients showed significant relative decreases in perfusion in the left hippocampus and in the basal ganglia compared with the control group. The PTSD group also had significantly lower cerebral glucosemetabolic activity in the left hippocampus and the superior temporal and precentral gyri than in the control group. These specific patterns of perfusion and glucose metabolism may be closely related to various neurophysiologic symptoms of PTSD. PMID:22464826

  6. Epithelial and Mesenchymal Tumor Compartments Exhibit In Vivo Complementary Patterns of Vascular Perfusion and Glucose Metabolism1

    PubMed Central

    Galie, Mirco; Farace, Paolo; Nanni, Cristina; Spinelli, Antonello; Nicolato, Elena; Boschi, Federico; Magnani, Paolo; Trespidi, Silvia; Ambrosini, Valentina; Fanti, Stefano; Merigo, Flavia; Osculati, Francesco; Marzola, Pasquina; Sbarbati, Andrea

    2007-01-01

    Glucose transport and consumption are increased in tumors, and this is considered a diagnostic index of malignancy. However, there is recent evidence that carcinoma-associated stromal cells are capable of aerobic metabolism with low glucose consumption, at least partly because of their efficient vascular supply. In the present study, using dynamic contrast-enhanced magnetic resonance imaging and [F-18]fluorodeoxyglucose (FDG) positron emission tomography (PET), we mapped in vivo the vascular supply and glucose metabolism in syngeneic experimental models of carcinoma and mesenchymal tumor. We found that in both tumor histotypes, regions with high vascular perfusion exhibited a significantly lower FDG uptake. This reciprocity was more conspicuous in carcinomas than in mesenchymal tumors, and regions with a high-vascular/low-FDG uptake pattern roughly overlapped with a stromal capsule and intratumoral large connectival septa. Accordingly, mesenchymal tumors exhibited a higher vascular perfusion and a lower FDG uptake than carcinomas. Thus, we provide in vivo evidence of vascular/metabolic reciprocity between epithelial and mesenchymal histotypes in tumors, suggesting a new intriguing aspect of epithelial-stromal interaction. Our results suggests that FDG-PET-based clinical analysis can underestimate the malignity or tumor extension of carcinomas exhibiting any trait of “mesenchymalization” such as desmoplasia or epithelial-mesenchymal transition. PMID:18030358

  7. Penumbra Pattern Assessment in Acute Stroke Patients: Comparison of Quantitative and Non-Quantitative Methods in Whole Brain CT Perfusion

    PubMed Central

    Baumann, Alena B.; Meinel, Felix G.; Helck, Andreas D.; Opherk, Christian; Straube, Andreas; Reiser, Maximilian F.; Sommer, Wieland H.

    2014-01-01

    Background And Purpose While penumbra assessment has become an important part of the clinical decision making for acute stroke patients, there is a lack of studies measuring the reliability and reproducibility of defined assessment techniques in the clinical setting. Our aim was to determine reliability and reproducibility of different types of three-dimensional penumbra assessment methods in stroke patients who underwent whole brain CT perfusion imaging (WB-CTP). Materials And Methods We included 29 patients with a confirmed MCA infarction who underwent initial WB-CTP with a scan coverage of 100 mm in the z-axis. Two blinded and experienced readers assessed the flow-volume-mismatch twice and in two quantitative ways: Performing a volumetric mismatch analysis using OsiriX imaging software (MMVOL) and visual estimation of mismatch (MMEST). Complementarily, the semiquantitative Alberta Stroke Programme Early CT Score for CT perfusion was used to define mismatch (MMASPECTS). A favorable penumbral pattern was defined by a mismatch of ≥30% in combination with a cerebral blood flow deficit of ≤90 ml and an MMASPECTS score of ≥1, respectively. Inter- and intrareader agreement was determined by Kappa-values and ICCs. Results Overall, MMVOL showed considerably higher inter-/intrareader agreement (ICCs: 0.751/0.843) compared to MMEST (0.292/0.749). In the subgroup of large (≥50 mL) perfusion deficits, inter- and intrareader agreement of MMVOL was excellent (ICCs: 0.961/0.942), while MMEST interreader agreement was poor (0.415) and intrareader agreement was good (0.919). With respect to penumbra classification, MMVOL showed the highest agreement (interreader agreement: 25 agreements/4 non-agreements/κ: 0.595; intrareader agreement 27/2/0.833), followed by MMEST (22/7/0.471; 23/6/0.577), and MMASPECTS (18/11/0.133; 21/8/0.340). Conclusion The evaluated approach of volumetric mismatch assessment is superior to pure visual and ASPECTS penumbra pattern assessment in WB

  8. Perfusion functional MRI reveals cerebral blood flow pattern under psychological stress

    NASA Astrophysics Data System (ADS)

    Wang, Jiongjiong; Rao, Hengyi; Wetmore, Gabriel S.; Furlan, Patricia M.; Korczykowski, Marc; Dinges, David F.; Detre, John A.

    2005-12-01

    Despite the prevalence of stress in everyday life and its impact on happiness, health, and cognition, little is known about the neural substrate of the experience of everyday stress in humans. We use a quantitative and noninvasive neuroimaging technique, arterial spin-labeling perfusion MRI, to measure cerebral blood flow (CBF) changes associated with mild to moderate stress induced by a mental arithmetic task with performance monitoring. Elicitation of stress was verified by self-report of stress and emotional state and measures of heart rate and salivary-cortisol level. The change in CBF induced by the stress task was positively correlated with subjective stress rating in the ventral right prefrontal cortex (RPFC) and left insula/putamen area. The ventral RPFC along with right insula/putamen and anterior cingulate showed sustained activation after task completion in subjects reporting a high stress level during arithmetic tasks. Additionally, variations of baseline CBF in the ventral RPFC and right orbitofrontal cortex were found to correlate with changes in salivary-cortisol level and heart rate caused by undergoing stress tasks. We further demonstrated that the observed right prefrontal activation could not be attributed to increased cognitive demand accompanying stress tasks and extended beyond neural pathways associated with negative emotions. Our results provide neuroimaging evidence that psychological stress induces negative emotion and vigilance and that the ventral RPFC plays a key role in the central stress response. anterior cingulate cortex | arterial spin labeling | right prefrontal cortex

  9. Perfusion functional MRI reveals cerebral blood flow pattern under psychological stress

    PubMed Central

    Wang, Jiongjiong; Rao, Hengyi; Wetmore, Gabriel S.; Furlan, Patricia M.; Korczykowski, Marc; Dinges, David F.; Detre, John A.

    2005-01-01

    Despite the prevalence of stress in everyday life and its impact on happiness, health, and cognition, little is known about the neural substrate of the experience of everyday stress in humans. We use a quantitative and noninvasive neuroimaging technique, arterial spin-labeling perfusion MRI, to measure cerebral blood flow (CBF) changes associated with mild to moderate stress induced by a mental arithmetic task with performance monitoring. Elicitation of stress was verified by self-report of stress and emotional state and measures of heart rate and salivary-cortisol level. The change in CBF induced by the stress task was positively correlated with subjective stress rating in the ventral right prefrontal cortex (RPFC) and left insula/putamen area. The ventral RPFC along with right insula/putamen and anterior cingulate showed sustained activation after task completion in subjects reporting a high stress level during arithmetic tasks. Additionally, variations of baseline CBF in the ventral RPFC and right orbitofrontal cortex were found to correlate with changes in salivary-cortisol level and heart rate caused by undergoing stress tasks. We further demonstrated that the observed right prefrontal activation could not be attributed to increased cognitive demand accompanying stress tasks and extended beyond neural pathways associated with negative emotions. Our results provide neuroimaging evidence that psychological stress induces negative emotion and vigilance and that the ventral RPFC plays a key role in the central stress response. PMID:16306271

  10. Techniques of autologous pericardial leaflet replacement for aortic valve reconstruction.

    PubMed

    Rankin, J Scott; Nöbauer, Christian; Crooke, Philip S; Schreiber, Christian; Lange, Rüdiger; Mazzitelli, Domenico

    2014-08-01

    Glutaraldehyde-fixed autologous pericardium rarely calcifies or retracts, and it is a useful substitute for cardiac valve leaflets. Current understanding of aortic valve geometry provides good models for aortic leaflet design, and pericardial leaflet construction is illustrated in this article for bicuspid and tri-leaflet valves. Outcomes have been characterized by low valve-related complication rates, and results of recent series are encouraging. Perhaps sufficient data are available to consider autologous pericardial leaflet replacement in highly selected younger patients with irreparable leaflets and contraindications to warfarin. PMID:25087813

  11. Heterogeneity of Mitral Leaflet Matrix Composition and Turnover Correlates with Regional Leaflet Strain.

    PubMed

    Stephens, Elizabeth H; Connell, Patrick S; Fahrenholtz, Monica M; Timek, Tomasz A; Daughters, George T; Kuo, Joyce J; Patton, Aaron M; Ingels, Neil B; Miller, D Craig; Grande-Allen, K Jane

    2015-06-01

    To determine how extracellular matrix and contractile valvular cells contribute to the heterogeneous motion and strain across the mitral valve (MV) during the cardiac cycle, regional MV material properties, matrix composition, matrix turnover, and cell phenotype were related to regional leaflet strain. Radiopaque markers were implanted into 14 sheep to delineate the septal (SEPT), lateral (LAT), and anterior and posterior commissural leaflets (ANT-C, POST-C). Videofluoroscopy imaging was used to calculate radial and circumferential strains. Mechanical properties were assessed using uniaxial tensile testing and micropipette aspiration. Matrix composition and cell phenotypes were immunohistochemically evaluated within each leaflet region [basal leaflet (BL), mid-leaflet (ML), and free edge]. SEPT-BL segments were stiffer and stronger than other valve tissues, while LAT segments demonstrated more extensibility and strain. Collagens I and III in SEPT were greater than in LAT, although LAT showed greater collagen turnover [matrix metalloprotease (MMP)-13, lysyl oxidase] and cell activation [smooth muscle alpha-actin (SMaA), and non-muscle myosin (NMM)]. MMP13, NMM, and SMaA were strongly correlated with each other, as well as with radial and circumferential strains in both SEPT and LAT. SMaA and MMP13 in POST-C ML was greater than ANT-C, corresponding to greater radial strains in POST-C. This work directly relates leaflet strain, material properties, and matrix turnover, and suggests a role for myofibroblasts in the heterogeneity of leaflet composition and strain. New approaches to MV repair techniques and ring design should preserve this normal coupling between leaflet composition and motion. PMID:26213589

  12. Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; McPherson, David D.; Kim, Hyunggun

    2015-01-01

    Posterior leaflet prolapse following chordal elongation or rupture is one of the primary valvular diseases in patients with degenerative mitral valves (MVs). Quadrangular resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of posterior leaflet prolapse. Virtual MV repair simulation of leaflet resection in association with patient-specific 3D echocardiographic data can provide quantitative biomechanical and physiologic characteristics of pre- and post-resection MV function. We have developed a solid personalized computational simulation protocol to perform virtual MV repair using standard clinical guidelines of posterior leaflet resection with annuloplasty ring implantation. A virtual MV model was created using 3D echocardiographic data of a patient with posterior chordal rupture and severe mitral regurgitation. A quadrangle-shaped leaflet portion in the prolapsed posterior leaflet was removed, and virtual plication and suturing were performed. An annuloplasty ring of proper size was reconstructed and virtual ring annuloplasty was performed by superimposing the ring and the mitral annulus. Following the quadrangular resection and ring annuloplasty simulations, patient-specific annular motion and physiologic transvalvular pressure gradient were implemented and dynamic finite element simulation of MV function was performed. The pre-resection MV demonstrated a substantial lack of leaflet coaptation which directly correlated with the severe mitral regurgitation. Excessive stress concentration was found along the free marginal edge of the posterior leaflet involving the chordal rupture. Following the virtual resection and ring annuloplasty, the severity of the posterior leaflet prolapse markedly decreased. Excessive stress concentration disappeared over both anterior and posterior leaflets, and complete leaflet coaptation was effectively restored. This novel personalized virtual MV repair strategy has great

  13. Ethylene Production and Leaflet Abscission in Mèlia azédarach L. 1

    PubMed Central

    Morgan, Page W.; Durham, James I.

    1980-01-01

    Ethylene production or content was compared to leaflet abscission in detached, compound leaves of Mèlia azédarach L. In late autumn, when abscission was progressing from basal leaves upward, the oldest leaves both produced ethylene at the highest rates and abscised their leaflets first. When C2H4 levels were measured in intercellular air removed immediately after leaves were harvested, C2H4 levels were also highest in basal leaves and declined progressively in more apical leaves. Levels as high as 1.8 microliters C2H4 liter−1 air were observed. Earlier in the season groups of leaves demonstrated a pattern of sequential initiation of abscission from base to apex, but the peak rates of C2H4 production followed an opposite trend, being highest in the youngest leaves. Peak rates of C2H4 production occurred after the initiation of leaflet abscission and presumably are related to either the auxin content or a climacteric-like, autocatalytic phase of C2H4 production not directly involved in the initiation of abscission. In these experiments, the early abscission of the older leaflets reflects their greater sensitivity to C2H4, presumably due to lower auxin content. C2H4 production rates in all experiments, with rare exceptions, exceeded 3 microliters per kilogram fresh weight per hour at least 24 hours before leaflet abscission reached 10%. This achieving of a threshold internal C2H4 level is viewed as an initiating event in leaflet abscission. Hypobaric conditions, to facilitate the escape of endogenous C2H4, delayed abscission compared to controls, and termination of hypobaric exposure allowed a normal progression of abscission as well as normal C2H4 synthesis rates. All of the data indicate that C2H4 initiates leaflet abscission in intact but detached leaves of Mèlia azédarach L. The seasonal patterns observed suggest that C2H4, in concert with those hormones which govern sensitivity to C2H4, regulate autumn leaf fall in this species. PMID:16661401

  14. Multitracer study in Heidenhain variant of Creutzfeldt-Jakob disease: mismatch pattern of cerebral hypometabolism and perfusion imaging.

    PubMed

    Pichler, Robert; Ciovica, Ioana; Rachinger, Johanna; Weiss, Serge; Aichner, Franz T

    2008-02-01

    Creutzfeldt-Jakob disease (CJD) is a subacute spongiform encephalopathy. This fatal prion disease is characterized by rapidly progressive dementia with a variety of neurological disorders. Diagnostic methods provided by nuclear medicine might be helpful for evaluation of patients with probable CJD as additional diagnostic tools to MRI and cerebro-spinal fluid evaluation. The experience with FDG-PET and brain perfusion SPECT is presented. PMID:18283251

  15. Leaflet escape in a revised Edwards-Duromedics mitral prosthesis.

    PubMed

    Mert, Murat; Ozkara, Ahmet; Hatemi, AliCan

    2003-07-01

    The original Duromedics-Edwards bileaflet valve was withdrawn from the market in 1988 after 12 reports of leaflet escape. The leaflet was modified by the manufacturer, and the revised Edwards-Duromedics and Edwards TEKNA valves were introduced in 1990 and 1993, respectively. However, problems of leaflet escape have now been reported with the new models. A case is reported of sudden leaflet fracture of a revised Duromedics mitral valve 86 months after implantation; this was managed successfully by emergency replacement with a St. Jude Medical mechanical prosthesis. The fracture had occurred transversely, with the two fragments embolizing bilaterally to the right common iliac and left external iliac arteries. In the absence of an exact diagnosis, but with a high index of suspicion, the key to survival of patients with leaflet escape is immediate reoperation. PMID:12918855

  16. Congenital absence of pulmonary valve leaflets.

    PubMed Central

    Buendia, A; Attie, F; Ovseyevitz, J; Zghaib, A; Zamora, C; Zavaleta, D; Vargas-Barron, J; Richheimer, R

    1983-01-01

    Congenital absence of pulmonary valve leaflets is an uncommon condition usually associated with ventricular septal defect and an obstructive pulmonary valve ring. Twenty-one patients with these malformations are described. Twenty had an associated ventricular septal defect with ventriculoarterial concordance, and one also had transposition of the great arteries, ventricular septal defect, and obstructive pulmonary valve ring. The clinical features, cardiac catheterisation findings, and angiocardiographic results are presented. Twelve patients underwent cardiac surgery. Three patients died, one in the early, and the other two in the late postoperative period. The results, according to the surgical technique employed and postoperative cardiac catheterisation findings, showed that patients in whom the bioprostheses were implanted in the pulmonary position had a better late follow-up. Images PMID:6860509

  17. Is Posterior Leaflet Extension and Associated Commissurotomy

    PubMed Central

    Omeroglu, Suat Nail; Kirali, Kaan; Mansuroglu, Denyan; Goksedef, Deniz; Balkanay, Mehmet; Ipek, Gokhan; Isik, Omer; Yakut, Cevat

    2004-01-01

    In this prospective study, the long-term effect of posterior leaflet extension with glutaraldehyde-preserved autologous pericardium and associated mitral valve commissurotomy was investigated in patients with mixed mitral valve disease of rheumatic origin. Mitral commissurotomy and posterior leaflet extension using a pericardial patch were performed in 25 patients from 1 January 1994 through 31 December 1995 for mixed mitral valve disease. Preoperatively, no patient had chordal rupture or papillary muscle dysfunction. Four patients had left atrial thrombosis. The mean age was 35.7 ± 15.4 years. Associated procedures were tricuspid annuloplasty in 4 patients, aortic annuloplasty in 3, aortic and tricuspid annuloplasty in 1, and aortic homograft replacement in 1. There were no early deaths. One patient died 2 years after surgery due to noncardiac causes. Mitral valve area increased from 1.53 ± 0.63 cm2 to 2 ± 0.33 cm2 (P = 0.09), and left atrial diameter decreased from 5.8 ± 1 cm to 4.86 ± 1.27 cm (P = 0.07) after 6.1 ± 0.7 years (range, 5.5 to 7.1 years). Mitral insufficiency was reduced significantly, from grade 2.65 ± 0.9 to grade 1.2 ± 0.9 (P = 0.007). Functional capacity improved in all patients (New York Heart Association functional class, 3 ± 0.58 preoperatively vs 1.44 ± 0.82 postoperatively; P = 0.001). Three patients required reoperation and valve replacement. This type of reconstruction may be a good alternative for patients who are not able to use anticoagulant therapy. Long-term results of this technique are acceptable; however, the risk of reoperation is an important disadvantage in these young patients. PMID:15562843

  18. A Parametric Computational Study of the Impact of Non-circular Configurations on Bioprosthetic Heart Valve Leaflet Deformations and Stresses: Possible Implications for Transcatheter Heart Valves.

    PubMed

    Duraiswamy, Nandini; Weaver, Jason D; Ekrami, Yasamin; Retta, Stephen M; Wu, Changfu

    2016-06-01

    Although generally manufactured as circular devices with symmetric leaflets, transcatheter heart valves can become non-circular post-implantation, the impact of which on the long-term durability of the device is unclear. We investigated the effects of five non-circular (EllipMajor, EllipMinor, D-Shape, TriVertex, TriSides) annular configurations on valve leaflet stresses and valve leaflet deformations through finite element analysis. The highest in-plane principal stresses and strains were observed under an elliptical configuration with an aspect ratio of 1.25 where one of the commissures was on the minor axis of the ellipse. In this elliptical configuration (EllipMinor), the maximum principal stress increased 218% and the maximum principal strain increased 80% as compared with those in the circular configuration, and occurred along the free edge of the leaflet whose commissures were not on the minor axis (i.e., the "stretched" leaflet). The D-Shape configuration was similar to this elliptical configuration, with the degree to which the leaflets were stretched or sagging being less than the EllipMinor configuration. The TriVertex and TriSides configurations had similar leaflet deformation patterns in all three leaflets and similar to the Circular configuration. In the D-Shape, TriVertex, and TriSides configurations, the maximum principal stress was located near the commissures similar to the Circular configuration. In the EllipMinor and EllipMajor configurations, the maximum principal stress occurred near the center of the free edge of the "stretched" leaflets. These results further affirm recommendations by the International Standards Organization (ISO) that pre-clinical testing should consider non-circular configurations for transcatheter valve durability testing. PMID:26864541

  19. On the Biaxial Mechanical Response of Porcine Tricuspid Valve Leaflets.

    PubMed

    Amini Khoiy, Keyvan; Amini, Rouzbeh

    2016-10-01

    Located on the right side of the heart, the tricuspid valve (TV) prevents blood backflow from the right ventricle to the right atrium. Similar to other cardiac valves, quantification of TV biaxial mechanical properties is essential in developing accurate computational models. In the current study, for the first time, the biaxial stress-strain behavior of porcine TV was measured ex vivo under different loading protocols using biaxial tensile testing equipment. The results showed a highly nonlinear response including a compliant region followed by a rapid transition to a stiff region for all of the TV leaflets both in the circumferential and in the radial directions. Based on the data analysis, all three leaflets were found to be anisotropic, and they were stiffer in the circumferential direction in comparison to the radial direction. It was also concluded that the posterior leaflet was the most anisotropic leaflet. PMID:27538260

  20. Fatal leaflet escape in an Edwards TEKNA aortic prosthesis.

    PubMed

    Pfeiffer, Heidi; Bertolini, Julia; Scheld, Hans Heinrich; Brinkmann, Bernd

    2006-01-01

    The case is reported of a 26-year-old male patient who died eight years after the replacement of an aortic valve with a bileaflet mechanical valve (TEKNA; Edwards, USA). Following prosthesis implantation, the patient had been in a good state of health, and his death occurred unexpectedly. Forensic autopsy revealed a leaflet escape, with two fragments of the leaflet being found bilaterally in the common iliac arteries. Death occurred due to an acute cardiac insufficiency. Immunohistochemical investigations revealed fresh myocardial fiber necroses. Stereomicroscopic and scanning electron microscopic investigations demonstrated surface erosions of the leaflet. Although the valve was withdrawn from the market in June 2000, it had previously been implanted in over 18,000 patients. Thus, from a clinical viewpoint, the question of using a prophylactic replacement in affected patients must be discussed. PMID:16480019

  1. INTERLAYER MICROMECHANICS OF THE AORTIC HEART VALVE LEAFLET

    PubMed Central

    Buchanan, Rachel M.; Sacks, Michael S.

    2014-01-01

    While the mechanical behaviors of the fibrosa and ventricularis layers of the aortic valve (AV) leaflet are understood, little information exists on their mechanical interactions mediated by the GAG-rich central spongiosa layer. Parametric simulations of the interlayer interactions of the AV leaflets in flexure utilized a tri-layered finite element (FE) model of circumferentially oriented tissue sections to investigate inter-layer sliding hypothesized to occur. Simulation results indicated that the leaflet tissue functions as a tightly bonded structure when the spongiosa effective modulus was at least 25% that of the fibrosa and ventricularis layers. Novel studies that directly measured transmural strain in flexure of AV leaflet tissue specimens validated these findings. Interestingly, a smooth transmural strain distribution indicated that the layers of the leaflet indeed act as a bonded unit, consistent with our previous observations (Stella and Sacks, 2007) of a large number of transverse collagen fibers interconnecting the fibrosa and ventricularis layers. Additionally, when the tri-layered FE model was refined to match the transmural deformations, a layer-specific bimodular material model (resulting in four total moduli) accurately matched the transmural strain and moment-curvature relations simultaneously. Collectively, these results provide evidence, contrary to previous assumptions, that the valve layers function as a bonded structure in the low-strain flexure deformation mode. Most likely, this results directly from the transverse collagen fibers that bind the layers together to disable physical sliding and maintain layer residual stresses. Further, the spongiosa may function as a general dampening layer while the AV leaflets deforms as a homogenous structure despite its heterogeneous architecture. PMID:24292631

  2. Three-Dimensional Echocardiography-based Prediction of Posterior Leaflet Resection

    PubMed Central

    Rim, Yonghoon; Choi, Ahnryul; Laing, Susan T.; McPherson, David D.; Kim, Hyunggun

    2014-01-01

    Clinical long-term outcomes have shown that partial leaflet resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of mitral valve (MV) leaflet prolapse. We report a 61-year-old male for three-dimensional transesophageal echocardiography (3D TEE)-based virtual posterior leaflet resection and ring annuloplasty. Severe mitral regurgitation was found and computational evaluation demonstrated substantial leaflet malcoaptation and high stress concentration. Following virtual resection and ring annuloplasty, posterior leaflet prolapse markedly decreased, sufficient leaflet coaptation was restored, and high stress concentration disappeared. Virtual MV repair strategies using 3D TEE have the potential to help optimize MV repair. PMID:25109487

  3. Ln Is a Key Regulator of Leaflet Shape and Number of Seeds per Pod in Soybean[W

    PubMed Central

    Jeong, Namhee; Suh, Su Jeoung; Kim, Min-Hee; Lee, Seukki; Moon, Jung-Kyung; Kim, Hong Sig; Jeong, Soon-Chun

    2012-01-01

    Narrow leaflet soybean (Glycine max) varieties tend to have more seeds per pod than broad leaflet varieties. Narrow leaflet in soybean is conferred by a single recessive gene, ln. Here, we show that the transition from broad (Ln) to narrow leaflet (ln) is associated with an amino acid substitution in the EAR motif encoded by a gene (designated Gm-JAGGED1) homologous to Arabidopsis JAGGED (JAG) that regulates lateral organ development and the variant exerts a pleiotropic effect on fruit patterning. The genomic region that regulates both the traits was mapped to a 12.6-kb region containing only one gene, Gm-JAG1. Introducing the Gm-JAG1 allele into a loss-of-function Arabidopsis jagged mutant partially restored the wild-type JAG phenotypes, including leaf shape, flower opening, and fruit shape, but the Gm-jag1 (ln) and EAR-deleted Gm-JAG1 alleles in the jagged mutant did not result in an apparent phenotypic change. These observations indicate that despite some degree of functional change of Gm-JAG1 due to the divergence from Arabidopsis JAG, Gm-JAG1 complemented the functions of JAG in Arabidopsis thaliana. However, the Gm-JAG1 homoeolog, Gm-JAG2, appears to be sub- or neofunctionalized, as revealed by the differential expression of the two genes in multiple plant tissues, a complementation test, and an allelic analysis at both loci. PMID:23243125

  4. Diffusion in phospholipid bilayer membranes: dual-leaflet dynamics and the roles of tracer–leaflet and inter-leaflet coupling

    PubMed Central

    Hill, Reghan J.; Wang, Chih-Ying

    2014-01-01

    A variety of observations—sometimes controversial—have been made in recent decades when attempting to elucidate the roles of interfacial slip on tracer diffusion in phospholipid membranes. Evans–Sackmann theory (1988) has furnished membrane viscosities and lubrication-film thicknesses for supported membranes from experimentally measured lateral diffusion coefficients. Similar to the Saffman and Delbrück model, which is the well-known counterpart for freely supported membranes, the bilayer is modelled as a single two-dimensional fluid. However, the Evans–Sackman model cannot interpret the mobilities of monotopic tracers, such as individual lipids or rigidly bound lipid assemblies; neither does it account for tracer–leaflet and inter-leaflet slip. To address these limitations, we solve the model of Wang and Hill, in which two leaflets of a bilayer membrane, a circular tracer and supports are coupled by interfacial friction, using phenomenological friction/slip coefficients. This furnishes an exact solution that can be readily adopted to interpret the mobilities of a variety of mosaic elements—including lipids, integral monotopic and polytopic proteins, and lipid rafts—in supported bilayer membranes. PMID:25002822

  5. Relationship between leaflet nitrogen: Potassium ratio and yield of pecan

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study examines the relationship between foliar N:K ratio and nutmeat yield of ‘Desirable’ [Carya illinoinensis (Wangenh) K. Koch] pecan. Regression analysis of linear and curvilinear relationships between leaflet N:K ratio and in-shell yield identified associations relevant to orchard nutrition...

  6. Stem versus leaflet inoculation of peanut with Sclerotinia minor

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tamspan 90, a Spanish peanut cultivar, exhibits physiological resistance to Sclerotinia minor (S.M), as indicated by the low rate of lesion expansion (RLE) on inoculated stems. The purpose of this study was to determine the RLE on stems and leaflets of two peanut cultivars (Okrun, a susceptible cul...

  7. 27 CFR 5.41 - Bottle cartons, booklets and leaflets.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Bottle cartons, booklets... Requirements for Distilled Spirits § 5.41 Bottle cartons, booklets and leaflets. (a) General. An individual covering, carton, or other container of the bottle used for sale at retail (other than a shipping...

  8. 27 CFR 5.41 - Bottle cartons, booklets and leaflets.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Bottle cartons, booklets... Requirements for Distilled Spirits § 5.41 Bottle cartons, booklets and leaflets. (a) General. An individual covering, carton, or other container of the bottle used for sale at retail (other than a shipping...

  9. An RCT study to evaluate a targeted, theory driven healthy eating leaflet.

    PubMed

    Baker, Holly J; Butler, Laurie T; Chambers, Stephanie A; Traill, W Bruce; Lobb, Alexandra E; Herbert, Georgia

    2010-12-01

    A theory based healthy eating leaflet was evaluated against an existing publicly available standard leaflet. The intervention leaflet was designed to encourage healthy eating in 18-30 year olds and was developed by modifying an existing British Nutrition Foundation leaflet. The intervention leaflet targeted attitudes and self-efficacy. Participants (n = 104) were randomly assigned either to the intervention, Foundation or a local food leaflet control condition. Cognitions were measured pre-intervention, immediately after reading the corresponding leaflet, and once again at two weeks follow-up. Critically, intentions to eat healthily were significantly greater at follow-up in the Intervention group compared to the other two groups, with the former leaflet also being perceived as more persuasive. The Intervention group also showed evidence of healthier eating at two weeks compared to the other two groups. Collectively the results illustrate the utility of a targeted theory-based approach. PMID:20970233

  10. Readability of medicinal package leaflets: a systematic review.

    PubMed

    Pires, Carla; Vigário, Marina; Cavaco, Afonso

    2015-01-01

    OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords "Readability and Package Leaflet" and "Readability and Package Insert" in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results

  11. Diet and Colorectal Cancer Risk: Evaluation of a Nutrition Education Leaflet

    ERIC Educational Resources Information Center

    Dyer, K. J.; Fearon, K. C. H.; Buckner, K.; Richardson, R. A.

    2005-01-01

    Objective: To evaluate the effect of a needs-based, nutrition education leaflet on nutritional knowledge. Design: Comparison of nutritional knowledge levels before and after exposure to a nutrition education leaflet. Setting: A regional colorectal out-patient clinic in Edinburgh. Method: A nutrition education leaflet, based on an earlier…

  12. Investigation of vortex dynamics downstream of moving leaflets using robust image velocimetry

    NASA Astrophysics Data System (ADS)

    Romano, Giovanni P.; Querzoli, Giorgio; Falchi, Massimo

    2009-10-01

    The interaction of a sudden flow through a rectangular slot with moving leaflets, hinged at its border, was investigated experimentally in a Plexiglas vessel. This configuration resembles schematically some key features of many biological flows, e.g. in sea-animal propulsion, where the moving flaps control the flow, optimizing thrust, or in heart valves, where leaflets prevent backflow. Therefore, the comprehension of the basic mechanisms of the flow-structure interaction and of the features of the flow is of interest in a wide range of applications. Although some detail of the phenomenon could depend on the specific leaflet design, material and forcing, the objective of the present work is to investigate the overall dependence of the flow field on the leaflet arrangement. Specifically, three leaflet configurations have been tested at Reynolds number Re = 2,000 and Strouhal number St = 0.2: two symmetrical leaflets, two non-symmetrical leaflets, one being twice as wide as the other, and a single leaflet. Velocity fields were obtained using Robust Image Velocimetry in order to accurately resolve the structure of the vorticity field. The dynamics of the opening leaflets, the vorticity fields and the features of the vortices generated during the leaflet opening were investigated and compared in the different leaflet configurations. Advantages in the opening time, maximum aperture and closing time were observed in the two-leaflet non-symmetrical case in comparison to the other configurations.

  13. The readability and utility of general dental practice patient information leaflets: an evaluation.

    PubMed

    Newton, J T

    1995-05-01

    One hundred and seventy-nine practice leaflets were assessed for readability and the amount of information they contained. In general most leaflets were quite difficult to read and provided only a minimum of information. Recommendations are made for practitioners who wish to improve their practice leaflets. PMID:7766454

  14. Effects of ozone and water deficit on field-grown soybean: II. Leaflet nonstructural carbohydrates

    SciTech Connect

    Miller, J.E.; Vozzo, S.F.; Patterson, R.P.

    1995-07-01

    Ozone (O{sub 3}) and water deficit can suppress photosynthesis, growth, and yield of crops, and both may alter plant carbohydrate status. Little is known, however, concerning the combined effects of these stresses on C assimilation and nonstructural carbohydrate reserves in field-grown plants. Soybean [Glycine max (L.) Merr. `Young`] plants were subjected to two soil moisture regimes (providing well-watered and periodically water-deficient conditions) and three levels of O{sub 3} concentrations were 0.018, 0.059, and 0.085 {mu}L L{sup -1} (seasonal mean 12 h d{sup -1} concentration). Leaflet carbohydrate concentrations were measured periodically during the growing season. Total soluble carbohydrates (TSCs) (sucrose and hexose) and starch were measured in the center leaflet of the sixth trifoliolate from the apex. Ozone stress suppressed leaflet concentrations of TSCs and starch on most sampling dates. Impacts of water deficit were less consistent, but starch concentrations usually increased when effects were significant. Interactions between the two stresses occurred infrequently, although water stress reduced the negative effects of O{sub 3} on sucrose and TSCs when the data were analyzed over the season. Ozone treatment also slightly increased the proportion of sucrose compared to starch in the total nonstructural carbohydrate (TNC) pool. The response of seasonal mean TNC concentrations, seasonal mean NCER, and seed yield to O{sub 3} followed similar patterns, although TNCs were suppressed more on a relative basis then NCER or yield. 34 refs., 4 figs., 4 tabs.

  15. The enigmatic fast leaflet rotation in Desmodium motorium

    PubMed Central

    Lev-Yadun, Simcha

    2013-01-01

    I propose that the enigmatic leaflet movements in elliptical circles every few minutes of the Indian telegraph (semaphore) plant Desmodium motorium ( = D. gyrans = Hedysarum gyrans = Codariocalyx motorius), which has intrigued scientists for centuries, is a new type of butterfly or general winged arthropod mimicry by this plant. Such leaflet movement may deceive a passing butterfly searching for an un-occupied site suitable to deposit its eggs, that the plant is already occupied. It may also attract insectivorous birds, reptiles or arthropods to the plant because it looks as if it is harboring a potential prey and while they patrol there, they can find insects or other invertebrates that indeed attack the plant. The possibility that diurnal mammalian herbivores may also be deterred by these movements should not be dismissed. PMID:23603964

  16. A Newly Developed Tri-Leaflet Polymeric Heart Valve Prosthesis

    PubMed Central

    Gaetano, Francesco De; Bagnoli, Paola; Zaffora, Adriano; Pandolfi, Anna; Serrani, Marta; Brubert, Jacob; Stasiak, Joanna; Moggridge, Geoff D.; Costantino, Maria Laura

    2016-01-01

    The potential of polymeric heart valves (PHV) prostheses is to combine the hemodynamic performances of biological valves with the durability of mechanical valves. The aim of this work is to design and develop a new tri-leaflet prosthetic heart valve (HV) made from styrenic block copolymers. A computational finite element model was implemented to optimize the thickness of the leaflets, to improve PHV mechanical and hydrodynamic performances. Based on the model outcomes, 8 prototypes of the designed valve were produced and tested in vitro under continuous and pulsatile flow conditions, as prescribed by ISO 5840 Standard. A specially designed pulse duplicator allowed testing the PHVs at different flow rates and frequency conditions. All the PHVs met the requirements specified in ISO 5840 Standard in terms of both regurgitation and effective orifice area (EOA), demonstrating their potential as HV prostheses. PMID:27274605

  17. Readability of medicinal package leaflets: a systematic review

    PubMed Central

    Pires, Carla; Vigário, Marina; Cavaco, Afonso

    2015-01-01

    OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords “Readability and Package Leaflet” and “Readability and Package Insert” in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the

  18. On the bending properties of porcine mitral, tricuspid, aortic, and pulmonary valve leaflets.

    PubMed

    Brazile, Bryn; Wang, Bo; Wang, Guangjun; Bertucci, Robbin; Prabhu, Raj; Patnaik, Sourav S; Butler, J Ryan; Claude, Andrew; Brinkman-Ferguson, Erin; Williams, Lakiesha N; Liao, Jun

    2015-01-01

    The atrioventricular valve leaflets (mitral and tricuspid) are different from the semilunar valve leaflets (aortic and pulmonary) in layered structure, ultrastructural constitution and organization, and leaflet thickness. These differences warrant a comparative look at the bending properties of the four types of leaflets. We found that the moment-curvature relationships in atrioventricular valves were stiffer than in semilunar valves, and the moment-curvature relationships of the left-side valve leaflets were stiffer than their morphological analog of the right side. These trends were supported by the moment-curvature curves and the flexural rigidity analysis (EI value decreased from mitral, tricuspid, aortic, to pulmonary leaflets). However, after taking away the geometric effect (moment of inertia I), the instantaneous effective bending modulus E showed a reversed trend. The overall trend of flexural rigidity (EI: mitral > tricuspid > aortic > pulmonary) might be correlated with the thickness variations among the four types of leaflets (thickness: mitral > tricuspid > aortic > pulmonary). The overall trend of the instantaneous effective bending modulus (E: mitral < tricuspid < aortic < pulmonary) might be correlated to the layered fibrous ultrastructures of the four types of leaflets, of which the fibers in mitral and tricuspid leaflets were less aligned, and the fibers in aortic and pulmonary leaflets were highly aligned. We also found that, for all types of leaflets, moment-curvature relationships are stiffer in against-curvature (AC) bending than in with-curvature bending (WC), which implies that leaflets tend to flex toward their natural curvature and comply with blood flow. Lastly, we observed that the leaflets were stiffer in circumferential bending compared with radial bending, likely reflecting the physiological motion of the leaflets, i.e., more bending moment and movement were experienced in radial direction than circumferential direction. PMID:25955006

  19. Effect of leaflet-to-chordae contact interaction on computational mitral valve evaluation

    PubMed Central

    2014-01-01

    Background Computational simulation using numerical analysis methods can help to assess the complex biomechanical and functional characteristics of the mitral valve (MV) apparatus. It is important to correctly determine physical contact interaction between the MV apparatus components during computational MV evaluation. We hypothesize that leaflet-to-chordae contact interaction plays an important role in computational MV evaluation, specifically in quantitating the degree of leaflet coaptation directly related to the severity of mitral regurgitation (MR). In this study, we have performed dynamic finite element simulations of MV function with and without leaflet-to-chordae contact interaction, and determined the effect of leaflet-to-chordae contact interaction on the computational MV evaluation. Methods Computational virtual MV models were created using the MV geometric data in a patient with normal MV without MR and another with pathologic MV with MR obtained from 3D echocardiography. Computational MV simulation with full contact interaction was specified to incorporate entire physically available contact interactions between the leaflets and chordae tendineae. Computational MV simulation without leaflet-to-chordae contact interaction was specified by defining the anterior and posterior leaflets as the only contact inclusion. Results Without leaflet-to-chordae contact interaction, the computational MV simulations demonstrated physically unrealistic contact interactions between the leaflets and chordae. With leaflet-to-chordae contact interaction, the anterior marginal chordae retained the proper contact with the posterior leaflet during the entire systole. The size of the non-contact region in the simulation with leaflet-to-chordae contact interaction was much larger than for the simulation with only leaflet-to-leaflet contact. Conclusions We have successfully demonstrated the effect of leaflet-to-chordae contact interaction on determining leaflet coaptation in

  20. Age-related changes in neurochemical components and retinal projections of rat intergeniculate leaflet.

    PubMed

    Fiuza, Felipe P; Silva, Kayo D A; Pessoa, Renata A; Pontes, André L B; Cavalcanti, Rodolfo L P; Pires, Raquel S; Soares, Joacil G; Nascimento Júnior, Expedito S; Costa, Miriam S M O; Engelberth, Rovena C G J; Cavalcante, Jeferson S

    2016-02-01

    Aging leads to several anatomical and functional deficits in circadian timing system. In previous works, we observed morphological alterations with age in hypothalamic suprachiasmatic nuclei, one central component of this system. However, there are few data regarding aging effects on other central components of this system, such as thalamic intergeniculate leaflet (IGL). In this context, we studied possible age-related alterations in neurochemical components and retinal projections of rat IGL. For this goal, young (3 months), adult (13 months), and aged (23 months) Wistar rats were submitted to an intraocular injection of neural tracer, cholera toxin subunit b (CTb), 5 days before a tissue fixation process by paraformaldehyde perfusion. Optical density measurements and cell count were performed at digital pictures of brain tissue slices processed by immunostaining for glutamic acid decarboxylase (GAD), enkephalin (ENK), neuropeptide Y (NPY) and CTb, characteristic markers of IGL and its retinal terminals. We found a significant age-related loss in NPY immunoreactive neurons, but not in immunoreactivity to GAD and ENK. We also found a decline of retinal projections to IGL with age. We conclude aging impairs both a photic environmental clue afferent to IGL and a neurochemical expression which has an important modulatory circadian function, providing strong anatomical correlates to functional deficits of the aged biological clock. PMID:26718202

  1. Patterns of pulmonary perfusion scans in normal subjects. IV. The prevalence of abnormal scans in smokers 30 to 49 years of age

    SciTech Connect

    Fedullo, P.F.; Kapitan, K.S.; Brewer, N.S.; Ashburn, W.L.; Hartman, M.T.; Moser, K.M.

    1989-05-01

    The usefulness of ventilation-perfusion scans in the diagnosis of pulmonary embolism is limited by the wide range of pulmonary diseases that are associated with abnormal scans, and by the largely undetermined prevalence of abnormal scans in persons without cardiopulmonary disease. In prior studies, we found perfusion defects to be rarely present in young persons and in older nonsmokers. To determine if normal older smokers have a higher prevalence of abnormal ventilation and perfusion scans, we performed six-view /sup 99m/Tc perfusion (Q) scans and /sup 133/Xe ventilation (V) scans in 40 subjects 30 to 49 yr of age who had no known cardiopulmonary disease. Each subject had undergone a history, physical examination, electrocardiogram, spirometry, and posteroanterior chest roentgenogram prior to scanning. All V and Q scans were interpreted blindly and independently by two experienced readers. No subject demonstrated a lobar or segmental defect on two views. One subject had a matched subsegmental defect, and one subject had delayed washout from a subsegmental area of the right upper lobe during V scanning, with a normal Q scan. We conclude that abnormal V and Q scans are uncommon among normal smokers 30 to 49 yr of age.

  2. Measurement of mitral leaflet and annular geometry and stress after repair of posterior leaflet prolapse: Virtual repair using a patient specific finite element simulation

    PubMed Central

    Ge, Liang; Morrel, William G.; Ward, Alison; Mishra, Rakesh; Zhang, Zhihong; Guccione, Julius M.; Grossi, Eugene A.; Ratcliffe, Mark B.

    2014-01-01

    Background Recurrent mitral regurgitation after mitral valve (MV) repair for degenerative disease occurs at a rate of 2.6% per year and re-operation rate progressively reaches 20% at 19.5 years. We believe that MV repair durability is related to initial post-operative leaflet and annular geometry with subsequent leaflet remodeling due to stress. We tested the hypothesis that MV leaflet and annular stress is increased after MV repair. Methods Magnetic resonance imaging was performed before and intra-operative 3D trans-esophageal echocardiography was performed before and after repair of posterior leaflet (P2) prolapse in a single patient. The repair consisted of triangular resection and annuloplasty band placement. Images of the heart were manually co-registered. The left ventricle and MV were contoured, surfaced and a 3D finite element (FE) model was created. Elements of the P2 region were removed to model leaflet resection and virtual sutures were used to repair the leaflet defect and attach the annuloplasty ring. Results The principal findings of the current study are 1) FE simulation of MV repair is able to accurately predict changes in MV geometry including changes in annular dimensions and leaflet coaptation, 2) average posterior leaflet stress is increased, and 3) average anterior leaflet and annular stress are reduced after triangular resection and mitral annuloplasty. Conclusions We successfully conducted virtual mitral valve prolapse repair using FE modeling methods. Future studies will examine the effects of leaflet resection type as well as annuloplasty ring size and shape. PMID:24630767

  3. Pulmonary ventilation/perfusion scan

    MedlinePlus

    V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan ... A pulmonary ventilation/perfusion scan is actually two tests. They may be done separately or together. During the perfusion scan, a health ...

  4. Behavior of Bilayer Leaflets in Asymmetric Model Membranes: Atomistic Simulation Studies.

    PubMed

    Tian, Jianhui; Nickels, Jonathan; Katsaras, John; Cheng, Xiaolin

    2016-08-25

    Spatial organization within lipid bilayers is an important feature for a range of biological processes. Leaflet compositional asymmetry and lateral lipid organization are just two of the ways in which membrane structure appears to be more complex than initially postulated by the fluid mosaic model. This raises the question of how the phase behavior in one bilayer leaflet may affect the apposing leaflet and how one begins to construct asymmetric model systems to investigate these interleaflet interactions. Here we report on all-atom molecular dynamics simulations (a total of 4.1 μs) of symmetric and asymmetric bilayer systems composed of liquid-ordered (Lo) or liquid-disordered (Ld) leaflets, based on the nanodomain-forming POPC/DSPC/cholesterol system. We begin by analyzing an asymmetric bilayer with leaflets derived from simulations of symmetric Lo and Ld bilayers. In this system, we observe that the properties of the Lo and Ld leaflets are similar to those of the Lo and Ld leaflets in corresponding symmetric systems. However, it is not obvious that mixing the equilibrium structures of their symmetric counterparts is the most appropriate way to construct asymmetric bilayers nor that these structures will manifest interleaflet couplings that lead to domain registry/antiregistry. We therefore constructed and simulated four additional asymmetric bilayer systems by systematically adding or removing lipids in the Ld leaflet to mimic potential density fluctuations. We find that the number of lipids in the Ld leaflet affects its own properties, as well as those of the apposing Lo leaflet. Collectively, the simulations reveal the presence of weak acyl chain interdigitation across bilayer leaflets, suggesting that interdigitation alone does not contribute significantly to the interleaflet coupling in nonphase-separated bilayers of this chemical composition. However, the properties of both leaflets appear to be sensitive to changes in in-plane lipid packing, possibly

  5. Ventilation-perfusion imaging in pulmonary papillomatosis

    SciTech Connect

    Espinola, D.; Rupani, H.; Camargo, E.E.; Wagner, H.N. Jr.

    1981-11-01

    Three children with laryngeal papillomas involving the lungs had serial ventilation-perfusion scintigrams to assess results of therapy designed to reduce the bronchial involvement. Different imaging patterns were observed depending on size, number, and location of lesions. In early parenchymal involvement a ventilation-perfusion mismatch was seen. The initial and follow-up studies correlated well with clinical and radiographic findings. This noninvasive procedure is helpful in evaluating ventilatory and perfusion impairment in these patients as well as their response to treatment.

  6. Effect of information leaflets on knowledge in patients with gastrointestinal diseases.

    PubMed Central

    Hawkey, G M; Hawkey, C J

    1989-01-01

    Twelve patient information leaflets concerning common gastrointestinal diseases were produced by the British Digestive Foundation and evaluated to determine whether patients knew more about their disease if they received a leaflet. Eleven hundred and fifty patients attending gastroenterology clinics in the United Kingdom were assessed by postal questionnaire of whom half had received a leaflet relevant to their diagnosis six weeks before assessment. Seven hundred and fifty one replied (398 leafleted, 353 non-leafleted). Most patients found the leaflets helpful and easy to understand; few found them worrying. They were regarded as a better source of information than doctors, particularly for information about the characteristics of the illness and side effects of treatment. In all diagnostic groups assessed the patients' knowledge of their disease was significantly greater if they had received a leaflet than if they had not. Individual responses by patients without leaflets showed that fundamental misconceptions persisted about digestive diseases. The British Digestive Foundation leaflets are an effective means of imparting disease related information to patients. PMID:2599449

  7. Differences between follicular waves 1 and 2 in patterns of emergence of 2-mm follicles, associated FSH surges, and ovarian vascular perfusion in heifers.

    PubMed

    Ginther, O J; Siddiqui, M A R; Baldrighi, J M; Wolf, C A; Greene, J M

    2015-10-01

    The emergence (first detection) of 2-mm follicles, FSH surges, and ovarian vascular perfusion for follicular wave 1 and surge 1 (n = 26) and wave 2 and surge 2 (n = 25) were studied daily in heifers. The day the future dominant follicle was closest to 5.5 mm was designated Day 0 for each wave. In wave 1, many 2-mm follicles (41%) emerged on Days -5 to -3, whereas FSH surge 1 did not begin until Day -3. Concentration of FSH increased abruptly in 1 day to a peak on the day of maximal number of emerging 2-mm follicles, although the day of maximal number relative to Day 0 differed among individuals. The first emergence of 2-mm follicles in wave 2 occurred concurrently with the first increase in the FSH of surge 2. In wave 1, ovarian resistance to vascular perfusion was negatively correlated (r = -0.48, P < 0.05) with a number of 2-mm follicles on Days -4 to -1 for ovaries that did not contain the preovulatory follicle; vascular perfusion increased with an increase in the number of small follicles. The following hypotheses were supported for wave 1 but not for wave 2: (1) an increase in the number of emerging 2-mm follicles of a follicular wave occurs before the beginning of an increase in FSH, (2) the day of maximal number of emerging 2-mm follicles occurs concurrently with an abrupt FSH increase on different days among individuals, and (3) the association between the number of emerging 2-mm follicles and the extent of ovarian vascular perfusion is positive. PMID:26159090

  8. Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study.

    PubMed

    Boronyak, Steven M; Fredi, Joseph L; Young, Michael N; Dumont, Douglas M; Williams, Phillip E; Byram, Brett C; Merryman, W David

    2016-07-01

    This study reports the initial in vivo use of a combined radiofrequency ablation and cryo-anchoring (RFC) catheter as an alternative to surgical mitral valve (MV) leaflet resection. Radiofrequency ablation thermally shrinks enlarged collagenous tissues, providing an alternative to leaflet resection, and cryo-anchoring provides reversible attachment of a catheter to freely mobile MV leaflets. Excised porcine MVs (n = 9) were tested in a left heart flow simulator to establish treatment efficacy criteria. Resected leaflet area was quantified by tracking markers on the leaflet surface, and leaflet length reductions were directly measured on echocardiography. Leaflet area decreased by 38 ± 2.7%, and leaflet length decreased by 9.2 ± 1.8% following RFC catheter treatment. The RFC catheter was then tested acutely in healthy pigs (n = 5) under epicardial echocardiographic guidance, open-chest without cardiopulmonary bypass, using mid-ventricular free wall access. Leaflet length was quantified using echocardiography. Quantitative assessment of MV leaflet length revealed that leaflet resection was successful in 4 of 5 pigs, with a leaflet length reduction of 13.3 ± 4.6%. Histological, mechanical, and gross pathological findings also confirmed that RFC catheter treatment was efficacious. The RFC catheter significantly reduces MV leaflet size in an acute animal model, providing a possible percutaneous alternative to surgical leaflet resection. PMID:26508331

  9. Tri-layered elastomeric scaffolds for engineering heart valve leaflets

    PubMed Central

    Masoumi, Nafiseh; Annabi, Nasim; Assmann, Alexander; Larson, Benjamin L.; Hjortnaes, Jesper; Alemdar, Neslihan; Kharaziha, Mahshid; Manning, Keefe B.; Mayer, John E.; Khademhosseini, Ali

    2014-01-01

    Tissue engineered heart valves (TEHVs) that can grow and remodel have the potential to serve as permanent replacements of the current non-viable prosthetic valves particularly for pediatric patients. A major challenge in designing functional TEHVs is to mimic both structural and anisotropic mechanical characteristics of the native valve leaflets. To establish a more biomimetic model of TEHV, we fabricated tri-layered scaffolds by combining electrospinning and microfabrication techniques. These constructs were fabricated by assembling microfabricated poly(glycerol sebacate) (PGS) and fibrous PGS/poly(-caprolactone) (PCL) electrospun sheets to develop elastic scaffolds with tunable anisotropic mechanical properties similar to the mechanical characteristics of the native heart valves. The engineered scaffolds supported valvular interstitial cells (VICs) and mesenchymal stem cells (MSCs) growth within the 3D structure and promoted the deposition of heart valve extracellular matrix (ECM). MSCs were also organized and aligned along the anisotropic axes of the engineered tri-layered scaffolds. In addition, the fabricated constructs opened and closed properly in an ex vivo model of porcine heart valve leaflet tissue replacement. The engineered tri-layered scaffolds have the potential for successful translation towards TEHV replacements. PMID:24947233

  10. Comparison of elasticities of components of a cardiac bioprosthesis leaflet.

    PubMed

    Páez, J M; San Martin, A C; Sestafe, J V; Jorge-Herrero, E; Navidad, R; Cordón, A; Candela, I; Castillo-Olivares, J L

    1996-01-01

    The mechanoelastic behavior of calf pericardium employed in cardiac bioprostheses was compared with that of three types of thread (Nylon, Prolene, and silk) used to suture this biological tissue. The elastic limit (EL) of each material was determined by means of tensile tests and the mathematical functions that govern the stress/strain curves within the EL have been described. The first derivative of these functions for each point to the curves allowed the immediate calculation of the elastic modulus (EM), which was considered the best parameter for comparing the elasticities of the materials being assessed. It was observed that the deformation of the pericardium produced by the working stress of a pericardial leaflet was approximately 1000 times greater than that produced in the surgical threads. When the elasticities were compared on the basis of the EM, that of pericardium was 749.06, 626.95, and 1253.17 times greater than that of the Nylon, Prolene, and silk suture threads, respectively. These results demonstrate that the interaction between these materials (pericardium and the threads) could be generating detrimental forces that can diminish the durability of the leaflets of the bioprostheses constructed of calf pericardium. PMID:8788105

  11. Biomechanical and structural properties of the explanted bioprosthetic valve leaflets.

    PubMed

    Purinya, B; Kasyanov, V; Volkolakov, J; Latsis, R; Tetere, G

    1994-01-01

    Porcine bioprosthesis were treated with 0.625% glutaraldehyde and stabilized under changing pressure from 4 to 30 mmHg. Bovine pericardium and 12 biovalves (of age between 14 days and 80 months) after implantation in the human body were investigated (7 porcine PB and 5 pericardial bioprosthesis--PCB). Circumferential and radial strips from porcine aortic valve leaflets, bovine pericardium and bioprosthetic leaflets were studied in light, transmitting and scanning electron microscopy. Uniaxial load tests were carried out to examine the deformability and strength of these tissues. Microscopic examination of the biovalves revealed that the PB and PCB tissue retained its original architecture, but with alterations in detailed structure. The collagen bundles stuck together with vacuolization between them. There were some areas of the collagen structure fragmentation which could lead to complete necrosis. Eighty months after implantation in patients, the PCB became more extensible and its ultimate strain increases 2.5 times. Ultimate stress decreases in the radial direction from 9.43 to 2.88 MPa, and in the circumferential direction from 9.43 to 6.44 MPa. Forty-eight months after implantation, PB tissue's ultimate stress decreases in the circumferential direction from 4.06 to 1.99 MPa. At the same time ultimate strain increases from 13 to 22%. This study is to improve the methods of tissue stabilization in 0.625% glutaraldehyde solution for the first 48 h at cyclic, changing construction of biovalves soft supporting stent after 48 h. PMID:8106530

  12. Tri-layered elastomeric scaffolds for engineering heart valve leaflets.

    PubMed

    Masoumi, Nafiseh; Annabi, Nasim; Assmann, Alexander; Larson, Benjamin L; Hjortnaes, Jesper; Alemdar, Neslihan; Kharaziha, Mahshid; Manning, Keefe B; Mayer, John E; Khademhosseini, Ali

    2014-09-01

    Tissue engineered heart valves (TEHVs) that can grow and remodel have the potential to serve as permanent replacements of the current non-viable prosthetic valves particularly for pediatric patients. A major challenge in designing functional TEHVs is to mimic both structural and anisotropic mechanical characteristics of the native valve leaflets. To establish a more biomimetic model of TEHV, we fabricated tri-layered scaffolds by combining electrospinning and microfabrication techniques. These constructs were fabricated by assembling microfabricated poly(glycerol sebacate) (PGS) and fibrous PGS/poly(caprolactone) (PCL) electrospun sheets to develop elastic scaffolds with tunable anisotropic mechanical properties similar to the mechanical characteristics of the native heart valves. The engineered scaffolds supported the growth of valvular interstitial cells (VICs) and mesenchymal stem cells (MSCs) within the 3D structure and promoted the deposition of heart valve extracellular matrix (ECM). MSCs were also organized and aligned along the anisotropic axes of the engineered tri-layered scaffolds. In addition, the fabricated constructs opened and closed properly in an ex vivo model of porcine heart valve leaflet tissue replacement. The engineered tri-layered scaffolds have the potential for successful translation towards TEHV replacements. PMID:24947233

  13. CFD simulation of a novel bileaflet mechanical heart valve prosthesis: an estimation of the Venturi passage formed by the leaflets.

    PubMed

    Yokoyama, Y; Medart, D; Hormes, M; Schmitz, C; Hamilton, K; Kwant, P B; Takatani, S; Schmitz-Rode, T; Steinseifer, U

    2006-12-01

    The aim of this study was to validate the flow characteristics of the novel Helmholtz-Institute Aachen Bileaflet (HIA-BL) heart valve prosthesis. The curved leaflets of the HIA-BL valve form a Venturi passage between the leaflets at peak systole. By narrowing the cross section the flow accelerates and the static pressure at the central passage decreases according to the Venturi effect. The low-pressure zone between the leaflets is expected to stabilize the leaflets in fully open position at peak systole. To investigate the Venturi passage, the flow fields of two valve geometries were investigated by CFD (Computational Fluid Dynamics): one geometry exhibits curved leaflets resulting in a Venturi passage; the other geometry features straight leaflets. The flow profiles, pressure distribution and resulting torque of both passages were compared and investigated. Although flow profiles downstream of both valves were similar, the flow passages between the leaflets were different for the investigated leaflet geometries. The straight leaflet passage showed a large boundary layer separation zone near the leaflets and the lowest pressure at the leading edge of the leaflet. The Venturi passage showed a reduction of the boundary layer separation zones and the lowest pressure between the leaflets could be found in the narrowest flow cross section of the Venturi passage. Additionally, the resulting torque showed that the Venturi passage produced an opening momentum. The results demonstrate that the Venturi passage stabilizes the leaflets in open position at peak systole. PMID:17219353

  14. Readability Statistics of Patient Information Leaflets in a Speech and Language Therapy Department

    ERIC Educational Resources Information Center

    Pothier, Louise; Day, Rachael; Harris, Catherine; Pothier, David D.

    2008-01-01

    Background: Information leaflets are commonly used in Speech and Language Therapy Departments. Despite widespread use, they can be of variable quality. Aims: To revise current departmental leaflets using the National Health Service (NHS) Toolkit for Producing Patient Information and to test the effect that this has on the readability scores of the…

  15. The influence of leaflet skin friction and stiffness on the performance of bioprosthetic aortic valves.

    PubMed

    Dellimore, K; Kemp, I; Scheffer, C; Weich, H; Doubell, A

    2013-12-01

    Leaflet skin friction and stiffness were found to have a significant influence on the systolic performance of a 19 mm diameter bioprosthetic aortic valve based on fluid-structure interaction simulations at a heart rate of 72 bpm. Four different leaflet skin friction coefficients (0.0, 9.2 × 10(-4), 4.8 × 10(-2) and 4.8 × 10(-1)) were simulated along with three different leaflet elastic moduli (3.0 × 10(6), 3.5 × 10(6), 4.0 × 10(6) N m(-2)). Higher leaflet skin friction was found to increase the magnitude of the systolic transvalvular pressure gradient and the peak velocity through the valve, as well as decrease the valve orifice area. The results for the leaflet opening and closing kinematics also showed that higher leaflet skin friction combined with higher leaflet stiffness produces longer rapid valve opening, closing and ejection times, as well as smaller valve orifice areas. These results are consistent with clinical findings for calcified aortic valves and suggest that valve performance under stenotic conditions is strongly influenced by the combined effect of increasing leaflet stiffness and surface roughness caused by calcification. PMID:24264225

  16. Cochlear perfusion with a viscous fluid.

    PubMed

    Wang, Yi; Olson, Elizabeth S

    2016-07-01

    then clearance of viscous fluid within the cochlea, or to a temporary position shift of the Organ of Corti. After 0.5% HA perfusion, a short latency positive peak (P0) appeared in the CAP waveform. This P0 might be due to a change in the cochlea's traveling-wave pattern, or distortion in the cochlear microphonic. PMID:27220484

  17. A biomimetic bi-leaflet mitral prosthesis with enhanced physiological left ventricular swirl restorative capability

    NASA Astrophysics Data System (ADS)

    Tan, Sean Guo-Dong; Kim, Sangho; Leo, Hwa Liang

    2016-06-01

    Mechanical heart valve prostheses are often implanted in young patients due to their durability and long-term reliability. However, existing designs are known to induce elevated levels of blood damage and blood platelet activation. As a result, there is a need for patients to undergo chronic anti-coagulation treatment to prevent thrombosis, often resulting in bleeding complications. Furthermore, recent studies have suggested that the implantation of a mechanical prosthetic valve at the mitral position results in a significant alteration of the left ventricular flow field which may contribute to flow turbulence. This study proposes a bi-leaflet mechanical heart valve design (Bio-MHV) that mimics the geometry of a human mitral valve, with the aim of reducing turbulence levels in the left ventricle by replicating physiological flow patterns. An in vitro three-dimensional particle velocimetry imaging experiment was carried out to compare the hemodynamic performance of the Bio-MHV with that of the clinically established ATS valve. The Bio-MHV was found to replicate physiological left ventricular flow patterns and produced lower turbulence levels.

  18. How Tolerant are Membrane Simulations with Mismatch in Area per Lipid between Leaflets?

    PubMed

    Park, Soohyung; Beaven, Andrew H; Klauda, Jeffery B; Im, Wonpil

    2015-07-14

    Difficulties in estimating the correct number of lipids in each leaflet of complex bilayer membrane simulation systems make it inevitable to introduce a mismatch in lipid packing (i.e., area per lipid) and thus alter the lateral pressure of each leaflet. To investigate potential impacts of such mismatch on simulation results, we performed molecular dynamics simulations of saturated and monounsaturated lipid bilayers with and without gramicidin A or WALP23 at various mismatches by adjusting the number of lipids in the lower leaflet from no mismatch to a 25% reduction compared to that in the upper leaflet. All simulations were stable under the constant pressure barostat, but the mismatch induces asymmetric lipid packing between the leaflets, so that the upper leaflet becomes more ordered, and the lower leaflet becomes less ordered. The mismatch impacts on various bilayer properties are mild up to 5-10% mismatch, and bilayers with fully saturated chains appear to be more prone to these impacts than those with unsaturated tails. The nonvanishing leaflet surface tensions and the free energy derivatives with respect to the bilayer curvature indicate that the bilayer would be energetically unstable in the presence of mismatch. We propose a quantitative criterion for allowable mismatch based on the energetics derived from a continuum elastic model, which grows as a square root of the number of the lipids in the system. On the basis of this criterion, we infer that the area per lipid mismatch up to 5% would be tolerable in various membrane simulations of reasonable all-atom system sizes (40-160 lipids per leaflet). PMID:26575780

  19. Coupled Diffusion of Peripherally Bound Peptides along the Outer and Inner Membrane Leaflets

    PubMed Central

    Horner, Andreas; Antonenko, Yuri N.; Pohl, Peter

    2009-01-01

    Transmembrane signaling implies that peripheral protein binding to one leaflet be detected by the opposite leaflet. Therefore, protein recruitment into preexisting cholesterol and sphingolipid rich platforms may be required. However, no clear molecular picture has evolved about how these rafts in both leaflets are connected. By using planar lipid bilayers, we show that the peripheral binding of a charged molecule (poly-lysine, PLL) is detected at the other side of the bilayer without involvement of raft lipids. The diffusion coefficient, DP, of PLL differed by a factor of √2 when PLL absorbed to one or to both leaflets of planar membranes. Fluorescence correlation spectroscopy showed that the changes of the lipid diffusion coefficient, DM, were even more pronounced. Although DM remained larger than DP on PLL binding to the first membrane leaflet, DM dropped to DP on PLL binding to both leaflets, which indicated that the lipids sandwiched between two PLL molecules had formed a nanodomain. Due to its small area of ∼20 nm2 membrane electrostriction or leaflet interaction at bilayer midplane can only make a small contribution to interleaflet coupling. The tendency of the system to maximize the area where the membrane is free to undulate seems to be more important. As a spot with increased bending stiffness, the PLL bound patch in one leaflet attracts a stiffening additive on the other leaflet. That is to say, instead of suppressing undulations in two spots, two opposing PLL molecules migrate along a membrane at matching positions and suppress these undulations in a single spot. The gain in undulation energy is larger than the energy required for the alignment of two small PLL domains in opposite leafs and their coordinated diffusion. We propose that this type of mechanical interaction between two membrane separated ligands generally contributes to transmembrane signaling. PMID:19348751

  20. Methodology for ventilation/perfusion SPECT.

    PubMed

    Bajc, Marika; Neilly, Brian; Miniati, Massimo; Mortensen, Jan; Jonson, Björn

    2010-11-01

    Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the initial ventilation study and the perfusion study allows presentation of matching ventilation and perfusion slices in all projections as well as in rotating volume images based upon maximum intensity projections. Probabilistic interpretation of V/Q SPECT should be replaced by a holistic interpretation strategy on the basis of all relevant information about the patient and all ventilation/perfusion patterns. PE is diagnosed when there is more than one subsegment showing a V/Q mismatch representing an anatomic lung unit. Apart from pulmonary embolism, other pathologies should be identified and reported, for example, obstructive disease, heart failure, and pneumonia. Pitfalls exist both with respect to imaging technique and scan interpretation. PMID:20920632

  1. Perfusion visualization and analysis for pulmonary embolism

    NASA Astrophysics Data System (ADS)

    Vaz, Michael S.; Kiraly, Atilla P.; Naidich, David P.; Novak, Carol L.

    2005-04-01

    Given the nature of pulmonary embolism (PE), timely and accurate diagnosis is critical. Contrast enhanced high-resolution CT images allow physicians to accurately identify segmental and sub-segmental emboli. However, it is also important to assess the effect of such emboli on the blood flow in the lungs. Expanding upon previous research, we propose a method for 3D visualization of lung perfusion. The proposed method allows users to examine perfusion throughout the entire lung volume at a single glance, with areas of diminished perfusion highlighted so that they are visible independent of the viewing location. This may be particularly valuable for better accuracy in assessing the extent of hemodynamic alterations resulting from pulmonary emboli. The method also facilitates user interaction and may help identify small peripheral sub-segmental emboli otherwise overlooked. 19 patients referred for possible PE were evaluated by CT following the administration of IV contrast media. An experienced thoracic radiologist assessed the 19 datasets with 17 diagnosed as being positive for PE with multiple emboli. Since anomalies in lung perfusion due to PE can alter the distribution of parenchymal densities, we analyzed features collected from histograms of the computed perfusion maps and demonstrate their potential usefulness as a preliminary test to suggest the presence of PE. These histogram features also offer the possibility of distinguishing distinct patterns associated with chronic PE and may even be useful for further characterization of changes in perfusion or overall density resulting from associated conditions such as pneumonia or diffuse lung disease.

  2. Displacement of the anterior leaflet of the tricuspid valve: Rare variant of Ebstein's anomaly.

    PubMed

    Tsujii, Nobuyuki; Kurosaki, Kenichi; Yasuda, Kenji; Mizuno, Masanori; Sakaguchi, Heima; Hoashi, Takaya; Ichikawa, Hajime; Shiraishi, Isao

    2016-08-01

    In Ebstein's anomaly, the points of attachment, or hinges, of the septal and mural leaflets in the right ventricle are displaced away from the atrioventricular junction. In contrast, the junctional hinge of the anterior leaflet usually retains a normal position. Here, we report a case of giant right atrial aneurysm due to isolated displacement of the anterior leaflet of the tricuspid valve in an infant, a rare variant of Ebstein's anomaly. Enlargement of the right atrium, which was initially diagnosed during the fetal period, progressively and markedly dilated after birth and was successfully treated with surgical resection. Isolated displacement of the anterior leaflet should be recognized as a variant of Ebstein's anomaly. PMID:27324596

  3. An evidence-based patient information leaflet about otitis media with effusion.

    PubMed

    Kubba, H

    2000-01-01

    Leaflets are a useful resource for information provision. Many otolaryngology patients have poor reading skills, and may have difficulty understanding medical jargon. The aim of this project was to produce a patient information leaflet on otitis media with effusion whose content is based on the best available research evidence, and which is presented in a clear format with simple language. Patients were involved at the planning stage, and in testing the final draft. The leaflet was preferred by the majority compared to existing information material and was felt to be more informative and easier to understand. The leaflet has been given the Crystal Mark for clarity of language by the Plain English Campaign. This study shows that existing guidelines can be used to improve the quality of written information provision. PMID:11184057

  4. Outcome of Fetuses with Cerebral Ventriculomegaly and Septum Pellucidum Leaflet Abnormalities

    PubMed Central

    Li, Y; Sansgiri, R; Estroff, JA; Mehta, TS; Poussaint, TY; Robertson, RL; Robson, CD; Feldman, HA; Barnewolt, C; Levine, D

    2013-01-01

    Objective To assess outcomes of prenatal diagnosis of septal leaflet abnormality in fetuses referred for ventriculomegaly (VM). Methods In a prospective IRB-approved study with written informed consent, between 7/1/2003 to 5/15/2009, 425 pregnant women with 433 fetuses referred for VM were imaged with US and MRI. Four to six radiologists independently reviewed sonographic and MR images and recorded lateral ventricular diameters at the atrium and frontal horns, ventricular configuration, and the presence of VM and other CNS abnormalities. Final US, MR, and overall prenatal diagnoses were decided by consensus. Fetuses coded for septal leaflet abnormality were identified, and birth outcome, autopsy, postnatal imaging, and postnatal follow-up were obtained. Log-transformed ANCOVA, controlling for GA, was used to compare ventricular dimensions between fetuses with septal leaflet abnormalities and fetuses with isolated VM. Inter-rater agreement of septal leaflet abnormality was assessed with kappa statistics. Results 23 fetuses had septal leaflet abnormalities and 229 had isolated VM. Atrial and frontal horn diameters, adjusted for GA, were 77% and 98% larger, respectively, in fetuses with septal leaflet abnormalities than in fetuses with isolated VM (p<0.0001). Pre-conference consensus among US readers was moderate (kappa = 0.54) and among MR readers was good (kappa = 0.69). Additional MR CNS findings were seen in 12/23 (52%) fetuses. Eleven pregnancies with septal leaflet abnormalities underwent termination and 12 progressed to live birth with 3 neonatal demise. Neurodevelopmental follow-up was abnormal in all surviving children. Conclusion Even when septal leaflet abnormality is an isolated finding, developmental delay can occur postnatally. PMID:21178039

  5. Dynamic in vitro quantification of bioprosthetic heart valve leaflet motion using structured light projection.

    PubMed

    Iyengar AKS; Sugimoto, H; Smith, D B; Sacks, M S

    2001-11-01

    Quantification of heart valve leaflet deformation during the cardiac cycle is essential in understanding normal and pathological valvular function, as well as in the design of replacement heart valves. Due to the technical complexities involved, little work to date has been performed on dynamic valve leaflet motion. We have developed a novel experimental method utilizing a noncontacting structured laser-light projection technique to investigate dynamic leaflet motion. Using a simulated circulatory loop, a matrix of 150-200 laser light points were projected over the entire leaflet surface. To obtain unobstructed views of the leaflet surface, a stereo system of high-resolution boroscopes was used to track the light points at discrete temporal points during the cardiac cycle. The leaflet surface at each temporal point was reconstructed in three dimensions, and fit using our biquintic hermite finite element approach (Smith et al., Ann. Biomed. Eng. 26:598-611, 2001). To demonstrate our approach, we utilized a bovine pericardial bioprosthetic heart valve, which revealed regions of complex flexural deformation and substantially different shapes during the opening and closing phases. In conclusion, the current method has high spatial and temporal resolution and can reconstruct the entire surface of the cusp simultaneously. Because it is completely noncontacting, this approach is applicable to studies of fatigue and bioreactor technology for tissue engineered heart valves. PMID:11791679

  6. Planar Biaxial Behavior of Fibrin-Based Tissue-Engineered Heart Valve Leaflets

    PubMed Central

    Robinson, Paul S.

    2009-01-01

    To design more effective tissue-engineered heart valve replacements, the replacement tissue may need to mimic the biaxial stress–strain behavior of native heart valve tissue. This study characterized the planar biaxial properties of tissue-engineered valve leaflets and native aortic valve leaflets. Fibrin-based valve equivalent (VE) and porcine aortic valve (PAV) leaflets were subjected to incremental biaxial stress relaxation testing, during which fiber alignments were measured, over a range of strain ratios. Results showed that VE leaflets exhibited a modulus and fiber reorientation behavior that correlated with strain ratio. In contrast, PAV leaflets maintained their relaxed modulus and fiber alignment when exposed to nonequibiaxial strain, but exhibited changes in stress relaxation. In uniaxial and equi-biaxial tension, there were few observed differences in relaxation behavior between VE and PAV leaflets, despite differences in the modulus and fiber reorientation. Likewise, in both tissues there was similar relaxation response in the circumferential and radial directions in biaxial tension, despite different moduli in these two directions. This study presents some fundamental differences in the mechanical response to biaxial tension of fibrin-based tissue-engineered constructs and native valve tissue. It also highlights the importance of using a range of strain ratios when generating mechanical property data for valvular and engineered tissues. The data presented on the stress–strain, relaxation, and fiber reorientation of VE tissue will be useful in future efforts to mathematically model and improve fibrin-based tissue-engineered constructs. PMID:19368523

  7. Unilateral optic nerve transection alters light response of suprachiasmatic nucleus and intergeniculate leaflet

    NASA Technical Reports Server (NTRS)

    Tang, I-Hsiung; Murakami, Dean M.; Fuller, Charles A.

    2002-01-01

    The suprachiasmatic nucleus (SCN), the circadian pacemaker, receives photic input directly from the retina to synchronize the pacemaker to the environment. Additionally, the intergeniculate leaflet (IGL), which innervates the SCN, is known to modulate the retinal photic input to the SCN. To further understand the role of the IGL in mediating the photic input to the SCN, this study examined the effects of unilateral optic nerve transection (UONx) on the photic response of the SCN and IGL in adult and neonatal hamsters. UONx led to an overall reduction in light-induced c-Fos expression in the SCN and IGL. The c-Fos expression was greater in the SCN ipsilateral to the remaining eye, despite a symmetrically bilateral retinohypothalamic tract projection as revealed by intraocular injection of horseradish peroxidase. In contrast, UONx led to a greater c-Fos expression in the contralateral IGL. The contralateral IGL of UONx animals also revealed more neuropeptide Y-immunoreactive neurons, while the ipsilateral SCN of these animals exhibited a denser neuropeptide Y terminal field. The neonates with UONx showed a similar pattern with a slight compensation of the photic-induced c-Fos in the SCN. This study suggests that the IGL may have an ipsilateral inhibitory effect in mediating retinal photic input to the SCN.

  8. Simulation of long-term fatigue damage in bioprosthetic heart valves: effects of leaflet and stent elastic properties.

    PubMed

    Martin, Caitlin; Sun, Wei

    2014-08-01

    One of the major failure modes of bioprosthetic heart valves (BHVs) is noncalcific structural deterioration due to fatigue of the tissue leaflets; yet, the mechanisms of fatigue are not well understood. BHV durability is primarily assessed based on visual inspection of the leaflets following accelerated wear testing. In this study, we developed a computational framework to simulate BHV leaflet fatigue, which is both efficient and quantitative, making it an attractive alternative to traditional accelerated wear testing. We utilize a phenomenological soft tissue fatigue damage model developed previously to describe the stress softening and permanent set of the glutaraldehyde-treated bovine pericardium leaflets in BHVs subjected to cyclic loading. A parametric study was conducted to determine the effects of altered leaflet and stent elastic properties on the fatigue of the leaflets. The simulation results show that heterogeneity of the leaflet elastic properties, poor leaflet coaptation, and little stent-tip deflection may accelerate leaflet fatigue, which agrees with clinical findings. Therefore, the developed framework may be an invaluable tool for evaluating leaflet durability in new tissue valve designs, including traditional BHVs as well as new transcatheter valves. PMID:24092257

  9. Determination of correlation between backflow volume and mitral valve leaflet young modulus from two dimensional echocardiogram images

    NASA Astrophysics Data System (ADS)

    Jong, Rudiyanto P.; Osman, Kahar; Adib, M. Azrul Hisham M.

    2012-06-01

    Mitral valve prolapse without proper monitoring might lead to a severe mitral valve failure which eventually leads to a sudden death. Additional information on the mitral valve leaflet condition against the backflow volume would be an added advantage to the medical practitioner for their decision on the patients' treatment. A study on two dimensional echocardiography images has been conducted and the correlations between the backflow volume of the mitral regurgitation and mitral valve leaflet Young modulus have been obtained. Echocardiogram images were analyzed on the aspect of backflow volume percentage and mitral valve leaflet dimensions on different rates of backflow volume. Young modulus values for the mitral valve leaflet were obtained by using the principle of elastic deflection and deformation on the mitral valve leaflet. The results show that the backflow volume increased with the decrease of the mitral valve leaflet Young modulus which also indicate the condition of the mitral valve leaflet approaching failure at high backflow volumes. Mitral valve leaflet Young modulus values obtained in this study agreed with the healthy mitral valve leaflet Young modulus from the literature. This is an initial overview of the trend on the prediction of the behaviour between the fluid and the structure of the blood and the mitral valve which is extendable to a larger system of prediction on the mitral valve leaflet condition based on the available echocardiogram images.

  10. Simulation of long-term fatigue damage in bioprosthetic heart valves: effects of leaflet and stent elastic properties

    PubMed Central

    Martin, Caitlin

    2014-01-01

    One of the major failure modes of bioprosthetic heart valves (BHVs) is noncalcific structural deterioration due to fatigue of the tissue leaflets; yet, the mechanisms of fatigue are not well understood. BHV durability is primarily assessed based on visual inspection of the leaflets following accelerated wear testing. In this study, we developed a computational framework to simulate BHV leaflet fatigue, which is both efficient and quantitative, making it an attractive alternative to traditional accelerated wear testing. We utilize a phenomenological soft tissue fatigue damage model developed previously to describe the stress softening and permanent set of the glutaraldehyde-treated bovine pericardium leaflets in BHVs subjected to cyclic loading. A parametric study was conducted to determine the effects of altered leaflet and stent elastic properties on the fatigue of the leaflets. The simulation results show that heterogeneity of the leaflet elastic properties, poor leaflet coaptation, and little stent-tip deflection may accelerate leaflet fatigue, which agrees with clinical findings. Therefore, the developed framework may be an invaluable tool for evaluating leaflet durability in new tissue valve designs, including traditional BHVs as well as new transcatheter valves. PMID:24092257

  11. Effect of carbodiimide cross-linking of decellularized porcine pulmonary artery valvular leaflets.

    PubMed

    Xu, Xiu-Fang; Guo, Hai-Ping; Ren, Xue-Jun; Gong, Da; Ma, Jin-Hui; Wang, Ai-Ping; Shi, Hai-Feng; Xin, Yi; Wu, Ying; Li, Wen-Bin

    2014-01-01

    Decellularization provides low immunogenicity and is only slightly subject to calcification in tissue engineering. However, the mechanical properties of the tissues are weakened after decellularization. We adopted cross-linking agent 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) to treat decellularized porcine pulmonary artery valvular leaflets to improve their mechanical properties. Twenty porcine pulmonary artery valvular leaflets were divided into three groups: the fresh control group A, group B treated with trypsin and Triton X-100 to remove cells, and group C cross-linked with EDC after decellularization. All samples were evaluated the physical and mechanical properties and were then subcutaneously embedded in rabbits. These valvular leaflets were removed after 1, 2, or 4 weeks and checked for pathological changes. The cells of the valvular leaflets were completely removed. The thickness of the valvular leaflets was thinner in group B than in group A (P<0.01). In the subcutaneous embedding of the group B samples, there was mild immunological response after 1-2 weeks, and parts of the scaffolds were degraded. After 4 weeks, fibroblasts had grown into the scaffolds. In group C, there was an increase in the tensile strength and thermal shrinkage temperature in group C compared with group B (P<0.01). In subcutaneous embedding of the group C samples, there was a mild immunological response after 1-2 weeks. The fibroblasts had grown into the samples. The EDC-based cross-linking procedure can enhance the tensile strength of decellularized pulmonary artery valvular leaflets and both decrease the valvular leaflets' rejection and promote tissue regeneration in vivo. PMID:24753759

  12. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair.

    PubMed

    Ghulam Ali, Sarah; Fusini, Laura; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Mapelli, Massimo; Zanobini, Marco; Alamanni, Francesco; Pepi, Mauro

    2016-07-01

    A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing. PMID:27184171

  13. Light-dependent changes in the leaflet movement rhythm of the plant Desmodium gyrans.

    PubMed

    Sharma, Vijay Kumar; Bardal, Tom Kristian; Johnsson, Anders

    2003-01-01

    The movements of the lateral leaflets of the Indian telegraph plant Desmodium gyrans (L. F.) DC, have earlier been studied in detail with regards to the effects of chemicals, DC currents, and static magnetic fields. In the present paper we have discussed the oscillation of the lateral leaflets under the influence of white light of various light levels (0-75 micromol x m(-2) x s(-1)), produced by an array of LEDs (light emitting diodes). LEDs were used in contrast to fluorescense tubes as in earlier studies in order to minimize changes of wavelength when light intensity was decreased or increased. Furthermore, care was taken to ensure that the temperature in the experimental chamber was constant. When the oscillations were first monitored in bright light, the oscillations were found to be very rapid and with decreasing light intensity the oscillations slowed down. For light levels lower than about 20 micromol x m(-2) x s(-1) the period of the oscillation of the lateral leaflets was almost constant (or even decreased slightly towards complete darkness). We also show that the oscillations could completely stop under prolonged darkness (for longer than about 6 h) and that such halted oscillations could be restarted in most of the leaflets when he light was turned back on. Such stopping of the oscillation of the lateral leaflets in prolonged darkness suggests that these short period oscillations of the lateral leaflets could have a daily component and in natural environment these oscillations could serve the purpose of optimising the amount of light falling on the leaflets or/and facilitating transpiration of water through stomata. Such a finding could have an implication for the answer to the long standing question of adaptive significance of short period oscillation of the Indian telegraph plant Desmodium gyrans (L. F.) DC. PMID:12622232

  14. Measurement and reconstruction of the leaflet geometry for a pericardial artificial heart valve.

    PubMed

    Jiang, Hongjun; Campbell, Gord; Xi, Fengfeng

    2005-03-01

    This paper describes the measurement and reconstruction of the leaflet geometry for a pericardial heart valve. Tasks involved include mapping the leaflet geometries by laser digitizing and reconstructing the 3D freeform leaflet surface based on a laser scanned profile. The challenge is to design a prosthetic valve that maximizes the benefits offered to the recipient as compared to the normally operating naturally-occurring valve. This research was prompted by the fact that artificial heart valve bioprostheses do not provide long life durability comparable to the natural heart valve, together with the anticipated benefits associated with defining the valve geometries, especially the leaflet geometries for the bioprosthetic and human valves, in order to create a replicate valve fabricated from synthetic materials. Our method applies the concept of reverse engineering in order to reconstruct the freeform surface geometry. A Brown & Shape coordinate measuring machine (CMM) equipped with a HyMARC laser-digitizing system was used to measure the leaflet profiles of a Baxter Carpentier-Edwards pericardial heart valve. The computer software, Polyworks was used to pre-process the raw data obtained from the scanning, which included merging images, eliminating duplicate points, and adding interpolated points. Three methods, creating a mesh model from cloud points, creating a freeform surface from cloud points, and generating a freeform surface by B-splines are presented in this paper to reconstruct the freeform leaflet surface. The mesh model created using Polyworks can be used for rapid prototyping and visualization. To fit a freeform surface to cloud points is straightforward but the rendering of a smooth surface is usually unpredictable. A surface fitted by a group of B-splines fitted to cloud points was found to be much smoother. This method offers the possibility of manually adjusting the surface curvature, locally. However, the process is complex and requires additional

  15. Charged anaesthetics alter LM-fibroblast plasma-membrane enzymes by selective fluidization of inner or outer membrane leaflets.

    PubMed Central

    Sweet, W D; Schroeder, F

    1986-01-01

    The functional consequences of the differences in lipid composition and structure between the two leaflets of the plasma membrane were investigated. Fluorescence of 1,6-diphenylhexa-1,3,5-triene(DPH), quenching, and differential polarized phase fluorimetry demonstrated selective fluidization by local anaesthetics of individual leaflets in isolated LM-cell plasma membranes. As measured by decreased limiting anisotropy of DPH fluorescence, cationic (prilocaine) and anionic (phenobarbital and pentobarbital) amphipaths preferentially fluidized the cytofacial and exofacial leaflets respectively. Unlike prilocaine, procaine, also a cation, fluidized both leaflets of these membranes equally. Pentobarbital stimulated 5'-nucleotidase between 0.1 and 5 mM and inhibited at higher concentrations, whereas phenobarbital only inhibited, at higher concentrations. Cationic drugs were ineffective. Two maxima of (Na+ + K+)-ATPase activation were obtained with both anionic drugs. Only one activation maximum was obtained with both cationic drugs. The maximum in activity below 1 mM for all four drugs clustered about a single limiting anisotropy value in the cytofacial leaflet, whereas there was no correlation between activity and limiting anisotropy in the exofacial leaflets. Therefore, although phenobarbital and pentobarbital below 1 mM fluidized the exofacial leaflet more than the cytofacial leaflet, the smaller fluidization in the cytofacial leaflet was functionally significant for (Na+ + K+)-ATPase. Mg2+-ATPase was stimulated at 1 mM-phenobarbital, unaffected by pentobarbital and slightly stimulated by both cationic drugs at concentrations fluidizing both leaflets. Thus the activity of (Na+ + K+)-ATPase was highly sensitive to selective fluidization of the leaflet containing its active site, whereas the other enzymes examined were little affected by fluidization of either leaflet. PMID:3028369

  16. The Developmental Trajectory of Leaflet Morphology in Wild Tomato Species[C][W][OA

    PubMed Central

    Chitwood, Daniel H.; Headland, Lauren R.; Kumar, Ravi; Peng, Jie; Maloof, Julin N.; Sinha, Neelima R.

    2012-01-01

    Leaves between species vary in their size, serration, complexity, and shape. However, phylogeny is not the only predictor of leaf morphology. The shape of a leaf is the result of intricate developmental processes, including heteroblastic progression (changes in leaf size and shape at different nodes) and the developmental stage of an organ. The leaflets that arise from complex leaves are additionally modified by their positioning along the proximal-distal axis of a leaf and whether they fall on the left or right side of leaves. Even further, leaves are environmentally responsive, and their final shape is influenced by environmental inputs. Here, we comprehensively describe differences in leaflet shape between wild tomato (Solanum section Lycopersicon) species using a principal component analysis on elliptical Fourier descriptors arising from >11,000 sampled leaflets. We leverage differences in developmental rate to approximate a developmental series, which allows us to resolve the confounding differences in intrinsic leaflet form and developmental stage along positions of the heteroblastic leaf series and proximal-distal axis of leaves. We find that the resulting developmental trajectory of organs at different positions along these axes are useful for describing the changes in leaflet shape that occur during the shade avoidance response in tomato. We argue that it is the developmental trajectory, the changes in shape that occur over developmental time in organs reiterated at multiple positions, that is the relevant phenotype for discerning differences between populations and species, and to understand the underlying developmental processes that change during evolution. PMID:22247269

  17. Oenocarpus bacaba and Oenocarpus bataua Leaflets and Roots: A New Source of Antioxidant Compounds.

    PubMed

    Leba, Louis-Jérôme; Brunschwig, Christel; Saout, Mona; Martial, Karine; Bereau, Didier; Robinson, Jean-Charles

    2016-01-01

    Native palm trees fruit from the Amazonian rainforest, Oenocarpus bacaba and Oenocarpus bataua, are very often used in the diet of local communities, but the biological activities of their roots and leaflets remain poorly known. Total phenolic content (TPC) and antioxidant activity of root and leaflet extracts from Oenocarpus bacaba and Oenocarpus bataua were assessed by using different chemical assays, the oxygèn radical absorbance capacity (ORAC), the 2,2-diphenyl-l-picrylhydrazyl (DPPH) free radical-scavenging capacity and the ferric-reducing ability of plasma (FRAP). Cellular antioxidant activity and cytotoxicity were also measured in Normal Human Dermal Fibroblasts. The polyphenolic composition of Oenocarpus extracts was investigated by LC-MS(n). Oenocarpus leaflet extracts were more antioxidant than root extracts, being at least as potent as Euterpe oleracea berries known as superfruit. Oenocarpus root extracts were characterized by hydroxycinnamic acids (caffeoylquinic and caffeoylshikimic acids), while leaflet extracts contained mainly caffeoylquinic acids and C-glycosyl flavones. These results suggest that leaflets of both Oenocarpus species could be valorized as a new non-cytotoxic source of antioxidants from Amazonia, containing hydroxycinnamic acids and flavonoids, in the pharmaceutical, cosmetic or agri-food industry. PMID:27355943

  18. Interdigitation of long-chain sphingomyelin induces coupling of membrane leaflets in a cholesterol dependent manner.

    PubMed

    Róg, Tomasz; Orłowski, Adam; Llorente, Alicia; Skotland, Tore; Sylvänne, Tuulia; Kauhanen, Dimple; Ekroos, Kim; Sandvig, Kirsten; Vattulainen, Ilpo

    2016-02-01

    It has been a long-standing question how the two leaflets in a lipid bilayer modulate each others' physical properties. In this paper, we discuss how this interaction may take place through interdigitation. We use atomistic molecular dynamics simulations to consider asymmetric lipid membrane models whose compositions are based on the lipidomics data determined for exosomes released by PC-3 prostate cancer cells. The simulations show interdigitation to be exceptionally strong for long-chain sphingomyelin (SM) molecules. In asymmetric membranes the amide-linked chain of SM is observed to extend deep into the opposing membrane leaflet. Interestingly, we find that the conformational order of the amide-linked SM chain increases the deeper it penetrates to the opposing leaflet. Analysis of this finding reveals that the amide-linked SM chain interacts favorably with the lipid chains in the opposite leaflet, and that cholesterol modulates the effect of SM interdigitation by influencing the conformational order of lipid hydrocarbon chains in the opposing (cytosolic) leaflet. PMID:26654782

  19. Oenocarpus bacaba and Oenocarpus bataua Leaflets and Roots: A New Source of Antioxidant Compounds

    PubMed Central

    Leba, Louis-Jérôme; Brunschwig, Christel; Saout, Mona; Martial, Karine; Bereau, Didier; Robinson, Jean-Charles

    2016-01-01

    Native palm trees fruit from the Amazonian rainforest, Oenocarpus bacaba and Oenocarpus bataua, are very often used in the diet of local communities, but the biological activities of their roots and leaflets remain poorly known. Total phenolic content (TPC) and antioxidant activity of root and leaflet extracts from Oenocarpus bacaba and Oenocarpus bataua were assessed by using different chemical assays, the oxygèn radical absorbance capacity (ORAC), the 2,2-diphenyl-l-picrylhydrazyl (DPPH) free radical-scavenging capacity and the ferric-reducing ability of plasma (FRAP). Cellular antioxidant activity and cytotoxicity were also measured in Normal Human Dermal Fibroblasts. The polyphenolic composition of Oenocarpus extracts was investigated by LC-MSn. Oenocarpus leaflet extracts were more antioxidant than root extracts, being at least as potent as Euterpe oleracea berries known as superfruit. Oenocarpus root extracts were characterized by hydroxycinnamic acids (caffeoylquinic and caffeoylshikimic acids), while leaflet extracts contained mainly caffeoylquinic acids and C-glycosyl flavones. These results suggest that leaflets of both Oenocarpus species could be valorized as a new non-cytotoxic source of antioxidants from Amazonia, containing hydroxycinnamic acids and flavonoids, in the pharmaceutical, cosmetic or agri-food industry. PMID:27355943

  20. Hydrodynamic function of polyurethane prosthetic heart valves: influences of Young's modulus and leaflet thickness.

    PubMed

    Bernacca, Gillian M; O'Connor, Bernard; Williams, David F; Wheatley, David J

    2002-01-01

    The development of flexible polyurethane heart valves has been hindered by material degradation in vivo. Low modulus polyurethane leaflets are regarded as desirable to achieve good hydrodynamic function. However, low modulus materials may suffer high strain accumulation, hence poor durability. Higher modulus materials may improve durability, but may have poor hydrodynamic function. This study examines the hydrodynamic behaviour of biostable polyurethane valves, varying Young's modulus from 5 to 63.6 MPa and mean leaflet thickness from 48-238 microm. Parameters studied included mean pressure gradient, energy losses and regurgitation over 5 equivalent cardiac outputs (3.6, 4.9, 6.4, 8.0 and 9.61 min(-1)) At low cardiac output, modulus was not significantly correlated with any parameter of valve opening. At 9.61 min(-1), modulus significantly influenced mean pressure gradient (p = 0.033). Mean leaflet thickness significantly correlated with mean pressure gradient and energy losses during forward flow at all cardiac outputs (p<0.001). This study demonstrates that, over a wide range of moduli, valve hydrodynamic function is not affected significantly by the material modulus. Leaflet thickness is a highly significant factor. Higher modulus elastomers in a range up to 32.5 MPa may be useful in prosthetic heart valve leaflet manufacture, retaining good hydrodynamic function while potentially extending the lifetime of the valve. PMID:11762853

  1. Ex vivo lung perfusion.

    PubMed

    Reeb, Jeremie; Cypel, Marcelo

    2016-03-01

    Lung transplantation is an established life-saving therapy for patients with end-stage lung disease. Unfortunately, greater success in lung transplantation is hindered by a shortage of lung donors and the relatively poor early-, mid-, and long-term outcomes associated with severe primary graft dysfunction. Ex vivo lung perfusion has emerged as a modern preservation technique that allows for a more accurate lung assessment and improvement in lung quality. This review outlines the: (i) rationale behind the method; (ii) techniques and protocols; (iii) Toronto ex vivo lung perfusion method; (iv) devices available; and (v) clinical experience worldwide. We also highlight the potential of ex vivo lung perfusion in leading a new era of lung preservation. PMID:26700566

  2. Finite element modeling of mitral leaflet tissue using a layered shell approximation

    PubMed Central

    Ratcliffe, Mark B.; Guccione, Julius M.

    2012-01-01

    The current study presents a finite element model of mitral leaflet tissue, which incorporates the anisotropic material response and approximates the layered structure. First, continuum mechanics and the theory of layered composites are used to develop an analytical representation of membrane stress in the leaflet material. This is done with an existing anisotropic constitutive law from literature. Then, the concept is implemented in a finite element (FE) model by overlapping and merging two layers of transversely isotropic membrane elements in LS-DYNA, which homogenizes the response. The FE model is then used to simulate various biaxial extension tests and out-of-plane pressure loading. Both the analytical and FE model show good agreement with experimental biaxial extension data, and show good mutual agreement. This confirms that the layered composite approximation presented in the current study is able to capture the exponential stiffening seen in both the circumferential and radial directions of mitral leaflets. PMID:22971896

  3. Autoradiographic characterization of beta-adrenoceptors in rat heart valve leaflets

    SciTech Connect

    Pinto, J.E.; Nazarali, A.J.; Torda, T.; Saavedra, J.M.

    1989-03-01

    beta-Adrenoceptors were localized and characterized in valve leaflets of the rat heart. Sixteen micrometer-thick tissue sections containing the mitral and aortic valves were incubated with (-)3-(/sup 125/I)iodocyanopindolol followed by autoradiography with computerized microdensitometry and comparison with /sup 125/I-labeled standards. beta-Adrenoceptors were present in all the valves studied. The selective beta 1-adrenoceptor antagonist CGP 20712 A (100 nM) displaced not more than 20% of the total binding sites, suggesting that most of the beta-adrenoceptors in the valve leaflets are of the beta 2-subtype. Forskolin-binding sites were detected in the mitral valve leaflet by incubation of adjacent tissue sections with (12-/sup 3/H)forskolin. Our results indicate that catecholamines could regulate the function of the heart valves through stimulation of beta 2-adrenoceptors.

  4. Severe mitral regurgitation due to anterior mitral leaflet perforation after surgical treatment of discrete subaortic stenosis.

    PubMed

    Ozyuksel, Arda; Yildirim, Ozgur; Onsel, Ibrahim; Bilal, Mehmet Salih

    2014-01-01

    Congenital subvalvular aortic stenosis may be associated with anomalies of the mitral valve. In this case, we present a patient with severe mitral valve regurgitation due to a perforation in the anterior mitral leaflet detected 4 months after an operation for relief of subaortic stenosis. A 10-year-old male patient who was operated for subvalvular aortic stenosis in another clinic was admitted to our hospital, and transthoracic echocardiography revealed severe mitral valve regurgitation due to a defect that was demonstrated at the anterior valve leaflet. The perforated area at the mitral valve zone A1 was repaired with a PTFE patch. The patient was successfully operated for the mitral valve perforation and the postoperative course was uneventful. In our case, the perforation in the anterior mitral leaflet implies a possible implementation of inappropriate surgical technique which necessitated a second surgical intervention after the initial operation. PMID:24859561

  5. Severe mitral regurgitation due to anterior mitral leaflet perforation after surgical treatment of discrete subaortic stenosis

    PubMed Central

    Ozyuksel, Arda; Yildirim, Ozgur; Onsel, Ibrahim; Bilal, Mehmet Salih

    2014-01-01

    Congenital subvalvular aortic stenosis may be associated with anomalies of the mitral valve. In this case, we present a patient with severe mitral valve regurgitation due to a perforation in the anterior mitral leaflet detected 4 months after an operation for relief of subaortic stenosis. A 10-year-old male patient who was operated for subvalvular aortic stenosis in another clinic was admitted to our hospital, and transthoracic echocardiography revealed severe mitral valve regurgitation due to a defect that was demonstrated at the anterior valve leaflet. The perforated area at the mitral valve zone A1 was repaired with a PTFE patch. The patient was successfully operated for the mitral valve perforation and the postoperative course was uneventful. In our case, the perforation in the anterior mitral leaflet implies a possible implementation of inappropriate surgical technique which necessitated a second surgical intervention after the initial operation. PMID:24859561

  6. A Coarse Grained Model for a Lipid Membrane with Physiological Composition and Leaflet Asymmetry

    PubMed Central

    Sharma, Satyan; Kim, Brian N.; Stansfeld, Phillip J.; Sansom, Mark S. P.; Lindau, Manfred

    2015-01-01

    The resemblance of lipid membrane models to physiological membranes determines how well molecular dynamics (MD) simulations imitate the dynamic behavior of cell membranes and membrane proteins. Physiological lipid membranes are composed of multiple types of phospholipids, and the leaflet compositions are generally asymmetric. Here we describe an approach for self-assembly of a Coarse-Grained (CG) membrane model with physiological composition and leaflet asymmetry using the MARTINI force field. An initial set-up of two boxes with different types of lipids according to the leaflet asymmetry of mammalian cell membranes stacked with 0.5 nm overlap, reliably resulted in the self-assembly of bilayer membranes with leaflet asymmetry resembling that of physiological mammalian cell membranes. Self-assembly in the presence of a fragment of the plasma membrane protein syntaxin 1A led to spontaneous specific positioning of phosphatidylionositol(4,5)bisphosphate at a positively charged stretch of syntaxin consistent with experimental data. An analogous approach choosing an initial set-up with two concentric shells filled with different lipid types results in successful assembly of a spherical vesicle with asymmetric leaflet composition. Self-assembly of the vesicle in the presence of the synaptic vesicle protein synaptobrevin 2 revealed the correct position of the synaptobrevin transmembrane domain. This is the first CG MD method to form a membrane with physiological lipid composition as well as leaflet asymmetry by self-assembly and will enable unbiased studies of the incorporation and dynamics of membrane proteins in more realistic CG membrane models. PMID:26659855

  7. Determining the combined effect of the lymphatic valve leaflets and sinus on resistance to forward flow.

    PubMed

    Wilson, John T; van Loon, Raoul; Wang, Wei; Zawieja, David C; Moore, James E

    2015-10-15

    The lymphatic system is vital to a proper maintenance of fluid and solute homeostasis. Collecting lymphatics are composed of actively contracting tubular vessels segmented by bulbous sinus regions that encapsulate bi-leaflet check valves. Valve resistance to forward flow strongly influences pumping performance. However, because of the sub-millimeter size of the vessels with flow rates typically <1 ml/h and pressures of a few cmH2O, resistance is difficult to measure experimentally. Using a newly defined idealized geometry, we employed an uncoupled approach where the solid leaflet deflections of the open valve were computed and lymph flow calculations were subsequently performed. We sought to understand: 1) the effect of sinus and leaflet size on the resulting deflections experienced by the valve leaflets and 2) the effects on valve resistance to forward flow of the fully open valve. For geometries with sinus-to-root diameter ratios >1.39, the average resistance to forward flow was 0.95×10(6)[g/(cm4 s)]. Compared to the viscous pressure drop that would occur in a straight tube the same diameter as the upstream lymphangion, valve leaflets alone increase the pressure drop up to 35%. However, the presence of the sinus reduces viscous losses, with the net effect that when combined with leaflets the overall resistance is less than that of the equivalent continuing straight tube. Accurately quantifying resistance to forward flow will add to the knowledge used to develop therapeutics for treating lymphatic disorders and may eventually lead to understanding some forms of primary lymphedema. PMID:26315921

  8. Contactless mapping of rhythmical phenomena in tissue perfusion using PPGI

    NASA Astrophysics Data System (ADS)

    Huelsbusch, Markus; Blazek, Vladimir

    2002-04-01

    This paper presents the experimental setup and preliminary results of a near infrared CCD camera based Photoplethysmography Imaging (PPGI) system, which has been shown to be suitable for contactless and spatially resolved assessment of rhythmical blood volume changes in the skin. To visualize the complex rhythmical patterns in the dermal perfusion the Wavelet Transform is utilized. It is able to jointly assess time and frequency behavior of signals and thus allows to analyze instationary oscillations and variabilities in the different human rhythmics. The presented system is expected to provide new insights into the functional sequences of physiological tissue perfusion as well as of the perfusion status in ulcer formation and wound healing.

  9. Two distinct subpopulations of neurons in the thalamic intergeniculate leaflet identified by subthreshold currents.

    PubMed

    Chrobok, Lukasz; Palus, Katarzyna; Lewandowski, Marian Henryk

    2016-08-01

    The intergeniculate leaflet (IGL) is a flat retinorecipient thalamic structure implicated in orchestrating circadian rhythm, historically considered to be a subdivision of the neighboring ventrolateral geniculate nucleus (VLG). IGL consists of two main neuronal subpopulations: enkephalinergic and neuropeptide Y (NPY)-synthesizing cells. These cell types have different functions, connectivity and firing pattern in vivo, which suggest that they have different membrane currents to support their functional differences. We therefore performed patch-clamp experiments combined with immunohistochemical staining to clarify possible differences in the subthreshold currents of IGL neurons. Our results suggest that IGL neurons can be divided into two subpopulations based on two ionic currents. A T-type calcium current (IT) was identified in neurons that do not synthesise NPY, whereas all NPY-positive neurons were found to express a marked A-type potassium current (IA). Due to the fact that the clear electrophysiological discriminants between IGL and VLG are lacking, we decided to compare the amplitudes of the identified currents between those two structures. Our data suggest that VLG neurons can be characterized by a high amplitude IT and a low IA. Finally, we compared both currents with WAG/Rij rats, a well-established model of absence epilepsy, with co-occurring retinal pathologies, sleep-onset disturbances, and seizures exhibiting circadian rhythmicity. Data presented in this study uncovered pathologies in the IT exhibiting neurons of the IGL and VLG. In conclusion, the data presented here suggest that different subthreshold current expression supports the functional differences of thalamic nuclei. Those differences are promising for possible pharmacological manipulations of specified cell types in pathophysiologies including absence epilepsy. PMID:27208616

  10. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

    PubMed Central

    Li, Wilson W.L.; van Paridon, Marieke; Bindraban, Navin R.; de Mol, Bas A.J.M.

    2016-01-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature. PMID:27547149

  11. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

    PubMed Central

    Prifti, Edvin; Ademaj, Fadil; Ikonomi, Majlinda; Demiraj, Aurel

    2015-01-01

    The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. PMID:26187170

  12. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation.

    PubMed

    Prifti, Edvin; Ademaj, Fadil; Ikonomi, Majlinda; Demiraj, Aurel

    2015-01-01

    The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. PMID:26187170

  13. Complex tricuspid valve repair for infective endocarditis: leaflet augmentation, chordae and annular reconstruction.

    PubMed

    Tarola, Christopher L; Losenno, Katie L; Chu, Michael W A

    2015-01-01

    Surgical treatment of tricuspid valve (TV) endocarditis remains a challenge because of extensive valve destruction, high risk of reinfection, poor outcomes with valve replacement and complex patient compliance issues. Reconstruction of the TV is certainly favoured over replacement; however, diffuse, multifocal vegetations and complete debridement often leave insufficient building materials necessary for repair. We describe our surgical reconstructive technique that relies upon extensive autologous pericardial patch augmentation of the destroyed TV leaflets to establish leaflet coaptation, supplemented with expanded polytetrafluoroethylene neo-chordae and annular reconstruction. We report our outcomes in a series of patients with grossly infected TVs with more than 50% of valvular destruction. PMID:25989809

  14. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm.

    PubMed

    Tomsic, Anton; Li, Wilson W L; van Paridon, Marieke; Bindraban, Navin R; de Mol, Bas A J M

    2016-08-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature. PMID:27547149

  15. Importance of capillary perfusion.

    PubMed

    Hardaway, R M

    1979-11-01

    Perfusion is more critical than oxygen in the maintenance of cell viability. A high hematocrit or high fibrinogen level increases blood viscosity and predisposes to disseminated intravascular coagulation. It is recommended that a hematocrit of about 30 be maintained in periods of circulatory stress such as shock or extracorporeal circulation. PMID:495856

  16. Distribution of perfusion.

    PubMed

    Glenny, Robb; Robertson, H Thomas

    2011-01-01

    Local driving pressures and resistances within the pulmonary vascular tree determine the distribution of perfusion in the lung. Unlike other organs, these local determinants are significantly influenced by regional hydrostatic and alveolar pressures. Those effects on blood flow distribution are further magnified by the large vertical height of the human lung and the relatively low intravascular pressures in the pulmonary circulation. While the distribution of perfusion is largely due to passive determinants such as vascular geometry and hydrostatic pressures, active mechanisms such as vasoconstriction induced by local hypoxia can also redistribute blood flow. This chapter reviews the determinants of regional lung perfusion with a focus on vascular tree geometry, vertical gradients induced by gravity, the interactions between vascular and surrounding alveolar pressures, and hypoxic pulmonary vasoconstriction. While each of these determinants of perfusion distribution can be examined in isolation, the distribution of blood flow is dynamically determined and each component interacts with the others so that a change in one region of the lung influences the distribution of blood flow in other lung regions. PMID:23737171

  17. Assessment of cerebral perfusion in childhood strokes

    SciTech Connect

    Gates, G.F.; Fishman, L.S.; Segall, H.D.

    1982-11-01

    Thirty-three children who had strokes were studied by dynamic and static scintigraphy, 29 by CT scanning, and 10 by cerebral angiography. The accuracy of dynamic scintigraphy in stroke detection during the first week of clinical symptoms was 94% while CT scanning was 60% accurate and static scintigraphy 11% accurate. During the second week the accuracy of CT scanning increased to 100%, but static scintigraphy improved to only 50%. Fifty percent of scintiangiograms performed during the first week showed either luxuriant perfusion or flip-flop patterns. In some patients these two flow patterns changed to that of cerebral hemispheric ischemia after going through a phase during which perfusion appeared to be equal in the two hemispheres. Dynamic scintigraphy is believed to be the test of choice for stroke detection in children during the first week.

  18. The Design of a Smokefree Home Leaflet and Home Pack: A Guernsey Case Study

    ERIC Educational Resources Information Center

    Amey, Vidya

    2011-01-01

    Purpose: This paper aims to explore the beliefs and attitudes of young mothers in relation to smokefree homes and passive smoke in Guernsey, and to encourage them to contribute to the designing of a smokefree home leaflet and pack aimed at young mothers. Design/methodology/approach: Semi-structured interviews were conducted with 11 participants…

  19. Application of finite element analysis to the design of tissue leaflets for a percutaneous aortic valve.

    PubMed

    Smuts, A N; Blaine, D C; Scheffer, C; Weich, H; Doubell, A F; Dellimore, K H

    2011-01-01

    Percutaneous Aortic Valve (PAV) replacement is an attractive alternative to open heart surgery, especially for patients considered to be poor surgical candidates. Despite this, PAV replacement still has its limitations and associated risks. Bioprosthetic heart valves still have poor long-term durability due to calcification and mechanical failure. In addition, the implantation procedure often presents novel challenges, including damage to the expandable stents and bioprosthetic leaflets. In this study, a simplified version of Fung's elastic constitutive model for skin, developed by Sun and Sacks, was implemented using finite element analysis (FEA) and applied to the modelling of bovine and kangaroo pericardium. The FEA implementation was validated by simulating biaxial tests and by comparing the results with experimental data. Concepts for different PAV geometries were developed by incorporating valve design and performance parameters, along with stent constraints. The influence of effects such as different leaflet material, material orientation and abnormal valve dilation on the valve function was investigated. The stress distribution across the valve leaflet was also examined to determine the appropriate fibre direction for the leaflet. The simulated attachment forces were compared with suture tearing tests performed on the pericardium to evaluate suture density. It is concluded that kangaroo pericardium is suitable for PAV applications, and superior to bovine pericardium, due to its lower thickness and greater extensibility. PMID:21094482

  20. Teenage Pregnancy: An Intensive and Critical Problem in Search of a Solution. Student Fact Finder Leaflet.

    ERIC Educational Resources Information Center

    Glover-Smith, Alma

    This document presents materials from a course designed to teach adolescents about teenage pregnancy and parenting. The materials are organized into nine modules, each of which contains instructions on how to use the module; a pre- and post-test on the information presented in the module; a fact finder leaflet of information; and relevant…

  1. Fabrication of elastomeric scaffolds with curvilinear fibrous structures for heart valve leaflet engineering.

    PubMed

    Hobson, Christopher M; Amoroso, Nicholas J; Amini, Rouzbeh; Ungchusri, Ethan; Hong, Yi; D'Amore, Antonio; Sacks, Michael S; Wagner, William R

    2015-09-01

    Native semi-lunar heart valves are composed of a dense fibrous network that generally follows a curvilinear path along the width of the leaflet. Recent models of engineered valve leaflets have predicted that such curvilinear fiber orientations would homogenize the strain field and reduce stress concentrations at the commissure. In the present work, a method was developed to reproduce this curvilinear fiber alignment in electrospun scaffolds by varying the geometry of the collecting mandrel. Elastomeric poly(ester urethane)urea was electrospun onto rotating conical mandrels of varying angles to produce fibrous scaffolds where the angle of fiber alignment varied linearly over scaffold length. By matching the radius of the conical mandrel to the radius of curvature for the native pulmonary valve, the electrospun constructs exhibited a curvilinear fiber structure similar to the native leaflet. Moreover, the constructs had local mechanical properties comparable to conventional scaffolds and native heart valves. In agreement with prior modeling results, it was found under quasi-static loading that curvilinear fiber microstructures reduced strain concentrations compared to scaffolds generated on a conventional cylindrical mandrels. Thus, this simple technique offers an attractive means for fabricating scaffolds where key microstructural features of the native leaflet are imitated for heart valve tissue engineering. PMID:25771748

  2. Fabrication of elastomeric scaffolds with curvilinear fibrous structures for heart valve leaflet engineering

    PubMed Central

    Hobson, Christopher M.; Amoroso, Nicholas J.; Amini, Rouzbeh; Ungchusri, Ethan; Hong, Yi; D’Amore, Antonio; Sacks, Michael S.; Wagner, William R.

    2015-01-01

    Native semi-lunar heart valves are composed of a dense fibrous network that generally follows a curvilinear path along the width of the leaflet. Recent models of engineered valve leaflets have predicted that such curvilinear fiber orientations would homogenize the strain field and reduce stress concentrations at the commissure. In the present work, a method was developed to reproduce this curvilinear fiber alignment in electrospun scaffolds by varying the geometry of the collecting mandrel. Elastomeric poly(ester urethane)urea was electrospun onto rotating conical mandrels of varying angles to produce fibrous scaffolds where the angle of fiber alignment varied linearly over scaffold length. By matching the radius of the conical mandrel to the radius of curvature for the native pulmonary valve, the electrospun constructs exhibited a curvilinear fiber structure similar to the native leaflet. Moreover, the constructs had local mechanical properties comparable to conventional scaffolds and native heart valves. In agreement with prior modeling results, it was found under quasi-static loading that curvilinear fiber microstructures reduced strain concentrations compared to scaffolds generated on a conventional cylindrical mandrels. Thus, this simple technique offers an attractive means for fabricating scaffolds where key microstructural features of the native leaflet are imitated for heart valve tissue engineering. PMID:25771748

  3. Real time, non-invasive assessment of leaflet deformation in heart valve tissue engineering.

    PubMed

    Kortsmit, J; Driessen, N J B; Rutten, M C M; Baaijens, F P T

    2009-03-01

    In heart valve tissue engineering, most bioreactors try to mimic physiological flow and operate with a preset transvalvular pressure applied to the tissue. The induced deformations are unknown and can vary during culturing as a consequence of changing mechanical properties of the engineered construct. Real-time measurement and control of local tissue strains are desired to systematically study the effects of mechanical loading on tissue development and, consequently, to design an optimal conditioning protocol. In this study, a method is presented to assess local tissue strains in heart valve leaflets during culturing. We hypothesize that local tissue strains can be determined from volumetric deformation. Volumetric deformation is defined as the amount of fluid displaced by the deformed heart valve leaflets in a stented configuration, and is measured, non-invasively, using a flow sensor. A numerical model is employed to relate volumetric deformation to local tissue strains in various regions of the leaflets (e.g. belly and commissures). The flow-based deformation measurement method was validated and its functionality was demonstrated in a tissue engineering experiment. Tri-leaflet, stented heart valves were cultured in vitro and during mechanical conditioning, realistic values for volumetric and local deformation were obtained. PMID:19093211

  4. 27 CFR 4.38a - Bottle cartons, booklets and leaflets.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Bottle cartons, booklets... for Wine § 4.38a Bottle cartons, booklets and leaflets. (a) General. An individual covering, carton, or other container of the bottle used for sale at retail (other than a shipping container), or...

  5. 27 CFR 4.38a - Bottle cartons, booklets and leaflets.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Bottle cartons, booklets... for Wine § 4.38a Bottle cartons, booklets and leaflets. (a) General. An individual covering, carton, or other container of the bottle used for sale at retail (other than a shipping container), or...

  6. Photosynthetic carbon metabolism in leaflets, stipules and tendrils of Pisum sativum L

    SciTech Connect

    Cote, R.; Grodzinski, B. )

    1990-05-01

    Gas exchange and photosynthetic carbon metabolism have been investigated for each of the dominant parts of the pea leaf (P. sativum) in a normal and a semi-leafless phenotype (cv. Improved Laxton's Progress, and cv. Curly, respectively). On a fresh weight basis, net photosynthesis of leaflets and stipules have similar rates, while in tendrils the rte is 40% lower. However, on a surface area basis, tendrils are only 5-10% less efficient photosynthetically when the area is corrected by a factor {pi}/2. Transpiration rates are similar for leaflets and stipules, but double for tendrils even though stomatal frequency on tendrils is reduced by 50%. Dark respiration is higher in tendrils than leaflets and stipules. Gas exchange is comparable in both cultivars. The early {sup 14}C-labelled products of stipules, leaflets and tendrils are similar in both phenotypes, however the tendrils clearly partition about 2-3 times more of the newly fixed {sup 14}CO{sub 2} into the amino acid fraction. These data will be discussed in relation to the anatomy and function of pea tendrils.

  7. Daily changes of amino acids in soybean leaflets are modified by C02 enrichment

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effects of CO2 enrichment on plant growth and on nitrogen partitioning were examined using soybean [Glycine max (L.) Merr. cv. Clark] leaflets and wheat leaves (Triticum aestivum L. cv. Oxen). Both species were grown from single seeds in matching controlled environment chambers. Continuous amb...

  8. Detection of apoptosis through the lipid order of the outer plasma membrane leaflet.

    PubMed

    Darwich, Zeinab; Klymchenko, Andrey S; Kucherak, Oleksandr A; Richert, Ludovic; Mély, Yves

    2012-12-01

    Cell plasma membranes of living cells maintain their asymmetry, so that the outer leaflet presents a large quantity of sphingomyelin, which is critical for formation of ordered lipid domains. Here, a recently developed probe based on Nile Red (NR12S) was applied to monitor changes in the lipid order specifically at the outer leaflet of cell membranes. Important key features of NR12S are its ratiometric response exclusively to lipid order (liquid ordered vs. liquid disordered phase) and not to surface charge, the possibility of using it at very low concentrations (10-20nM) and the very simple staining protocol. Cholesterol extraction, oxidation and sphingomyelin hydrolysis were found to red shift the emission spectrum of NR12S, indicating a decrease in the lipid order at the outer plasma membrane leaflet. Remarkably, apoptosis induced by three different agents (actinomycin D, camptothecin, staurosporine) produced very similar spectroscopic effects, suggesting that apoptosis also significantly decreases the lipid order at this leaflet. The applicability of NR12S to detect apoptosis was further validated by fluorescence microscopy and flow cytometry, using the ratio between the blue and red parts of its emission band. Thus, for the first time, an environment-sensitive probe, sensitive to lipid order, is shown to detect apoptosis, suggesting a new concept in apoptosis sensing. PMID:22846507

  9. An inverse modeling approach for semilunar heart valve leaflet mechanics: exploitation of tissue structure.

    PubMed

    Aggarwal, Ankush; Sacks, Michael S

    2016-08-01

    Determining the biomechanical behavior of heart valve leaflet tissues in a noninvasive manner remains an important clinical goal. While advances in 3D imaging modalities have made in vivo valve geometric data available, optimal methods to exploit such information in order to obtain functional information remain to be established. Herein we present and evaluate a novel leaflet shape-based framework to estimate the biomechanical behavior of heart valves from surface deformations by exploiting tissue structure. We determined accuracy levels using an "ideal" in vitro dataset, in which the leaflet geometry, strains, mechanical behavior, and fibrous structure were known to a high level of precision. By utilizing a simplified structural model for the leaflet mechanical behavior, we were able to limit the number of parameters to be determined per leaflet to only two. This approach allowed us to dramatically reduce the computational time and easily visualize the cost function to guide the minimization process. We determined that the image resolution and the number of available imaging frames were important components in the accuracy of our framework. Furthermore, our results suggest that it is possible to detect differences in fiber structure using our framework, thus allowing an opportunity to diagnose asymptomatic valve diseases and begin treatment at their early stages. Lastly, we observed good agreement of the final resulting stress-strain response when an averaged fiber architecture was used. This suggests that population-averaged fiber structural data may be sufficient for the application of the present framework to in vivo studies, although clearly much work remains to extend the present approach to in vivo problems. PMID:26449480

  10. Development and Validation of Educational Leaflet for Caregivers of Preterm Infants

    PubMed Central

    Khurana, Sonia; Rao, Bhamini Krishna; Lewis, Leslie Edward S.; Bhat, Ramesh; Purkayastha, Jayashree; Kamath, Asha

    2016-01-01

    Introduction Facilitation of child development is usually emphasized in the form of early intervention classes and practical demonstrations. However, non-adherence to home program for such interventions has been reported due to various reasons. Aim To develop and validate an educational leaflet as a supplement guide for caregivers to promote better development of their child during 4-6 months of age. Materials and Methods An in-depth literature review and focus group discussion with the experts was conducted to formulate the content of leaflet. Initial framework consisted of introduction, main text with pictorial representation and instructions about facilitation of various milestones, do’s–don’ts and disclaimer. Validation was done through a questionnaire consisting of 9 questions pertaining to completeness, understandability, legibility, clarity and utility of educational material for caregivers and a section for comments. Leaflet with enclosed questionnaire was distributed to 14 validators (2 neonatologists, 4 paediatricians and 8 physiotherapists), along with a covering letter stating the purpose and relevance of this educational material, and the importance of their participation in validation process. Scoring was done on 5 point Likert scale for each item in the material. Results Responses from the 14 evaluators were collected and analysed. Item level content validity index (I-CVI) was calculated for individual items which ranged from 0.73 – 1. Scale level Content Validity Index (S-CVI) was calculated for complete nine items and it was found to be 0.91. Validators expressed their views to include a column on normal milestones across 4-6 months of age and also to highlight the significance of performing each activity mentioned in the leaflet. These suggestions were incorporated in consensus with the subject experts and the final draft was made. Conclusion Educational leaflet for caregivers of 4-6 months preterm infants has been developed and validated

  11. Regional Myocardial Perfusion Rates in Patients with Coronary Artery Disease

    PubMed Central

    Cannon, Paul J.; Dell, Ralph B.; Dwyer, Edward M.

    1972-01-01

    Regional myocardial perfusion rates were estimated from the myocardial washout of 133Xenon in 24 patients with heart disease whose coronary arteriograms were abnormal and 17 similar subjects whose coronary arteriograms were judged to be normal. Disappearance rates of 133Xe from multiple areas of the heart were monitored externally with a multiple-crystal scintillation camera after the isotope had been injected into a coronary artery and local myocardial perfusion rates were calculated by the Kety formula. The mean myocardial perfusion rates in the left ventricle exceeded those in the right ventricle or atrial regions in subjects without demonstrable coronary artery disease. In this group there was a significant lack of homogeneity of local perfusion rates in left ventricular myocardium; the mean coefficient of variation of left ventricular local perfusion rates was 15.8%. In the patients with radiographically demonstrable coronary artery disease, a variety of myocardial perfusion patterns were observed. Local capillary blood flow rates were depressed throughout the myocardium of patients with diffuse coronary disease but were subnormal only in discrete myocardial regions of others with localized occlusive disease. Local myocardial perfusion rates were similar to those found in the group with normal coronary arteriograms in patients with slight degrees of coronary disease and in those areas of myocardium distal to marked coronary constrictions or occlusions which were well supplied by collateral vessels. In subjects with right coronary disease, the mean right ventricular perfusion rates were significantly subnormal; in seven subjects of this group perfusion of the inferior left ventricle by a dominant right coronary artery was absent or depressed. The average mean left ventricular perfusion rate of 12 subjects with significant disease of two or more branches of the left coronary artery was significantly lower than that of the group with normal left coronary

  12. In vitro hydrodynamic evaluation of a biovalve with stent (tubular leaflet type) for transcatheter pulmonary valve implantation.

    PubMed

    Sumikura, Hirohito; Nakayama, Yasuhide; Ohnuma, Kentaro; Kishimoto, Satoru; Takewa, Yoshiaki; Tatsumi, Eisuke

    2015-12-01

    We have been developing an autologous heart valve-shaped tissue with a stent (stent-biovalve) for transcatheter pulmonary valve implantation (TPVI) using "in-body tissue architecture" technology. In this study, the hydrodynamic performance of a stent-biovalve with tubular leaflets was evaluated by changing its leaflet height in an in vitro test in order to determine the appropriate stent-biovalve form for the pulmonary valve. A specially designed, self-expandable, stent-mounted, cylindrical acrylic mold was placed in a dorsal subcutaneous pouch of goat, and the implant was extracted 2 months later. Only the cylindrical acrylic mold was removed from the implant, and a tubular hollow structure of membranous connective tissue impregnated with the stent strut was obtained. Half of tubular tissue was completely folded in half inwards, and 3 commissure parts were connected to form 3 leaflets, resulting in the preparation of a stent-biovalve with tubular leaflets (25-mm ID). The stent-biovalve with adjusting leaflet height (13, 14, 15, 17, 20, and 25 mm) was fixed to a specially designed pulsatile mock circulation circuit under pulmonary valve conditions using 37 °C saline. The mean pressure difference and effective orifice area were better than those of the biological valve. The lowest and highest leaflet heights had a high regurgitation rate due to lack of coaptation or prevention of leaflet movement, respectively. The lowest regurgitation (ca. 11%) was observed at a height of 15 mm. The leaflet height was found to significantly affect the hydrodynamics of stent-biovalves, and the existence of an appropriate leaflet height became clear. PMID:26141924

  13. Engineering tissue constructs to mimic native aortic and pulmonary valve leaflets' structures and mechanics

    NASA Astrophysics Data System (ADS)

    Masoumi, Nafiseh

    There are several disadvantages correlated with current heart valve replacement, including anticoagulation therapy for patients with mechanical valves and the low durability of bioprosthetic valves. The non-viable nature of such devices is a critical drawback especially for pediatric cases due to the inability of the graft to grow in vivo with the patients. A tissue engineered heart valve (TEHV) with remodeling and growth ability, is conceptually appealing to use in the surgical repair and could serve as a permanent replacements when operating for pediatric valvular lesions. It is critical that scaffolds for functional heart valve tissue engineering, be capable of mimicking the native leaflet's structure and mechanical properties at the time of implantation. Meanwhile, the scaffolds should be able to support cellular proliferation and native-like tissue formation as the TEHV remodels toward a scaffold-free state. Our overall hypothesis is that an "ideal" engineered construct, designed based on native leaflet's structure and mechanics, will complement a native heart valve leaflet in providing benchmarks for use in the design of clinically-applicable TEHV. This hypothesis was addressed through several experiments conducted in the present study. To establish a functional biomimetic TEHV, we developed scaffolds capable of matching the anisotropic stiffness of native leaflet while promoting native-like cell and collagen content and supporting the ECM generation. Scaffolds with various polymer contents (e.g., poly (glycerol sebacate) (PGS) and poly (epsilon-caprolactone) (PCL)) and structural designs (e.g., microfabricated and microfibrous scaffolds), were fabricated based on native leaflet's structure and mechanics. It was found that the tri-layered scaffold, designed with assembly of microfabricated PGS and microfibrous PGS/PCL was a functional leaflet capable of promoting tissue formation. Furthermore, to investigate the effect of cyclic stress and flexure

  14. The surface microstructure of cusps and leaflets in rabbit and mouse heart valves

    PubMed Central

    Ye, Xia; Zhou, Ming; Lei, Weining

    2014-01-01

    Summary In this investigation, scanning electron microscopy was used to characterize the microstructure on the surfaces of animal heart valve cusps/leaflets. The results showed that though these surfaces appear smooth to the naked eye, they are actually comprised of a double hierarchical structure consisting of a cobblestone-like microstructure and nano-cilia along with mastoids with a directional arrangement. Such nanostructures could play a very important role in the hemocompatibility characteristics of heart valves. On this basis, the model of the microstructure was constructed and theoretical analysis was used to obtain optimal geometric parameters for the rough surface of artificial valve cusps/leaflets. This model may help improve reconstructive techniques and it may be beneficial in the design and fabrication of valve substitutes or partial substitutes. Namely, the model may help ameliorate heart valve replacement surgery. PMID:24991498

  15. Detection of cholesterol-rich microdomains in the inner leaflet of the plasma membrane

    SciTech Connect

    Hayashi, Masami; Shimada, Yukiko; Inomata, Mitsushi; Ohno-Iwashita, Yoshiko . E-mail: iwashita@tmig.or.jp

    2006-12-22

    The C-terminal domain (D4) of perfringolysin O binds selectively to cholesterol in cholesterol-rich microdomains. To address the issue of whether cholesterol-rich microdomains exist in the inner leaflet of the plasma membrane, we expressed D4 as a fusion protein with EGFP in MEF cells. More than half of the EGFP-D4 expressed in stable cell clones was bound to membranes in raft fractions. Depletion of membrane cholesterol with {beta}-cyclodextrin reduced the amount of EGFP-D4 localized in raft fractions, confirming EGFP-D4 binding to cholesterol-rich microdomains. Subfractionation of the raft fractions showed most of the EGFP-D4 bound to the plasma membrane rather than to intracellular membranes. Taken together, these results strongly suggest the existence of cholesterol-rich microdomains in the inner leaflet of the plasma membrane.

  16. The enigmatic fast leaflet rotation in Desmodium motorium: butterfly mimicry for defense?

    PubMed

    Lev-Yadun, Simcha

    2013-06-01

    I propose that the enigmatic leaflet movements in elliptical circles every few minutes of the Indian telegraph (semaphore) plant Desmodium motorium ( = D. gyrans = Hedysarum gyrans = Codariocalyx motorius), which has intrigued scientists for centuries, is a new type of butterfly or general winged arthropod mimicry by this plant. Such leaflet movement may deceive a passing butterfly searching for an un-occupied site suitable to deposit its eggs, that the plant is already occupied. It may also attract insectivorous birds, reptiles or arthropods to the plant because it looks as if it is harboring a potential prey and while they patrol there, they can find insects or other invertebrates that indeed attack the plant. The possibility that diurnal mammalian herbivores may also be deterred by these movements should not be dismissed. PMID:23603964

  17. Perturbations of plant leaflet rhythms caused by electromagnetic radio-frequency radiation.

    PubMed

    Ellingsrud, S; Johnsson, A

    1993-01-01

    The minute-range up and down rhythms of the lateral leaflets of Desmodium gyrans has been studied when exposed to electromagnetic radiation in the radio-frequency (RF) range. The RF radiation was applied as homogeneous 27.12 MHz fields in specially-designed exposure cells(and in some cases as non-homogeneous radiation of 27 MHz, amplitude modulated by 50 Hz, in front of commercial diathermy equipment). All fields were applied as pulses. We report effects in the leaflet rhythms such as temporary changes in the amplitude, period, and phase. The radiation could also cause temporary or complete cessations of the rhythms. The lowest dose (8 W/cm2) used was still effective. PMID:8323575

  18. Lung Ventilation/Perfusion Scan

    MedlinePlus

    ... from the NHLBI on Twitter. What Is a Lung Ventilation/Perfusion Scan? A lung ventilation/perfusion scan, or VQ scan, is a ... that measures air and blood flow in your lungs. A VQ scan most often is used to ...

  19. A meso-scale layer-specific structural constitutive model of the mitral heart valve leaflets.

    PubMed

    Zhang, Will; Ayoub, Salma; Liao, Jun; Sacks, Michael S

    2016-03-01

    Fundamental to developing a deeper understanding of pathophysiological remodeling in mitral valve (MV) disease is the development of an accurate tissue-level constitutive model. In the present work, we developed a novel meso-scale (i.e. at the level of the fiber, 10-100μm in length scale) structural constitutive model (MSSCM) for MV leaflet tissues. Due to its four-layer structure, we focused on the contributions from the distinct collagen and elastin fiber networks within each tissue layer. Requisite collagen and elastin fibrous structural information for each layer were quantified using second harmonic generation microscopy and conventional histology. A comprehensive mechanical dataset was also used to guide model formulation and parameter estimation. Furthermore, novel to tissue-level structural constitutive modeling approaches, we allowed the collagen fiber recruitment function to vary with orientation. Results indicated that the MSSCM predicted a surprisingly consistent mean effective collagen fiber modulus of 162.72MPa, and demonstrated excellent predictive capability for extra-physiological loading regimes. There were also anterior-posterior leaflet-specific differences, such as tighter collagen and elastin fiber orientation distributions (ODF) in the anterior leaflet, and a thicker and stiffer atrialis in the posterior leaflet. While a degree of angular variance was observed, the tight valvular tissue ODF also left little room for any physically meaningful angular variance in fiber mechanical responses. Finally, a novel fibril-level (0.1-1μm) validation approach was used to compare the predicted collagen fiber/fibril mechanical behavior with extant MV small angle X-ray scattering data. Results demonstrated excellent agreement, indicating that the MSSCM fully captures the tissue-level function. Future utilization of the MSSCM in computational models of the MV will aid in producing highly accurate simulations in non-physiological loading states that can

  20. Mechanical failure (leaflet disruption) of a porcine aortic heterograft: rare cause of acute aortic insufficiency.

    PubMed

    Housman, L B; Pitt, W A; Mazur, J H; Litchford, B; Gross, S A

    1978-08-01

    Use of the Hancock, glutaraldehyde-preserved, stented heterograft for aortic valve replacement has gained wide acceptance in the past 7 years. Nevertheless, very little is known about the long-term mechanical and pathological characteristics following implantation. A rare case is presented in which mechanical valve failure occurred secondary to leaflet disruption in the absence of infection 23 months after implantation. The literature is reviewed and the implications of this unusual complication are discussed. PMID:567263

  1. Distribution of extracellular matrix components in normal and degenerated canine tricuspid valve leaflets.

    PubMed

    Aupperle, H; März, I; Thielebein, J; Kiefer, B; Dinges, G; Schoon, H-A

    2009-07-01

    The aim of the present study was to investigate the composition and distribution of various extracellular matrix (ECM) components in normal canine tricuspid valves (TVs) and in TVs affected by chronic valvular disease (CVD). The parietal (pTV) and septal (sTV) leaflets of the TVs from 27 dogs were investigated immunohistochemically for expression of collagen types I, III, IV and VI, elastin, laminin, fibronectin and heparan sulphate. Normal pTV consisted mainly of elastin and collagen VI in the atrialis, fibronectin in the thin spongiosa and mixed collagens in the fibrosa. The layered structure was less distinct in sTV, with numerous adipocytes and proteoglycans in the spongiosa and collagen III predominating in the fibrosa. The earliest stages of CVD affecting the pTV were recognized in the spongiosa and progression to advanced disease was characterized by nodular accumulation of proteoglycans within the free edge of the leaflet. These nodular lesions of the pTV contained more fibronectin, elastin and collagens I and VI than those affecting the sTV. These findings contrast with those reported in CVD affecting the mitral valve (MV) in which the early lesions affect the atrialis and advanced disease involves the entire leaflet. The pathogenesis of CVD in TV may involve initial alterations of the tricuspid annulus that lead to early lesions within the spongiosa, resulting in further shear stress and proteoglycan accumulation at the free edge of the pTV. PMID:19342061

  2. Getting to the Outer Leaflet: Physiology of Phosphatidylserine Exposure at the Plasma Membrane.

    PubMed

    Bevers, Edouard M; Williamson, Patrick L

    2016-04-01

    Phosphatidylserine (PS) is a major component of membrane bilayers whose change in distribution between inner and outer leaflets is an important physiological signal. Normally, members of the type IV P-type ATPases spend metabolic energy to create an asymmetric distribution of phospholipids between the two leaflets, with PS confined to the cytoplasmic membrane leaflet. On occasion, membrane enzymes, known as scramblases, are activated to facilitate transbilayer migration of lipids, including PS. Recently, two proteins required for such randomization have been identified: TMEM16F, a scramblase regulated by elevated intracellular Ca(2+), and XKR8, a caspase-sensitive protein required for PS exposure in apoptotic cells. Once exposed at the cell surface, PS regulates biochemical reactions involved in blood coagulation, and bone mineralization, and also regulates a variety of cell-cell interactions. Exposed on the surface of apoptotic cells, PS controls their recognition and engulfment by other cells. This process is exploited by parasites to invade their host, and in specialized form is used to maintain photoreceptors in the eye and modify synaptic connections in the brain. This review discusses what is known about the mechanism of PS exposure at the surface of the plasma membrane of cells, how actors in the extracellular milieu sense surface exposed PS, and how this recognition is translated to downstream consequences of PS exposure. PMID:26936867

  3. [Drug information for patients (Package Leaflets), and user testing in EU].

    PubMed

    Yamamoto, Michiko; Doi, Hirohisa; Furukawa, Aya

    2015-01-01

    Patients and consumers have desired high quality drug information in their pharmacotherapy, and are entitled to receive it. It is desirable that the information should be aimed at shared decision-making between patients and healthcare professionals about medications. The quality of drug information available to patients should also be assured. With an aim to improve the quality of "Drug Guide for Patients", we investigated Patient Information Leaflets (PILs) which are approved by the Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom (UK) with regard to the criteria of development and user testing for assuring the quality of the PILs. In the European Union (EU), these are called Package Leaflets (PLs). PILs have been a legal requirement in the UK since 1999 for all medications. The user testing of PILs has been implemented as evidence since 2005 so that people can rely on the information provided in the leaflet. Execution of PILs which follow the guidance of the user testing, according to the guidance of this user testing, would reflect the views of patients. Here, we introduce the development process and implementation of user testing of PILs. In terms of readability, accessibility and understandability of drug information for patients, we need to discuss involving the public in decisions on how its quality should be assured and how it can be made easily be comprehensible for patients, in order to make effective use of "Drug Guide for Patients" in the future in Japan. PMID:25747226

  4. Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation

    PubMed Central

    Prifti, Edvin; Ikonomi, Majlinda; Veshti, Altin; Demiraj, Aurel; Xhaxho, Roland

    2015-01-01

    Introduction The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves. Case presentation We describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast’s surgery. A preoperative echocardiography demonstrated a mass >1 cm2 originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE. Discussion With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl’s excrescences. Conclusion To summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis. PMID:26209756

  5. Transmembrane protein diffusion in gel-supported dual-leaflet membranes.

    PubMed

    Wang, Chih-Ying; Hill, Reghan J

    2014-11-18

    Tools to measure transmembrane-protein diffusion in lipid bilayer membranes have advanced in recent decades, providing a need for predictive theoretical models that account for interleaflet leaflet friction on tracer mobility. Here we address the fully three-dimensional flows driven by a (nonprotruding) transmembrane protein embedded in a dual-leaflet membrane that is supported above and below by soft porous supports (e.g., hydrogel or extracellular matrix), each of which has a prescribed permeability and solvent viscosity. For asymmetric configurations, i.e., supports with contrasting permeability, as realized for cells in contact with hydrogel scaffolds or culture media, the diffusion coefficient can reflect interleaflet friction. Reasonable approximations, for sufficiently large tracers on low-permeability supports, are furnished by a recent phenomenological theory from the literature. Interpreting literature data, albeit for hard-supported membranes, provides a theoretical basis for the phenomenological Stokes drag law as well as strengthening assertions that nonhydrodynamic interactions are important in supported bilayer systems, possibly leading to overestimates of the membrane/leaflet viscosity. Our theory provides a theoretical foundation for future experimental studies of tracer diffusion in gel-supported membranes. PMID:25418298

  6. Nonlinear solid finite element analysis of mitral valves with heterogeneous leaflet layers

    NASA Astrophysics Data System (ADS)

    Prot, V.; Skallerud, B.

    2009-02-01

    An incompressible transversely isotropic hyperelastic material for solid finite element analysis of a porcine mitral valve response is described. The material model implementation is checked in single element tests and compared with a membrane implementation in an out-of-plane loading test to study how the layered structures modify the stress response for a simple geometry. Three different collagen layer arrangements are used in finite element analysis of the mitral valve. When the leaflets are arranged in two layers with the collagen on the ventricular side, the stress in the fibre direction through the thickness in the central part of the anterior leaflet is homogenized and the peak stress is reduced. A simulation using membrane elements is also carried out for comparison with the solid finite element results. Compared to echocardiographic measurements, the finite element models bulge too much in the left atrium. This may be due to evidence of active muscle fibres in some parts of the anterior leaflet, whereas our constitutive modelling is based on passive material.

  7. Transmembrane Protein Diffusion in Gel-Supported Dual-Leaflet Membranes

    PubMed Central

    Wang, Chih-Ying; Hill, Reghan J.

    2014-01-01

    Tools to measure transmembrane-protein diffusion in lipid bilayer membranes have advanced in recent decades, providing a need for predictive theoretical models that account for interleaflet leaflet friction on tracer mobility. Here we address the fully three-dimensional flows driven by a (nonprotruding) transmembrane protein embedded in a dual-leaflet membrane that is supported above and below by soft porous supports (e.g., hydrogel or extracellular matrix), each of which has a prescribed permeability and solvent viscosity. For asymmetric configurations, i.e., supports with contrasting permeability, as realized for cells in contact with hydrogel scaffolds or culture media, the diffusion coefficient can reflect interleaflet friction. Reasonable approximations, for sufficiently large tracers on low-permeability supports, are furnished by a recent phenomenological theory from the literature. Interpreting literature data, albeit for hard-supported membranes, provides a theoretical basis for the phenomenological Stokes drag law as well as strengthening assertions that nonhydrodynamic interactions are important in supported bilayer systems, possibly leading to overestimates of the membrane/leaflet viscosity. Our theory provides a theoretical foundation for future experimental studies of tracer diffusion in gel-supported membranes. PMID:25418298

  8. Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

    PubMed

    Oliver, S; Rajan, L; Turner, H; Oakley, A; Entwistle, V; Watt, I; Sheldon, T A; Rosser, J

    1996-11-16

    With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice. PMID:8939120

  9. The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England.

    PubMed Central

    Hart, A R; Barone, T L; Gay, S P; Inglis, A; Griffin, L; Tallon, C A; Mayberry, J F

    1997-01-01

    OBJECTIVE: To raise compliance in a general practice based colorectal cancer screening programme by the use of a simple health educational leaflet. DESIGN: A randomised controlled trial of the leaflet's effect on completion of faecal occult blood tests. The leaflet explained the high frequency of colorectal cancer, the principles of screening, and addressed reasons for non-compliance. SETTING: The British town of Market Harborough where most of the population are registered with a single practice. PARTICIPANTS: These comprised 1571 residents aged 61 to 70 years registered with the practice. Residents were invited to receive a free faecal occult blood test in a colorectal cancer screening programme. Half the population were randomly assigned to receive the educational leaflet about screening. RESULTS: Compliance in test and control groups, positive rate of stool testing, and pathology detected were measured. Compliance was higher in men who received the leaflet in those aged 61 to 65 years (36% v 27%, chi2 = 4.0, p < 0.05) and in men aged 66 to 70 years (39% v 23%, chi2 = 9.7, p < 0.01). In women, use of the leaflet did not affect compliance in those aged either 61 to 65 years (38% v 36%, chi2 = 0.1, NS) or 66 to 70 years (31% v 31%, chi2 = 0.0, NS). The positive rate of stool testing in patients observing the required dietary restrictions was 1.6%. A significant lesion was detected in 1.4% of people tested (2 carcinomas and 5 patients with adenomatous polyps). CONCLUSIONS: Health education leaflets addressing reasons for non-compliance significantly increased compliance in men and should be used in screening programmes. Reasons for the lack of success of the leaflet in women should be investigated and other interventions for raising compliance should be developed. PMID:9196650

  10. Advanced modeling strategy for the analysis of heart valve leaflet tissue mechanics using high-order finite element method.

    PubMed

    Mohammadi, Hadi; Bahramian, Fereshteh; Wan, Wankei

    2009-11-01

    Modeling soft tissue using the finite element method is one of the most challenging areas in the field of biomechanical engineering. To date, many models have been developed to describe heart valve leaflet tissue mechanics, which are accurate to some extent. Nevertheless, there is no comprehensive method to modeling soft tissue mechanics, This is because (1) the degree of anisotropy in the heart valve leaflet changes layer by layer due to a variety of collagen fiber densities and orientations that cannot be taken into account in the model and also (2) a constitutive material model fully describing the mechanical properties of the leaflet structure is not available in the literature. In this framework, we develop a new high-order element using p-type finite element formulation to create anisotropic material properties similar to those of the heart valve leaflet tissue in only one single element. This element also takes the nonlinearity of the leaflet tissue into consideration using a bilinear material model. This new element is composed a two-dimensional finite element in the principal directions of leaflet tissue and a p-type finite element in the direction of thickness. The proposed element is easy to implement, much more efficient than standard elements available in commercial finite element packages. This study is one step towards the modeling of soft tissue mechanics using a meshless finite element approach to be applied in real-time haptic feedback of soft-tissue models in virtual reality simulation. PMID:19773193

  11. Ex vivo lung perfusion.

    PubMed

    Machuca, Tiago N; Cypel, Marcelo

    2014-08-01

    Lung transplantation (LTx) is an established treatment option for eligible patients with end-stage lung disease. Nevertheless, the imbalance between suitable donor lungs available and the increasing number of patients considered for LTx reflects in considerable waitlist mortality. Among potential alternatives to address this issue, ex vivo lung perfusion (EVLP) has emerged as a modern preservation technique that allows for more accurate lung assessment and also improvement of lung function. Its application in high-risk donor lungs has been successful and resulted in safe expansion of the donor pool. This article will: (I) review the technical details of EVLP; (II) the rationale behind the method; (III) report the worldwide clinical experience with the EVLP, including the Toronto technique and others; (IV) finally, discuss the growing literature on EVLP application for donation after cardiac death (DCD) lungs. PMID:25132972

  12. Ex vivo lung perfusion

    PubMed Central

    Machuca, Tiago N.

    2014-01-01

    Lung transplantation (LTx) is an established treatment option for eligible patients with end-stage lung disease. Nevertheless, the imbalance between suitable donor lungs available and the increasing number of patients considered for LTx reflects in considerable waitlist mortality. Among potential alternatives to address this issue, ex vivo lung perfusion (EVLP) has emerged as a modern preservation technique that allows for more accurate lung assessment and also improvement of lung function. Its application in high-risk donor lungs has been successful and resulted in safe expansion of the donor pool. This article will: (I) review the technical details of EVLP; (II) the rationale behind the method; (III) report the worldwide clinical experience with the EVLP, including the Toronto technique and others; (IV) finally, discuss the growing literature on EVLP application for donation after cardiac death (DCD) lungs. PMID:25132972

  13. Cerebral perfusion and cortical thickness indicate cortical involvement in mild Parkinson's disease.

    PubMed

    Madhyastha, Tara M; Askren, Mary K; Boord, Peter; Zhang, Jing; Leverenz, James B; Grabowski, Thomas J

    2015-12-01

    Cortical dysfunction in Parkinson's disease (PD) may be caused by disruption to ascending systems or by intrinsic cortical neuropathology. We introduce and conduct a joint analysis of metabolism and atrophy capable of identifying whether metabolic disruption occurs in mild PD without cortical atrophy, to determine the extent and spatial pattern of cortical involvement in mild PD. The design was observational, studying 23 cognitively normal participants with mild PD (mean Hoehn & Yahr stage 2) and 21 healthy controls. Cortical thickness (obtained from analysis of structural magnetic resonance imaging [MRI] with FreeSurfer) and cerebral perfusion measures (obtained from arterial spin labeling [ASL]) analyzed independently and then together in a joint multiple factorial analysis to identify spatial patterns of perfusion and cortical thickness. We identify a pattern of changes in perfusion and cortical thickness characterized by symmetric parietal cortical thinning and reduced precuneus perfusion, with relative preservation of thickness and perfusion in the anterior cingulate cortex (ACC), right prefrontal gyrus, and medial frontal gyrus. The expression of this pattern is correlated with motor system symptoms and speed of processing. A spatial pattern of joint parietal cortical thinning and disproportionate reduction in perfusion occurs in our nondemented PD sample. We found no PD-related components of reduced perfusion without cortical thinning. This suggests that PD affects the cortex itself, even when symptoms are relatively mild. PMID:25759166

  14. Non-Ischemic Perfusion Defects due to Delayed Arrival of Contrast Material on Stress Perfusion Cardiac Magnetic Resonance Imaging after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Kim, Yeo Koon; Park, Sang Joon; Cheon, Gi Jeong; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2014-01-01

    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients. PMID:24644408

  15. [Leaflets and websites on colorectal cancer screening and their quality assessment from experts' views].

    PubMed

    Dreier, M; Borutta, B; Seidel, G; Münch, I; Töppich, J; Bitzer, E-M; Dierks, M-L; Walter, U

    2014-03-01

    In Germany, individuals who have statutory health insurance have free access to colorectal cancer (CRC) screening tests, and can choose between a fecal occult blood test and a screening colonoscopy. Evidence-based health information may support informed choices regarding whether or not to undergo CRC screening. The aim of this study was to assess whether the available German information materials on CRC screening meet evidence-based health information standards. A systematic search was made for print media and websites on CRC screening addressed to German people with average CRC risk (search period for print media August 2010, for websites January-March 2012). The identified information was assessed with a newly developed comprehensive list of criteria. In all, 41 print media, including 28 flyers and 13 brochures, and 36 websites were identified and assessed. These materials reported more often the benefits than the risks of CRC screening, and quantified presentations of benefits and risks were less frequently given. Most of the materials called for participation and did not indicate the option to decide whether or not to attend CRC screening. This bias in favor of screening was increased by fear-provoking or downplayed wording. Most materials included false and misleading information. The requirements for evidence-based patient information were currently not met by most of the leaflets and websites in Germany. Feedback was given to the producers of the leaflets including a discussion of the findings. The results may be used to revise existing leaflets or to develop new health information on CRC screening. PMID:24562712

  16. Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy.

    PubMed

    Vriesendorp, Pieter A; Schinkel, Arend F L; Soliman, Osama I I; Kofflard, Marcel J M; de Jong, Peter L; van Herwerden, Lex A; Ten Cate, Folkert J; Michels, Michelle

    2015-03-01

    Severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HC) may benefit from surgical myectomy. In patients with enlarged mitral leaflets and mitral regurgitation, myectomy can be combined with anterior mitral leaflet extension (AMLE) to stiffen the midsegment of the leaflet. The aim of this study was to evaluate the long-term results of myectomy combined with AMLE in patients with obstructive HC. This prospective, observational, single-center cohort study included 98 patients (49 ± 14 years, 37% female) who underwent myectomy combined with AMLE from 1991 to 2012. End points included all-cause mortality and change in clinical and echocardiographic characteristics. Mortality was compared with age- and gender-matched patients with nonobstructive HC and subjects from the general population. Long-term follow-up was 8.3 ± 6.1 years. There was no operative mortality, and New York Heart Association class was reduced from 2.8 ± 0.5 to 1.3 ± 0.5 (p <0.001), left ventricular outflow tract gradient from 93 ± 25 to 9 ± 8 mm Hg (p <0.001), mitral valve regurgitation from grade 2.0 ± 0.9 to 0.5 ± 0.8 (p <0.001), and systolic anterior motion of the mitral valve from grade 2.4 ± 0.9 to 0.1 ± 0.3 (p <0.001). The 1-, 5-, 10-, and 15-year cumulative survival rates were 98%, 92%, 86%, and 83%, respectively, and did not differ from the general population (99%, 97%, 92%, and 85%, respectively, p = 0.3) or patients with nonobstructive HC (98%, 97%, 88%, and 83%, respectively, p = 0.8). In conclusion, in selected patients with obstructive HC, myectomy combined with AMLE is a low-risk surgical procedure. It results in long-term symptom relief and survival similar to the general population. PMID:25591899

  17. Hydrostatic determinants of cerebral perfusion

    SciTech Connect

    Wagner, E.M.; Traystman, R.J.

    1986-05-01

    We examined the cerebral blood flow response to alterations in perfusion pressure mediated through decreases in mean arterial pressure, increases in cerebrospinal fluid (CSF) pressure, and increases in jugular venous (JV) pressure in 42 pentobarbital anesthetized dogs. Each of these three pressures was independently controlled. Cerebral perfusion pressure was defined as mean arterial pressure minus JV or CSF pressure, depending on which was greater. Mean hemispheric blood flow was measured with the radiolabeled microsphere technique. Despite 30-mm Hg reductions in mean arterial pressure or increases in CSF or JV pressure, CBF did not change as long as the perfusion pressure remained greater than approximately 60 mm Hg. However, whenever perfusion pressure was reduced to an average of 48 mm Hg, cerebral blood flow decreased 27% to 33%. These results demonstrate the capacity of the cerebral vascular bed to respond similarly to changes in the perfusion pressure gradient obtained by decreasing mean arterial pressure, increasing JV pressure or increasing CSF pressure, and thereby support the above definition of cerebral perfusion pressure.

  18. CAD of myocardial perfusion

    NASA Astrophysics Data System (ADS)

    Storm, Corstiaan J.; Slump, Cornelis H.

    2007-03-01

    Our purpose is in the automated evaluation of the physiological relevance of lesions in coronary angiograms. We aim to extract as much as possible quantitative information about the physiological condition of the heart from standard angiographic image sequences. Coronary angiography is still the gold standard for evaluating and diagnosing coronary abnormalities as it is able to locate precisely the coronary artery lesions. The dimensions of the stenosis can be assessed nowadays successfully with image processing based Quantitative Coronary Angiography (QCA) techniques. Our purpose is to assess the clinical relevance of the pertinent stenosis. We therefore analyze the myocardial perfusion as revealed in standard angiographic image sequences. In a Region-of-Interest (ROI) on the angiogram (without an overlaying major blood vessel) the contrast is measured as a function of time (the so-called time-density curve). The required hyperemic state of exercise is induced artificially by the injection of a vasodilator drug e.g. papaverine. In order to minimize motion artifacts we select based on the recorded ECG signal end-diastolic images in both a basal and a hyperemic run in the same projection to position the ROI. We present the development of the algorithms together with results of a small study of 20 patients which have been catheterized following the standard protocol.

  19. Regional pulmonary perfusion following human heart-lung transplantation

    SciTech Connect

    Lisbona, R.; Hakim, T.S.; Dean, G.W.; Langleben, D.; Guerraty, A.; Levy, R.D. )

    1989-08-01

    Ventilation and perfusion scans were obtained in six subjects who had undergone heart-lung transplantation with consequent denervation of the cardiopulmonary axis. Two of the subjects had developed obliterative bronchiolitis, which is believed to be a form of chronic rejection. Their pulmonary function tests demonstrated airflow obstruction and their scintigraphic studies were abnormal. In the remaining four subjects without obstructive airways disease, ventilation and planar perfusion scans were normal. Single photon emission computed tomography imaging of pulmonary perfusion in these patients revealed a layered distribution of blood flow indistinguishable from that of normal individuals. It is concluded that neurogenic mechanisms have little influence on the pattern of local pulmonary blood flow at rest.

  20. Phase response curve for the ultradian rhythm of the lateral leaflets of Desmodium gyrans using DC current pulses.

    PubMed

    Sharma, V K; Jensen, C; Johnsson, A

    2001-01-01

    In the present study the leaf movement rhythm was perturbed by the application of DC current pulses (15 microA, 10 seconds, voltage applied: 10 V) to the upper part of the pulvinus, passing through the pulvinus and its stalk. The pulses were applied at four different positions of the leaflets: when the leaves were at the lowermost position, when moving up, at the uppermost position and when moving down. The pre-perturbed and the post-perturbed rhythms were compared. We found that the rhythms were shifted in phase and the phase shifts observed at the four different positions of the leaflets were significantly different in magnitude as well as direction. Furthermore, we could also observe phase advances, which is in contrast to an earlier finding. A phase response curve (PRC) was constructed to illustrate the sensitivity of the oscillating leaflet system to DC pulses. Substantial delays of about 50 s (as compared to the period of about 200 s) were obtained when pulses were administered at the lowermost position and when leaflet were moving upwards, while advances or no phase shifts were recorded in the uppermost position and when leaflet were moving down respectively. PMID:11302218

  1. Mitral Valve Replacement After Failed Mitral Ring Insertion With or Without Leaflet/Chordal Repair for Pure Mitral Regurgitation.

    PubMed

    Roberts, William C; Moore, Meagan; Ko, Jong Mi; Hamman, Baron L

    2016-06-01

    Mitral repair operations for correction of pure mitral regurgitation (MR) are generally quite successful. Occasionally, however, the reparative procedure incompletely corrects the MR or the MR recurs. From March 1993 to January 2016, twenty nine patients had mitral valve replacement after the initial mitral repair operation, and observations in them were analyzed. All 29 patients at the repair operation had an annular ring inserted and later (<1 year in 6 and >1 year in 21) mitral valve replacement. The cause of the MR before the repair operation appears to have been prolapse in 16 patients (55%), secondary (functional) in 12 (41%) (ischemic in 5), and infective endocarditis which healed in 1 (3%). At the replacement operation the excised anterior mitral leaflet was thickened in all 29 patients. Some degree of stenosis appeared to have been present in 16 of the 29 patients before the replacement operation, although only 10 had an echocardiographic or hemodynamic recording of a transvalvular gradient; at least 11 patients had restricted motion of the posterior mitral leaflet; 10, ring dehiscence; 2, severe hemolysis; and 2, left ventricular outflow obstruction. In conclusion, there are multiple reasons for valve replacement after earlier mitral repair. Uniformly, at the time of the replacement, the mitral leaflets were thickened by fibrous tissue. Measurement of the area enclosed by the 360° rings and study of the excised leaflet suggest that the ring itself may have contributed to the leaflet scarring and development of some transmitral stenosis. PMID:27087174

  2. Hydrothermal Pretreatment of Date Palm (Phoenix dactylifera L.) Leaflets and Rachis to Enhance Enzymatic Digestibility and Bioethanol Potential.

    PubMed

    Fang, Chuanji; Schmidt, Jens Ejbye; Cybulska, Iwona; Brudecki, Grzegorz P; Frankær, Christian Grundahl; Thomsen, Mette Hedegaard

    2015-01-01

    Date palm residues are one of the most promising lignocellulosic biomass for bioethanol production in the Middle East. In this study, leaflets and rachis were subjected to hydrothermal pretreatment to overcome the recalcitrance of the biomass for enzymatic conversion. Evident morphological, structural, and chemical changes were observed by scanning electron microscopy, X-ray diffraction, and infrared spectroscopy after pretreatment. High glucan (>90% for both leaflets and rachis) and xylan (>75% for leaflets and >79% for rachis) recovery were achieved. Under the optimal condition of hydrothermal pretreatment (210°C/10 min) highly digestible (glucan convertibility, 100% to leaflets, 78% to rachis) and fermentable (ethanol yield, 96% to leaflets, 80% to rachis) solid fractions were obtained. Fermentability test of the liquid fractions proved that no considerable inhibitors to Saccharomyces cerevisiae were produced in hydrothermal pretreatment. Given the high sugar recovery, enzymatic digestibility, and ethanol yield, production of bioethanol by hydrothermal pretreatment could be a promising way of valorization of date palm residues in this region. PMID:26347878

  3. Hydrothermal Pretreatment of Date Palm (Phoenix dactylifera L.) Leaflets and Rachis to Enhance Enzymatic Digestibility and Bioethanol Potential

    PubMed Central

    Fang, Chuanji; Schmidt, Jens Ejbye; Cybulska, Iwona; Brudecki, Grzegorz P.; Frankær, Christian Grundahl; Thomsen, Mette Hedegaard

    2015-01-01

    Date palm residues are one of the most promising lignocellulosic biomass for bioethanol production in the Middle East. In this study, leaflets and rachis were subjected to hydrothermal pretreatment to overcome the recalcitrance of the biomass for enzymatic conversion. Evident morphological, structural, and chemical changes were observed by scanning electron microscopy, X-ray diffraction, and infrared spectroscopy after pretreatment. High glucan (>90% for both leaflets and rachis) and xylan (>75% for leaflets and >79% for rachis) recovery were achieved. Under the optimal condition of hydrothermal pretreatment (210°C/10 min) highly digestible (glucan convertibility, 100% to leaflets, 78% to rachis) and fermentable (ethanol yield, 96% to leaflets, 80% to rachis) solid fractions were obtained. Fermentability test of the liquid fractions proved that no considerable inhibitors to Saccharomyces cerevisiae were produced in hydrothermal pretreatment. Given the high sugar recovery, enzymatic digestibility, and ethanol yield, production of bioethanol by hydrothermal pretreatment could be a promising way of valorization of date palm residues in this region. PMID:26347878

  4. MR Perfusion Imaging in Acute Ischemic Stroke

    PubMed Central

    Copen, William A.; Schaefer, Pamela W.; Wu, Ona

    2011-01-01

    MR perfusion imaging offers the potential for measuring brain perfusion in acute stroke patients, at a time when treatment decisions based upon these measurements may affect outcomes dramatically. Rapid advancements in both acute stroke therapy and perfusion imaging techniques have resulted in continuing redefinition of the role that perfusion imaging should play in patient management. This review first discusses the basic pathophysiology of acute stroke, with specific attention to alterations in the various perfusion-related parameters that can be studied by MR perfusion imaging. Although these parameters are sometimes treated as somewhat interchangeable, they reveal greatly different information about brain perfusion. Therefore, subsequent discussion of the utility of different kinds of perfusion images focuses on the differences between them, as well as important artifacts that can complicate their interpretation. Finally, research on the continually evolving role of MR perfusion imaging in acute stroke care is summarized. PMID:21640299

  5. Genetic interaction and mapping studies on the leaflet development (lld) mutant in Pisum sativum.

    PubMed

    Kumar, Sushil; Mishra, Raghvendra Kumar; Kumar, Arvind; Chaudhary, Swati; Sharma, Vishakha; Kumari, Renu

    2012-01-01

    In Pisum sativum, the completely penetrant leaflet development (lld) mutation is known to sporadically abort pinnae suborgans in the unipinnate compound leaf. Here, the frequency and morphology of abortion was studied in each of the leaf suborgans in 36 genotypes and in presence of auxin and gibberellin, and their antagonists. Various lld genotypes were constructed by multifariously recombining lld with a coch homeotic stipule mutation and with af, ins, mare, mfp, tl and uni-tac leaf morphology mutations. It was observed that the suborgans at all levels of pinna subdivisions underwent lld-led abortion events at different stages of development. As in leafblades, lld aborted the pinnae in leaf-like compound coch stipules. The lld mutation interacted with mfp synergistically and with other leaf mutations additively. The rod-shaped and trumpet-shaped aborted pea leaf suborgans mimicked the phenotype of aborted leaves in HD-ZIP-III-deficient Arabidopsis thaliana mutants. Suborganwise aborted morphologies in lld gnotypes were in agreement with basipetal differentiation of leaflets and acropetal differentiation in tendrils. Altogether, the observations suggested that LLD was the master regulator of pinna development. On the basis of molecular markers found linked to lld, its locus was positioned on the linkage group III of the P. sativum genetic map. PMID:23271018

  6. A mirror code for protein-cholesterol interactions in the two leaflets of biological membranes.

    PubMed

    Fantini, Jacques; Di Scala, Coralie; Evans, Luke S; Williamson, Philip T F; Barrantes, Francisco J

    2016-01-01

    Cholesterol controls the activity of a wide range of membrane receptors through specific interactions and identifying cholesterol recognition motifs is therefore critical for understanding signaling receptor function. The membrane-spanning domains of the paradigm neurotransmitter receptor for acetylcholine (AChR) display a series of cholesterol consensus domains (referred to as "CARC"). Here we use a combination of molecular modeling, lipid monolayer/mutational approaches and NMR spectroscopy to study the binding of cholesterol to a synthetic CARC peptide. The CARC-cholesterol interaction is of high affinity, lipid-specific, concentration-dependent, and sensitive to single-point mutations. The CARC motif is generally located in the outer membrane leaflet and its reverse sequence CRAC in the inner one. Their simultaneous presence within the same transmembrane domain obeys a "mirror code" controlling protein-cholesterol interactions in the outer and inner membrane leaflets. Deciphering this code enabled us to elaborate guidelines for the detection of cholesterol-binding motifs in any membrane protein. Several representative examples of neurotransmitter receptors and ABC transporters with the dual CARC/CRAC motifs are presented. The biological significance and potential clinical applications of the mirror code are discussed. PMID:26915987

  7. Tissue-Engineered Fibrin-Based Heart Valve with a Tubular Leaflet Design

    PubMed Central

    Weber, Miriam; Heta, Eriona; Moreira, Ricardo; Gesche, Valentine N.; Schermer, Thomas; Frese, Julia

    2014-01-01

    The general approach in heart valve tissue engineering is to mimic the shape of the native valve in the attempt to recreate the natural haemodynamics. In this article, we report the fabrication of the first tissue-engineered heart valve (TEHV) based on a tubular leaflet design, where the function of the leaflets of semilunar heart valves is performed by a simple tubular construct sutured along a circumferential line at the root and at three single points at the sinotubular junction. The tubular design is a recent development in pericardial (nonviable) bioprostheses, which has attracted interest because of the simplicity of the construction and the reliability of the implantation technique. Here we push the potential of the concept further from the fabrication and material point of view to realize the tube-in-tube valve: an autologous, living HV with remodelling and growing capability, physiological haemocompatibility, simple to construct and fast to implant. We developed two different fabrication/conditioning procedures and produced fibrin-based constructs embedding cells from the ovine umbilical cord artery according to the two different approaches. Tissue formation was confirmed by histology and immunohistology. The design of the tube-in-tube foresees the possibility of using a textile coscaffold (here demonstrated with a warp-knitted mesh) to achieve enhanced mechanical properties in vision of implantation in the aortic position. The tube-in-tube represents an attractive alternative to the conventional design of TEHVs aiming at reproducing the valvular geometry. PMID:23829551

  8. A mirror code for protein-cholesterol interactions in the two leaflets of biological membranes

    PubMed Central

    Fantini, Jacques; Di Scala, Coralie; Evans, Luke S.; Williamson, Philip T. F.; Barrantes, Francisco J.

    2016-01-01

    Cholesterol controls the activity of a wide range of membrane receptors through specific interactions and identifying cholesterol recognition motifs is therefore critical for understanding signaling receptor function. The membrane-spanning domains of the paradigm neurotransmitter receptor for acetylcholine (AChR) display a series of cholesterol consensus domains (referred to as “CARC”). Here we use a combination of molecular modeling, lipid monolayer/mutational approaches and NMR spectroscopy to study the binding of cholesterol to a synthetic CARC peptide. The CARC-cholesterol interaction is of high affinity, lipid-specific, concentration-dependent, and sensitive to single-point mutations. The CARC motif is generally located in the outer membrane leaflet and its reverse sequence CRAC in the inner one. Their simultaneous presence within the same transmembrane domain obeys a “mirror code” controlling protein-cholesterol interactions in the outer and inner membrane leaflets. Deciphering this code enabled us to elaborate guidelines for the detection of cholesterol-binding motifs in any membrane protein. Several representative examples of neurotransmitter receptors and ABC transporters with the dual CARC/CRAC motifs are presented. The biological significance and potential clinical applications of the mirror code are discussed. PMID:26915987

  9. Inflammatory response assessment of a hybrid tissue-engineered heart valve leaflet.

    PubMed

    Alavi, S Hamed; Liu, Wendy F; Kheradvar, Arash

    2013-02-01

    Despite substantial research in the past few decades, only slight progress has been made toward developing biocompatible, tissue-engineered scaffolds for heart valve leaflets that can withstand the dynamic pressure inside the heart. Recent progress on the development of hybrid scaffolds, which are composed of a thin metal mesh enclosed by multi-layered tissue, appear to be promising for heart valve engineering. This approach retains all the advantages of biological scaffolds while developing a strong extracellular matrix backbone to withstand dynamic loading. This study aims to test the inflammatory response of hybrid tissue-engineered leaflets based on characterizing the activation of macrophage cells cultured on the surfaces of the tissue construct. The results indicate that integration of biological layers around a metal mesh core-regardless of its type-may reduce the evoked inflammatory responses by THP-1 monocyte-like cells. This observation implies that masking a metal implant within a tissue construct prior to implantation can hide it from the immune system and may improve the implant's biocompatibility. PMID:23053298

  10. Lateral organization, bilayer asymmetry, and inter-leaflet coupling of biological membranes

    SciTech Connect

    Smith, Jeremy C.; Cheng, Xiaolin; Nickels, Jonathan D.

    2015-07-29

    Understanding of cell membrane organization has evolved significantly from the classic fluid mosaic model. It is now recognized that biological membranes are highly organized structures, with differences in lipid compositions between inner and outer leaflets and in lateral structures within the bilayer plane, known as lipid rafts. These organizing principles are important for protein localization and function as well as cellular signaling. However, the mechanisms and biophysical basis of lipid raft formation, structure, dynamics and function are not clearly understood. One key question, which we focus on in this review, is how lateral organization and leaflet compositional asymmetry are coupled. Detailed information elucidating this question has been sparse because of the small size and transient nature of rafts and the experimental challenges in constructing asymmetric bilayers. Resolving this mystery will require advances in both experimentation and modeling. We discuss here the preparation of model systems along with experimental and computational approaches that have been applied in efforts to address this key question in membrane biology. Furthermore, we seek to place recent and future advances in experimental and computational techniques in context, providing insight into in-plane and transverse organization of biological membranes.

  11. Phytochemical Investigation of Cycas circinalis and Cycas revoluta Leaflets: Moderately Active Antibacterial Biflavonoids

    PubMed Central

    Moawad, Abeer; Hetta, Mona; Zjawiony, Jordan K.; Jacob, Melissa R.; Hifnawy, Mohamed; Ferreira, Daneel

    2013-01-01

    Chemical examination of the methanolic extract of the leaflets of Cycas circinalis L. led to the isolation of one new biflavonoid, (2S, 2″S)-2,3,2″,3″-tetrahydro-4′,4‴-di-O-methylamentoflavone (tetrahydroisoginkgetin; 2), and 15 known compounds, 11 of which are reported for the first time from C. circinalis. Chromatographic separation of the chloroform extract of C. revoluta Thunb. leaflets afforded 12 compounds, seven of which are reported for the first time from this species. The isolated compounds from both species include 14 biflavonoids, three lignans, three flavan-3-ols, two flavone-C-glucosides, two nor-isoprenoids, and one flavanone. This is the first report of NMR and CD data of 2,3,2″,3″-tetrahydro-4′-O-methyl- and 2,3-dihydro-4′-O-methyl-amentoflavone (6) and (7). The effect of O-methylation on the chemical shifts of the neighboring carbons in the 13C NMR spectra of the dihydro- and tetrahydro-amentoflavone skeletons provides a tool to identify the location of the methoxy groups. Compounds 2, 6, and 18 displayed moderate antibacterial activity against Staphylococcus aureus (IC50 values of 3.8, 9.6, and 8.2 μM, respectively) and methicillin-resistant S. aureus (MRSA; IC50 values of 5.9, 12.5, and 11.5 μM, respectively). PMID:20072955

  12. Lateral organization, bilayer asymmetry, and inter-leaflet coupling of biological membranes

    DOE PAGESBeta

    Smith, Jeremy C.; Cheng, Xiaolin; Nickels, Jonathan D.

    2015-07-29

    Understanding of cell membrane organization has evolved significantly from the classic fluid mosaic model. It is now recognized that biological membranes are highly organized structures, with differences in lipid compositions between inner and outer leaflets and in lateral structures within the bilayer plane, known as lipid rafts. These organizing principles are important for protein localization and function as well as cellular signaling. However, the mechanisms and biophysical basis of lipid raft formation, structure, dynamics and function are not clearly understood. One key question, which we focus on in this review, is how lateral organization and leaflet compositional asymmetry are coupled.more » Detailed information elucidating this question has been sparse because of the small size and transient nature of rafts and the experimental challenges in constructing asymmetric bilayers. Resolving this mystery will require advances in both experimentation and modeling. We discuss here the preparation of model systems along with experimental and computational approaches that have been applied in efforts to address this key question in membrane biology. Furthermore, we seek to place recent and future advances in experimental and computational techniques in context, providing insight into in-plane and transverse organization of biological membranes.« less

  13. Comparative anatomy of leaflets of Zamia acuminata and Z. pseudomonticola (Zamiaceae) in Costa Rica.

    PubMed

    Acuña-Castillo, Rafael; Marin-Méndez, Walter

    2013-06-01

    The genus Zamia is morphologically and ecologically the most diverse of the order Cycadales. Throughout its history this genus has been restricted to the New World and is presently almost entirely restricted to the Neotropics. Unusual anatomical traits of the leaflets, such as the sunken stomata and thick cuticle, are common in this and related genera. The objective of this research was to study and compare the leaflet anatomy of Zamia acuminata and Z pseudomonticola and establish possible phylogenetic relationships between the anatomical traits and the near relatives of these species. The leaf material was obtained from living plants and then processed for electron microscopy study. We found that both species are very similar to each other and to Z fairchildiana, and that they share several unusual traits with other species of the genus, such as the parenchyma morphology, the spatial distribution of tissues between the veins and the stomata morphology. The main differences between these species were seen in their fiber clusters and in the abundance oftrichome basal cells on the epidermis. The anatomical similarities between the three species could be the result of their close phylogenetic relationship and the divergences between them could be the result of recent speciation during the Pleistocene, resulting from geological changes in Southern Costa Rica. PMID:23885572

  14. Aortic Valve Reconstruction with Use of Pericardial Leaflets in Adults with Bicuspid Aortic Valve Disease: Early and Midterm Outcomes

    PubMed Central

    Song, Meong Gun; Yang, Hyun Suk; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

    2014-01-01

    In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm2/m2. The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure. PMID:25593520

  15. Three-dimensional macro-scale assessment of regional and temporal wall shear stress characteristics on aortic valve leaflets.

    PubMed

    Cao, K; Bukač, M; Sucosky, P

    2016-01-01

    The aortic valve (AV) achieves unidirectional blood flow between the left ventricle and the aorta. Although hemodynamic stresses have been shown to regulate valvular biology, the native wall shear stress (WSS) experienced by AV leaflets remains largely unknown. The objective of this study was to quantify computationally the macro-scale leaflet WSS environment using fluid-structure interaction modeling. An arbitrary Lagrangian-Eulerian approach was implemented to predict valvular flow and leaflet dynamics in a three-dimensional AV geometry subjected to physiologic transvalvular pressure. Local WSS characteristics were quantified in terms of temporal shear magnitude (TSM), oscillatory shear index (OSI) and temporal shear gradient (TSG). The dominant radial WSS predicted on the leaflets exhibited high amplitude and unidirectionality on the ventricularis (TSM>7.50 dyn/cm(2), OSI < 0.17, TSG>325.54 dyn/cm(2) s) but low amplitude and bidirectionality on the fibrosa (TSM < 2.73 dyn/cm(2), OSI>0.38, TSG < 191.17 dyn/cm(2) s). The radial WSS component computed in the leaflet base, belly and tip demonstrated strong regional variability (ventricularis TSM: 7.50-22.32 dyn/cm(2), fibrosa TSM: 1.26-2.73 dyn/cm(2)). While the circumferential WSS exhibited similar spatially dependent magnitude (ventricularis TSM: 1.41-3.40 dyn/cm(2), fibrosa TSM: 0.42-0.76 dyn/cm(2)) and side-specific amplitude (ventricularis TSG: 101.73-184.43 dyn/cm(2) s, fibrosa TSG: 41.92-54.10 dyn/cm(2) s), its temporal variations were consistently bidirectional (OSI>0.25). This study provides new insights into the role played by leaflet-blood flow interactions in valvular function and critical hemodynamic stress data for the assessment of the hemodynamic theory of AV disease. PMID:26155915

  16. Total ellipse of the heart valve: the impact of eccentric stent distortion on the regional dynamic deformation of pericardial tissue leaflets of a transcatheter aortic valve replacement.

    PubMed

    Gunning, Paul S; Saikrishnan, Neelakantan; Yoganathan, Ajit P; McNamara, Laoise M

    2015-12-01

    Transcatheter aortic valve replacements (TAVRs) are a percutaneous alternative to surgical aortic valve replacements and are used to treat patients with aortic valve stenosis. This minimally invasive procedure relies on expansion of the TAVR stent to radially displace calcified aortic valve leaflets against the aortic root wall. However, these calcium deposits can impede the expansion of the device causing distortion of the valve stent and pericardial tissue leaflets. The objective of this study was to elucidate the impact of eccentric TAVR stent distortion on the dynamic deformation of the tissue leaflets of the prosthesis in vitro. Dual-camera stereophotogrammetry was used to measure the regional variation in strain in a leaflet of a TAVR deployed in nominal circular and eccentric (eccentricity index = 28%) orifices, representative of deployed TAVRs in vivo. It was observed that (i) eccentric stent distortion caused incorrect coaptation of the leaflets at peak diastole resulting in a 'peel-back' leaflet geometry that was not present in the circular valve and (ii) adverse bending of the leaflet, arising in the eccentric valve at peak diastole, caused significantly higher commissure strains compared with the circular valve in both normotensive and hypertensive pressure conditions (normotension: eccentric = 13.76 ± 2.04% versus circular = 11.77 ± 1.61%, p = 0.0014, hypertension: eccentric = 15.07 ± 1.13% versus circular = 13.56 ± 0.87%, p = 0.0042). This study reveals that eccentric distortion of a TAVR stent can have a considerable impact on dynamic leaflet deformation, inducing deleterious bending of the leaflet and increasing commissures strains, which might expedite leaflet structural failure compared to leaflets in a circular deployed valve. PMID:26674192

  17. The pediatric template of brain perfusion

    PubMed Central

    Avants, Brian B; Duda, Jeffrey T; Kilroy, Emily; Krasileva, Kate; Jann, Kay; Kandel, Benjamin T; Tustison, Nicholas J; Yan, Lirong; Jog, Mayank; Smith, Robert; Wang, Yi; Dapretto, Mirella; Wang, Danny J J

    2015-01-01

    Magnetic resonance imaging (MRI) captures the dynamics of brain development with multiple modalities that quantify both structure and function. These measurements may yield valuable insights into the neural patterns that mark healthy maturation or that identify early risk for psychiatric disorder. The Pediatric Template of Brain Perfusion (PTBP) is a free and public neuroimaging resource that will help accelerate the understanding of childhood brain development as seen through the lens of multiple modality neuroimaging and in relation to cognitive and environmental factors. The PTBP uses cross-sectional and longitudinal MRI to quantify cortex, white matter, resting state functional connectivity and brain perfusion, as measured by Arterial Spin Labeling (ASL), in 120 children 7–18 years of age. We describe the PTBP and show, as a demonstration of validity, that global summary measurements capture the trajectories that demarcate critical turning points in brain maturation. This novel resource will allow a more detailed understanding of the network-level, structural and functional landmarks that are obtained during normal adolescent brain development. PMID:25977810

  18. Retrograde heart perfusion: the Langendorff technique of isolated heart perfusion.

    PubMed

    Bell, Robert M; Mocanu, Mihaela M; Yellon, Derek M

    2011-06-01

    In the late 19th century, a number of investigators were working on perfecting isolated heart model, but it was Oscar Langendorff who, in 1895, pioneered the isolated perfused mammalian heart. Since that time, the Langendorff preparation has evolved and provided a wealth of data underpinning our understanding of the fundamental physiology of the heart: its contractile function, coronary blood flow regulation and cardiac metabolism. In more recent times, the procedure has been used to probe pathophysiology of ischaemia/reperfusion and disease states, and with the dawn of molecular biology and genetic manipulation, the Langendorff perfused heart has remained a stalwart tool in the study of the impact upon the physiology of the heart by pharmacological inhibitors and targeted deletion or up-regulation of genes and their impact upon intracellular signalling and adaption to clinically relevant stressful stimuli. We present here the basic structure of the Langendorff system and the fundamental experimental rules which warrant a viable heart preparation. In addition, we discuss the use of the isolated retrograde perfused heart in the model of ischaemia-reperfusion injury ex-vivo, and its applicability to other areas of study. The Langendorff perfusion apparatus is highly adaptable and this is reflected not only in the procedure's longevity but also in the number of different applications to which it has been turned. PMID:21385587

  19. Idiopathic pulmonary fibrosis. A rare cause of scintigraphic ventilation-perfusion mismatch

    SciTech Connect

    Pochis, W.T.; Krasnow, A.Z.; Collier, B.D.; Mewissen, M.W.; Almagro, U.A.; Hellman, R.S.; Isitman, A.T. )

    1990-05-01

    A case of idiopathic pulmonary fibrosis with multiple areas of mismatch on ventilation-perfusion lung imaging in the absence of pulmonary embolism is presented. Idiopathic pulmonary fibrosis is one of the few nonembolic diseases producing a pulmonary ventilation-perfusion mismatch. In this condition, chest radiographs may not detect the full extent of disease, and xenon-133 ventilation imaging may be relatively insensitive to morbid changes in small airways. Thus, when examining patients with idiopathic pulmonary fibrosis, one should be aware that abnormal perfusion imaging patterns without matching ventilation abnormalities are not always due to embolism. In this setting, contrast pulmonary angiography is often needed for accurate differential diagnosis.

  20. Effect of the mitral valve on diastolic flow patterns

    NASA Astrophysics Data System (ADS)

    Seo, Jung Hee; Vedula, Vijay; Abraham, Theodore; Lardo, Albert C.; Dawoud, Fady; Luo, Hongchang; Mittal, Rajat

    2014-12-01

    The leaflets of the mitral valve interact with the mitral jet and significantly impact diastolic flow patterns, but the effect of mitral valve morphology and kinematics on diastolic flow and its implications for left ventricular function have not been clearly delineated. In the present study, we employ computational hemodynamic simulations to understand the effect of mitral valve leaflets on diastolic flow. A computational model of the left ventricle is constructed based on a high-resolution contrast computed-tomography scan, and a physiological inspired model of the mitral valve leaflets is synthesized from morphological and echocardiographic data. Simulations are performed with a diode type valve model as well as the physiological mitral valve model in order to delineate the effect of mitral-valve leaflets on the intraventricular flow. The study suggests that a normal physiological mitral valve promotes the formation of a circulatory (or "looped") flow pattern in the ventricle. The mitral valve leaflets also increase the strength of the apical flow, thereby enhancing apical washout and mixing of ventricular blood. The implications of these findings on ventricular function as well as ventricular flow models are discussed.

  1. Effect of the mitral valve on diastolic flow patterns

    SciTech Connect

    Seo, Jung Hee; Vedula, Vijay; Mittal, Rajat; Abraham, Theodore; Dawoud, Fady; Luo, Hongchang; Lardo, Albert C.

    2014-12-15

    The leaflets of the mitral valve interact with the mitral jet and significantly impact diastolic flow patterns, but the effect of mitral valve morphology and kinematics on diastolic flow and its implications for left ventricular function have not been clearly delineated. In the present study, we employ computational hemodynamic simulations to understand the effect of mitral valve leaflets on diastolic flow. A computational model of the left ventricle is constructed based on a high-resolution contrast computed-tomography scan, and a physiological inspired model of the mitral valve leaflets is synthesized from morphological and echocardiographic data. Simulations are performed with a diode type valve model as well as the physiological mitral valve model in order to delineate the effect of mitral-valve leaflets on the intraventricular flow. The study suggests that a normal physiological mitral valve promotes the formation of a circulatory (or “looped”) flow pattern in the ventricle. The mitral valve leaflets also increase the strength of the apical flow, thereby enhancing apical washout and mixing of ventricular blood. The implications of these findings on ventricular function as well as ventricular flow models are discussed.

  2. [Acute Leaflet Arrest in St. Jude Medical Regent Mechanical Aortic Valve;Report of a Case].

    PubMed

    Morishima, Yuji; Arakaki, Katsuya

    2015-06-01

    A 61-year-old woman was diagnosed with combined valvular disease and atrial fibrillation, and was admitted for surgery. We performed double valve replacement, tricuspid annuloplasty and maze operation. At the operation, a 19 mm St. Jude Medical Regent valve was implanted with non-everting mattress sutures at the aortic supra-annular position after mitral valve replacement. Although pulling down of the prosthesis into the aortic annulus was easy, the leaflets were unable to open at all in a movability test. After removing several stitches on the mitral side of the hinges, the subvalvular tissue was seen bulging into the hinge, hindering the free movement. The prosthesis was removed and replaced with a 17 mm Regent valve by the same technique. The patient's postoperative course was uneventful. We suggest it is necessary to pay special attention to the structural characteristics of the prosthesis. PMID:26066878

  3. Tissue-engineered heart valve with a tubular leaflet design for minimally invasive transcatheter implantation.

    PubMed

    Moreira, Ricardo; Velz, Thaddaeus; Alves, Nuno; Gesche, Valentine N; Malischewski, Axel; Schmitz-Rode, Thomas; Frese, Julia; Jockenhoevel, Stefan; Mela, Petra

    2015-06-01

    Transcatheter aortic valve implantation of (nonviable) bioprosthetic valves has been proven a valid alternative to conventional surgical implantation in patients at high or prohibitive mortality risk. In this study we present the in vitro proof-of-principle of a newly developed tissue-engineered heart valve for minimally invasive implantation, with the ultimate aim of adding the unique advantages of a living tissue with regeneration capabilities to the continuously developing transcatheter technologies. The tube-in-stent is a fibrin-based tissue-engineered valve with a tubular leaflet design. It consists of a tubular construct sewn into a self-expandable nitinol stent at three commissural attachment points and along a circumferential line so that it forms three coaptating leaflets by collapsing under diastolic back pressure. The tubular constructs were molded with fibrin and human umbilical vein cells. After 3 weeks of conditioning in a bioreactor, the valves were fully functional with unobstructed opening (systolic phase) and complete closure (diastolic phase). Tissue analysis showed a homogeneous cell distribution throughout the valve's thickness and deposition of collagen types I and III oriented along the longitudinal direction. Immunohistochemical staining against CD31 and scanning electron microscopy revealed a confluent endothelial cell layer on the surface of the valves. After harvesting, the valves underwent crimping for 20 min to simulate the catheter-based delivery. This procedure did not affect the valvular functionality in terms of orifice area during systole and complete closure during diastole. No influence on the extracellular matrix organization, as assessed by immunohistochemistry, nor on the mechanical properties was observed. These results show the potential of combining tissue engineering and minimally invasive implantation technology to obtain a living heart valve with a simple and robust tubular design for transcatheter delivery. The effect

  4. The influence of health literacy on comprehension of a colonoscopy preparation information leaflet

    PubMed Central

    Smith, Samuel G.; von Wagner, Christian; McGregor, Lesley M.; Curtis, Laura M.; Wilson, Elizabeth A. H.; Serper, Marina; Wolf, Michael S.

    2012-01-01

    BACKGROUND Successful bowel preparation is important for safe, efficacious, cost-effective colonoscopy procedures, however poor preparation is common. OBJECTIVE We sought to determine if there was an association between health literacy and comprehension of typical written instructions on how to prepare for a colonoscopy to enable more targeted interventions in this area. DESIGN Cross-sectional observational study SETTING Primary care clinics and federally qualified health centres in Chicago, Illinois. PATIENTS 764 participants (mean age: 63 years; Standard Deviation: 5.42) were recruited. The sample was from a mixed socio-demographic background and 71.9% of the participants were classified as having adequate health literacy scores. INTERVENTION 764 participants were presented with an information leaflet outlining the bowel preparatory instructions for colonoscopy. MAIN OUTCOME MEASURES Five questions assessing comprehension of the instructions in an ‘open book’ test. RESULTS Comprehension scores on the bowel preparation items were low. The mean number of items correctly answered was 3.2 (Standard Deviation, 1.2) out of a possible 5. Comprehensions scores overall and for each individual item differed significantly by health literacy level (all p<0.001). After controlling for gender, age, race, socio-economic status and previous colonoscopy experience in a multivariable model, health literacy was a significant predictor of comprehension (inadequate vs. adequate: β = −0.2; p < 0.001; marginal vs. adequate: β = −0.2; p < 0.001). LIMITATIONS The outcome represents a simulated task and not actual comprehension of preparation instructions for participants’ own recommended behavior. CONCLUSIONS Comprehension of a written colonoscopy preparation leaflet was generally low and significantly more so among people with low health literacy. Poor comprehension has implications for the safety and economic impact of gastroenterological procedures such as colonoscopy

  5. Tissue-Engineered Heart Valve with a Tubular Leaflet Design for Minimally Invasive Transcatheter Implantation

    PubMed Central

    Moreira, Ricardo; Velz, Thaddaeus; Alves, Nuno; Gesche, Valentine N.; Malischewski, Axel; Schmitz-Rode, Thomas; Frese, Julia

    2015-01-01

    Transcatheter aortic valve implantation of (nonviable) bioprosthetic valves has been proven a valid alternative to conventional surgical implantation in patients at high or prohibitive mortality risk. In this study we present the in vitro proof-of-principle of a newly developed tissue-engineered heart valve for minimally invasive implantation, with the ultimate aim of adding the unique advantages of a living tissue with regeneration capabilities to the continuously developing transcatheter technologies. The tube-in-stent is a fibrin-based tissue-engineered valve with a tubular leaflet design. It consists of a tubular construct sewn into a self-expandable nitinol stent at three commissural attachment points and along a circumferential line so that it forms three coaptating leaflets by collapsing under diastolic back pressure. The tubular constructs were molded with fibrin and human umbilical vein cells. After 3 weeks of conditioning in a bioreactor, the valves were fully functional with unobstructed opening (systolic phase) and complete closure (diastolic phase). Tissue analysis showed a homogeneous cell distribution throughout the valve's thickness and deposition of collagen types I and III oriented along the longitudinal direction. Immunohistochemical staining against CD31 and scanning electron microscopy revealed a confluent endothelial cell layer on the surface of the valves. After harvesting, the valves underwent crimping for 20 min to simulate the catheter-based delivery. This procedure did not affect the valvular functionality in terms of orifice area during systole and complete closure during diastole. No influence on the extracellular matrix organization, as assessed by immunohistochemistry, nor on the mechanical properties was observed. These results show the potential of combining tissue engineering and minimally invasive implantation technology to obtain a living heart valve with a simple and robust tubular design for transcatheter delivery. The effect

  6. Developing a tissue perfusion sensor.

    PubMed

    Harvey, S L R; Parker, K H; O'Hare, D

    2007-01-01

    The development of a electrochemical tissue perfusion sensor is presented. The sensor is a platinum/platinum ring-disc microelectrode that relies on the principle of collector-generator to monitor mass transport within its vicinity. Tissue perfusion is a mass transport mechanism that describes the movement of respiratory gases, nutrients and metabolites in tissue. The sensor's capability of detecting perfusion at the cellular level in a continuous fashion is unique. This sensor will provide insight into the way nutrients and metabolites are transported in tissue especially in cases were perfusion is low such as in wounds or ischemic tissue. We present experimental work for the development and testing of the sensors in vitro. Experimental flow recordings in free steam solutions as well as the flow through tissue-like media are shown. Tests on post operative human tissue are also presented. The sensor's feature such as the continuous recoding capacities, spatial resolution and the measurement range from ml/min to microl/min are highlighted. PMID:18002549

  7. Birds, Bats, and Butterflies. A Leaflet for Adults Who Want To Share Nature with Children. No. 1-4.

    ERIC Educational Resources Information Center

    Baldwin, Mark K., Ed.

    This series of leaflets provides information about nature education in outdoor settings. Each issue begins with an account of a personal experience with children in nature. Following the personal narrative is a section titled, "A Nature Primer," which provides scientific information about a topic in nature. The next section, "Ready, Set, Go"…

  8. Microstructured Nickel-Titanium Thin Film Leaflets for Hybrid Tissue Engineered Heart Valves Fabricated by Magnetron Sputter Deposition.

    PubMed

    Loger, K; Engel, A; Haupt, J; Lima de Miranda, R; Lutter, G; Quandt, E

    2016-03-01

    Heart valves are constantly exposed to high dynamic loading and are prone to degeneration. Therefore, it is a challenge to develop a durable heart valve substitute. A promising approach in heart valve engineering is the development of hybrid scaffolds which are composed of a mechanically strong inorganic mesh enclosed by valvular tissue. In order to engineer an efficient, durable and very thin heart valve for transcatheter implantations, we developed a fabrication process for microstructured heart valve leaflets made from a nickel-titanium (NiTi) thin film shape memory alloy. To examine the capability of microstructured NiTi thin film as a matrix scaffold for tissue engineered hybrid heart valves, leaflets were successfully seeded with smooth muscle cells (SMCs). In vitro pulsatile hydrodynamic testing of the NiTi thin film valve leaflets demonstrated that the SMC layer significantly improved the diastolic sufficiency of the microstructured leaflets, without affecting the systolic efficiency. Compared to an established porcine reference valve model, magnetron sputtered NiTi thin film material demonstrated its suitability for hybrid tissue engineered heart valves. PMID:26743538

  9. Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

    PubMed Central

    Oliver, S.; Rajan, L.; Turner, H.; Oakley, A.; Entwistle, V.; Watt, I.; Sheldon, T. A.; Rosser, J.

    1996-01-01

    With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice. Images p1253-a PMID:8939120

  10. Quantitative histologic analysis of the mitral valve anterior leaflet: ischemic alterations and implications for valve replacement design

    NASA Astrophysics Data System (ADS)

    Quick, David W.; Kunzelman, Karyn S.; Cochran, Richard P.

    1999-06-01

    There is a current trend to design innovative mitral valve replacements that mimic the native mitral valve (MV). A prerequisite for these new designs is the characterization of MV structure. This study was conducted to determine the distribution of MV collagen and glycosaminoglycan (GAGs) in MV anterior leaflets. Methods: Specimens from the mid-line of eight sheep MV anterior leaflets were stained with aniline blue (collagen) and alcian blue (GAGs). These specimens were analyzed using an image analysis system running Optimas software. Based on the luminance of stains within individual valve layers, the distribution of valvular collagen and GAGs from leaflet annulus to free-edge were determined. Results: Near the annulus, 100% of MV thickness is fibrosa (collagen dominated layer). Moving towards the free-edge, fibrosa prominence decreases and there is a transition to spongiosa (GAG dominated layer). Near the free-edge 100% of MV thickness is dominated by the spongiosa. Conclusions: Valvular collagen dominates MV structure near the annulus to support the stresses of bending and pressurization. Valvular GAGs dominate the MV near the free-edge to absorb the impact of leaflet coaptation. Image analysis has proven to be an effective tool to evaluate MV structure and facilitate the design of valve replacements.

  11. Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease.

    PubMed

    Chiappini, Bruno; Gregorini, Renato; De Remigis, Franco; Petrella, Licia; Villani, Carmine; Di Pietrantonio, Fabrizio; Pavicevic, Srdan; Mazzola, Alessandro

    2009-08-01

    The gold standard for the surgical treatment of prolapse of the posterior leaflet of the mitral valve (MV) for degenerative myxomatous disease has been represented by the quadrangular resection of the leaflet, according to the Carpentier technique. Since 2006 we performed a triangular resection of the prolapsing leaflet in 20 patients with myxomatous mitral regurgitation (MR). Seventeen patients (85%) underwent the triangular resection of P2; one patient (5%) had a triple scallops triangular resection (P1, P2, P3) and two (10%) a double scallops (P2, P3) resection. In this study, we report the immediate and mid-term clinical and echocardiographic results of a cohort of 20 patients, who underwent this technique. Thirty-day mortality was 0. Acute renal failure occurred in three patients (15%) and they resolved with conservative management. One patient (5%) required re-exploration for bleeding. At the mean follow-up of 13.1+/-4.2 months survival was 95%; one patient died of lymphoma during the follow-up time. All the cases were in New York Heart Association (NYHA) class I. Nineteen survivors underwent transthoracic echocardiography (TTE) (5), or transesophageal echocardiography (TEE) (13), performed by two skilled cardiologists. All patients showed no or trivial MV regurgitation. We believe that triangular resection of posterior MV leaflet (PMVL) provides excellent mid-term results providing the surgeon with a reliable and reproducible surgical option for myxomatous degenerative MV regurgitation. PMID:19414490

  12. Phenotypic expression of wild-type tomato and three wilty mutants in relation to abscisic acid accumulation in roots and leaflets of reciprocal grafts

    SciTech Connect

    Cornish, K.; Zeevaart, J.A.D. )

    1988-05-01

    Lycopersicon esculentum Mill. cv Rheinlands Ruhm (RR) and cv Moneymaker and the three wilty mutants flacca (flc), sitiens (sit), and sitiens{sup w} (sit{sup w}), together with the most reciprocal grafts, were grown in pots and in solution culture. Detached leaflets, and control and stem-girdled intact plants, were left turgid or were wilted in air. Detached leaflets and the leaflets and roots of the intact plants were analyzed for their abscisic acid (ABA) content. Turgid RR leaflets contained about 2.9 ng ABA per miligram dry weight. On average, the flc and sit leaflets contained 33 and 11% of this amount, respectively. The lack of ABA approximately correlated with the severity of the mutant phenotype. Mutant roots also contained less ABA than wild-type roots. Wild-type scions on mutant stocks (wild type/mutant) maintained the normal phenotype of ungrafted plants. Mutant scions grafted onto wild-type stocks reverted to a near wild-type phenotype. After the wild-type leaves were excised from solution culture-grown mutant/wild-type plants, the revertive morphology of the mutant scions was maintained, although endogenous ABA levels in the leaflets fell to typical mutant levels and the leaflets became wilty again. When stressed in air, both leaflets and roots of RR plants produced stress-induced ABA, but the mutant leaflets and roots did not. The roots and leaflets of the grafted plants behaved according to their own genotype, with the notable exception of mutant roots grown with wild-type scions. Roots of flc and sit{sup w} recovered the ability to accumulate stress-induced ABA when grafted with RR scions before the stress was imposed.

  13. Switchable nile red-based probe for cholesterol and lipid order at the outer leaflet of biomembranes.

    PubMed

    Kucherak, Oleksandr A; Oncul, Sule; Darwich, Zeinab; Yushchenko, Dmytro A; Arntz, Youri; Didier, Pascal; Mély, Yves; Klymchenko, Andrey S

    2010-04-01

    Cholesterol and sphingomyelin form together a highly ordered membrane phase, which is believed to play important biological functions in plasma membranes of mammalian cells. Since sphingomyelin is present mainly at the outer leaflet of cell membranes, monitoring its lipid order requires molecular probes capable to bind specifically at this leaflet and exhibit negligibly slow flip-flop. In the present work, such a probe was developed by modifying the solvatochromic fluorescent dye Nile Red with an amphiphilic anchor group. To evaluate the flip-flop of the obtained probe (NR12S), we developed a methodology of reversible redox switching of its fluorescence at one leaflet using sodium dithionite. This method shows that NR12S, in contrast to parent Nile Red, binds exclusively the outer membrane leaflet of model lipid vesicles and living cells with negligible flip-flop in the time scale of hours. Moreover, the emission maximum of NR12S in model vesicles exhibits a significant blue shift in liquid ordered phase (sphingomyelin-cholesterol) as compared to liquid disordered phase (unsaturated phospholipids). As a consequence, these two phases could be clearly distinguished in NR12S-stained giant vesicles by fluorescence microscopy imaging of intensity ratio between the blue and red parts of the probe emission spectrum. Being added to living cells, NR12S binds predominantly, if not exclusively, their plasma membranes and shows an emission spectrum intermediate between those in liquid ordered and disordered phases of model membranes. Importantly, the emission color of NR12S correlates well with the cholesterol content in cell membranes, which allows monitoring the cholesterol depletion process with methyl-beta-cyclodextrin by fluorescence spectroscopy and microscopy. The attractive photophysical and switching properties of NR12S, together with its selective outer leaflet staining and sensitivity to cholesterol and lipid order, make it a new powerful tool for studying model and

  14. Multidrug resistance in Lactococcus lactis: evidence for ATP-dependent drug extrusion from the inner leaflet of the cytoplasmic membrane.

    PubMed Central

    Bolhuis, H; van Veen, H W; Molenaar, D; Poolman, B; Driessen, A J; Konings, W N

    1996-01-01

    Lactococcus lactis possesses an ATP-dependent drug extrusion system which shares functional properties with the mammalian multidrug resistance (MDR) transporter P-glycoprotein. One of the intriguing aspects of both transporters is their ability to interact with a broad range of structurally unrelated amphiphilic compounds. It has been suggested that P-glycoprotein removes drugs directly from the membrane. Evidence is presented that this model is correct for the lactococcal multidrug transporter through studies of the extrusion mechanism of BCECF-AM and cationic diphenylhexatriene (DPH) derivatives from the membrane. The non-fluorescent probe BCECF-AM can be converted intracellularly into its fluorescent derivative, BCECF, by non-specific esterase activities. The development of fluorescence was decreased upon energization of the cells. These and kinetic studies showed that BCECF-AM is actively extruded from the membrane before it can be hydrolysed intracellularly. The increase in fluorescence intensity due to the distribution of TMA-DPH into the phospholipid bilayer is a biphasic process. This behaviour reflects the fast entry of TMA-DPH into the outer leaflet followed by a slower transbilayer movement to the inner leaflet of the membrane. The initial rate of TMA-DPH extrusion correlates with the amount of probe associated with the inner leaflet. Taken together, these results demonstrate that the lactococcal MDR transporter functions as a 'hydrophobic vacuum cleaner', expelling drugs from the inner leaflet of the lipid bilayer. Thus, the ability of amphiphilic substrates to partition in the inner leaflet of the membrane is a prerequisite for recognition by multidrug transporters. PMID:8861952

  15. A scanning electron microscopy study of the invasion of leaflets of a bloat-safe and a bloat-causing legume by rumen microorganisms.

    PubMed

    Fay, J P; Cheng, K J; Hanna, M R; Howarth, R E; Costerton, J W

    1981-04-01

    A newly developed technique using ruthenium red to detect foci of bacterial digestion in mounts of whole leaflets that had been incubated with rumen bacteria was used to compare the digestion of alfalfa, a bloat-causing legume, and sainfoin, a bloat-safe legume. When whole leaflets were suspended in an artificial rumen medium and inoculated with rumen bacteria, massive bacterial adhesion and proliferation were noted at the stomata of alfalfa leaflets after 6 h of incubation, whereas only a few isolated bacteria adhered near the stomata of sainfoin leaflets After 22 h of incubation, the epidermal layers of alfalfa leaflets had peeled away in many areas, revealing an extensive bacterial invasion of the underlying mesophyll tissue in which large bacterial microcolonies had formed in intercellular spaces, and in intracellular spaces in several areas where plant cell walls had broken down. After 22 h of incubation, the surface of sainfoin leaflets resembled that of alfalfa leaflets at 6 h, with bacterial microcolonies adhering to the area surrounding the stomata, but without sloughing of the epidermis. Uninoculated control leaflets of both species showed no surface alteration but part of their normal bacterial flora had proliferated to form microcolonies on the surface after 22 h incubation. Dry matter loss due to leaching or bacterial digestion when whole leaflets of legumes were suspended in an artificial rumen medium, alone or with rumen bacteria, was significantly higher in the bloat-causing group. Values of leaching and of bacterial digestion were positively correlated. We conclude that reported differences in plant anatomy, and in cell wall chemistry, produce distinct rates or organic nutrient release from legume leaflets, and that these same differences produce an equally distinct susceptibility of leaflets to bacterial invasion, plant cell rupture, and the consequent release of intracellular plant components. The rate of release of organic nutrients from legume

  16. Cerebral perfusion alterations in epileptic patients during peri-ictal and post-ictal phase: PASL vs DSC-MRI.

    PubMed

    Pizzini, Francesca B; Farace, Paolo; Manganotti, Paolo; Zoccatelli, Giada; Bongiovanni, Luigi G; Golay, Xavier; Beltramello, Alberto; Osculati, Antonio; Bertini, Giuseppe; Fabene, Paolo F

    2013-07-01

    Non-invasive pulsed arterial spin labeling (PASL) MRI is a method to study brain perfusion that does not require the administration of a contrast agent, which makes it a valuable diagnostic tool as it reduces cost and side effects. The purpose of the present study was to establish the viability of PASL as an alternative to dynamic susceptibility contrast (DSC-MRI) and other perfusion imaging methods in characterizing changes in perfusion patterns caused by seizures in epileptic patients. We evaluated 19 patients with PASL. Of these, the 9 affected by high-frequency seizures were observed during the peri-ictal period (within 5hours since the last seizure), while the 10 patients affected by low-frequency seizures were observed in the post-ictal period. For comparison, 17/19 patients were also evaluated with DSC-MRI and CBF/CBV. PASL imaging showed focal vascular changes, which allowed the classification of patients in three categories: 8 patients characterized by increased perfusion, 4 patients with normal perfusion and 7 patients with decreased perfusion. PASL perfusion imaging findings were comparable to those obtained by DSC-MRI. Since PASL is a) sensitive to vascular alterations induced by epileptic seizures, b) comparable to DSC-MRI for detecting perfusion asymmetries, c) potentially capable of detecting time-related perfusion changes, it can be recommended for repeated evaluations, to identify the epileptic focus, and in follow-up and/or therapy-response assessment. PMID:23623332

  17. Ex vivo lung graft perfusion.

    PubMed

    Briot, Raphaël; Gennai, Stéphane; Maignan, Maxime; Souilamas, Redha; Pison, Christophe

    2016-04-01

    This review proposes an update of the state of the art and the ongoing clinical trials of ex vivo lung perfusion for lung transplantation in patients. Ex vivo lung perfusion techniques (EVLP) can be used to evaluate a lung graft outside of the body. The goal of EVLP is to study the functional status of lung grafts that were first rejected for transplantation because they did not match all criteria for a conventional transplantation. After an EVLP evaluation, some of these lungs may be requalified for a possible transplantation in patients. This article proposes an overview of the developments of EVLP techniques. During EVLP, the perfusion and ventilation of the isolated lung preparation are very progressive in order to avoid oedema due to ischaemia-reperfusion injuries. Lung evaluation is mainly based on gasometric (PaO2/FiO2) and rheological criteria (low pulmonary arterial resistance). Several series of patients transplanted with EVLP evaluated lungs have been recently published with promising results. EVLP preparations also allow a better understanding of the physiopathology and treatments of ischaemia-reperfusion injuries. Organ procurements from "non-heart-beating" donors will probably require a wider application of these ex vivo techniques. The development of semi-automated systems might facilitate the clinical use of EVLP techniques. PMID:26746565

  18. Intestinal perfusion monitoring using photoplethysmography

    NASA Astrophysics Data System (ADS)

    Akl, Tony J.; Wilson, Mark A.; Ericson, M. Nance; Coté, Gerard L.

    2013-08-01

    In abdominal trauma patients, monitoring intestinal perfusion and oxygen consumption is essential during the resuscitation period. Photoplethysmography is an optical technique potentially capable of monitoring these changes in real time to provide the medical staff with a timely and quantitative measure of the adequacy of resuscitation. The challenges for using optical techniques in monitoring hemodynamics in intestinal tissue are discussed, and the solutions to these challenges are presented using a combination of Monte Carlo modeling and theoretical analysis of light propagation in tissue. In particular, it is shown that by using visible wavelengths (i.e., 470 and 525 nm), the perfusion signal is enhanced and the background contribution is decreased compared with using traditional near-infrared wavelengths leading to an order of magnitude enhancement in the signal-to-background ratio. It was further shown that, using the visible wavelengths, similar sensitivity to oxygenation changes could be obtained (over 50% compared with that of near-infrared wavelengths). This is mainly due to the increased contrast between tissue and blood in that spectral region and the confinement of the photons to the thickness of the small intestine. Moreover, the modeling results show that the source to detector separation should be limited to roughly 6 mm while using traditional near-infrared light, with a few centimeters source to detector separation leads to poor signal-to-background ratio. Finally, a visible wavelength system is tested in an in vivo porcine study, and the possibility of monitoring intestinal perfusion changes is showed.

  19. How to Test Mandatory Text Templates: The European Patient Information Leaflet

    PubMed Central

    Pander Maat, Henk; Lentz, Leo; Raynor, David K.

    2015-01-01

    The structure of patient information leaflets (PILs) supplied with medicines in the European Union is largely determined by a regulatory template, requiring a fixed sequence of pre-formulated headings and sub-headings. The template has been criticized on various occasions, but it has never been tested with users. This paper proposes an alternative template, informed by templates used in the USA and Australia, and by previous user testing.The main research question is whether the revision better enables users to find relevant information. Besides, the paper proposes a methodology for testing templates. Testing document templates is complex, as they are “empty”. For both the current and the alternative template, we produced a document with bogus text and real headings (reflecting the empty template) and a real-life document with readable text (reflecting the “filled” template). The documents were tested both in Dutch and in English, with 64 British and 64 Dutch users. The test used a set of scenario questions that covers the full range of template (sub)topics; users needed to indicate the text locations where they expected each question to be answered. The revised template improved findability of information; this effect was strongest for the “filled” template with readable text. When participants were shown both filled templates, there was a clear preference for the revised template. A closer analysis of the findability data revealed question-specific effects of topic grouping, topic ordering, subtopic granularity and wording of headings. Most of these favoured the revised template, but our revision led to adverse effects as well, for instance in the new heading Check with your doctor. Language-specific effects showed that the wording of the headings is a delicate task. Generally, we conclude that document template designs can be analyzed in terms of the four parameters grouping, ordering, granularity and wording. Furthermore, they need to be tested on

  20. Computed tomography perfusion imaging in spectacular shrinking deficit.

    PubMed

    Lee, Vivien H; John, Sayona; Mohammad, Yousef; Prabhakaran, Shyam

    2012-02-01

    Spectacular shrinking deficit (SSD) is characterized by abrupt onset of a major hemispheric stroke syndrome, followed by dramatic and rapid improvement. We retrospectively identified patients with SSD diagnosed at our institution between December 1, 2007, and June 30, 2009. We reviewed computed tomography perfusion (CTP) imaging to determine perfusion defect as a measure of initial ischemic penumbra, and magnetic resonance imaging diffusion-weighted imaging (DWI) to determine the final infarct core. Among the 472 consecutive ischemic stroke patients, 126 (27%) presented with major hemispheric ischemic stroke syndrome, defined as National Institutes of Health Stroke Scale score (NIHSS) ≥8 in the territory of the middle cerebral artery (MCA) or internal carotid artery (ICA). Out of these patients, we identified 8 SSD patients with available CTP data. In these 8 patients, the mean time to dramatic recovery was 3.4 hours (range, 0.75-7 hours), and the mean time from onset to CTP was 12.7 hours (range, 3-30 hours). All 8 patients had perfusion abnormalities in portions of the MCA territory (partial MCA territory in 5 patients and complete MCA territory in 3 patients). The mean time from onset to MRI DWI was 15.5 hours (range, 7.9-34 hours). Restricted diffusion was present in all patients in the corresponding MCA distribution. Vascular imaging revealed MCA occlusion in 2 patients. Cervical vascular imaging revealed carotid occlusion in 2 patients and high-grade carotid stenosis in 2 patients. The stroke mechanisms were cardioembolism in 2 patients, large artery in 4 patients, and unknown in 2 patients. Four patients had repeat CTP imaging available that demonstrated eventual resolution of the perfusion defect. SSD is associated with a "shrinking" clinical syndrome and a "shrinking" perfusion pattern on CTP that lags behind clinical recovery. CTP imaging corroborates that a larger territory is at risk in SSD and contributes to better understanding of SSD. PMID:20702113

  1. Regional brain perfusion in 10 normal dogs measured using Technetium-99m ethyl cysteinate dimer spect.

    PubMed

    Peremans, K; De Bondt, P; Audenaert, K; Van Laere, K; Gielen, I; Koole, M; Versijpt, J; Van Bree, H; Verschooten, F; Dierckx, R

    2001-01-01

    Single photon emission computed tomography (SPECT) of the brain using perfusion tracers allows estimation of regional brain perfusion. This allows in vivo examination of brain function in the setting of neuropsychologic and pathophysiologic changes. However functional imaging data on brain perfusion in dogs are limited. Hence, the aim of this study was to determine the scintigraphic regional perfusion pattern of the normal canine brain. Ten healthy shepherd type dogs were injected with 925 MBq Technetium-99m ethyl cysteinate (ECD) 20 minutes before the examination. Acquisition was performed using a triple head gamma camera equipped with fanbeam collimators. Uniform attenuation correction and triple energy window correction were applied. Computed tomographic images were obtained from the same dogs, reoriented along the orbito-meatal axis and SPECT perfusion data were coregistered to the CT-volume data. Based on morphological and suggested brain divisions, regions-of-interest (ROIs) were defined for the bilateral frontocerebral, temporocerebral, parietocerebral, occipitocerebral, cerebellar, thalamic, and striatal area. Regional count density was normalized on total counts. All dogs had the highest uptake in the thalamic/striatal area compared to a rather homogeneous cerebral uptake. No significant left/right count differences were found, but a rostro-caudal gradient (+12-13%) was present. In this group, age and gender did not influence the perfusion pattern. PMID:11768526

  2. Framework for cognitive analysis of dynamic perfusion computed tomography with visualization of large volumetric data

    NASA Astrophysics Data System (ADS)

    Hachaj, Tomasz; Ogiela, Marek R.

    2012-10-01

    The proposed framework for cognitive analysis of perfusion computed tomography images is a fusion of image processing, pattern recognition, and image analysis procedures. The output data of the algorithm consists of: regions of perfusion abnormalities, anatomy atlas description of brain tissues, measures of perfusion parameters, and prognosis for infracted tissues. That information is superimposed onto volumetric computed tomography data and displayed to radiologists. Our rendering algorithm enables rendering large volumes on off-the-shelf hardware. This portability of rendering solution is very important because our framework can be run without using expensive dedicated hardware. The other important factors are theoretically unlimited size of rendered volume and possibility of trading of image quality for rendering speed. Such rendered, high quality visualizations may be further used for intelligent brain perfusion abnormality identification, and computer aided-diagnosis of selected types of pathologies.

  3. Dynamic perfusion assessment during perforator flap surgery: an up-to-date

    PubMed Central

    MUNTEAN, MAXIMILIAN VLAD; MUNTEAN, VALENTIN; ARDELEAN, FILIP; GEORGESCU, ALEXANDRU

    2015-01-01

    Flap monitoring technology has progressed alongside flap design. The highly variable vascular anatomy and the complexity associated with modern perforator flaps demands dynamic, real-time, intraoperative information about the vessel location, perfusion patterns and flap physiology. Although most surgeons still assess flap perfusion and viability based solely on clinical experience, studies have shown that results may be highly variable and often misleading. Poor judgment of intraoperative perfusion leads to major complications. Employing dynamic perfusion imaging during flap reconstruction has led to a reduced complication rate, lower morbidity, shorter hospital stay, and an overall better result. With the emergence of multiple systems capable of intraoperative flap evaluation, the purpose of this article is to review the two systems that have been widely accepted and are currently used by plastic surgeons: Indocyanine green angiography (ICGA) and dynamic infrared thermography (DIRT). PMID:26609259

  4. Ultrasound perfusion signal processing for tumor detection

    NASA Astrophysics Data System (ADS)

    Kim, MinWoo; Abbey, Craig K.; Insana, Michael F.

    2016-04-01

    Enhanced blood perfusion in a tissue mass is an indication of neo-vascularity and a sign of a potential malignancy. Ultrasonic pulsed-Doppler imaging is a preferred modality for noninvasive monitoring of blood flow. However, the weak blood echoes and disorganized slow flow make it difficult to detect perfusion using standard methods without the expense and risk of contrast enhancement. Our research measures the efficiency of conventional power-Doppler (PD) methods at discriminating flow states by comparing measurement performance to that of an ideal discriminator. ROC analysis applied to the experimental results shows that power Doppler methods are just 30-50 % efficient at perfusion flows less than 1ml/min, suggesting an opportunity to improve perfusion assessment through signal processing. A new perfusion estimator is proposed by extending the statistical discriminator approach. We show that 2-D perfusion color imaging may be enhanced using this approach.

  5. Effects of Respiration Inhibitors and Uncouplers on Dark- and Light-Induced Leaflet Movements of Cassia fasciculata.

    PubMed

    Saeedi, S; Roblin, G

    1986-09-01

    Respiration inhibitors, in particular KCN and NaN(3), inhibited slightly the dark-induced (scotonasty) as well as the light-induced (photonasty) leaflet movements of Cassia fasciculata: they act only at concentrations higher than 1 millimolar and 0.1 millimolar, respectively. Amytal induced a stronger inhibitory effect on scotonasty. Salicylhydroxamic acid, which inhibits the cyanide-insensitive respiration pathway, was also poorly effective when applied alone. KCN and salicylhydroxamic acid applied together increased the inhibition. Uncouplers of oxidative phosphorylation were very effective: 2,4-dinitrophenol and carbonylcyanide-m-chlorophenylhydrazone inhibited the scotonastic movements at concentrations higher than 10 mum and 1 mum, respectively. Although uncouplers reduced the photonastic movements at higher concentrations, they promoted leaflet opening at other concentrations in an unexpected way. PMID:16665004

  6. Effects of Respiration Inhibitors and Uncouplers on Dark- and Light-Induced Leaflet Movements of Cassia fasciculata1

    PubMed Central

    Saeedi, Saed; Roblin, Gabriel

    1986-01-01

    Respiration inhibitors, in particular KCN and NaN3, inhibited slightly the dark-induced (scotonasty) as well as the light-induced (photonasty) leaflet movements of Cassia fasciculata: they act only at concentrations higher than 1 millimolar and 0.1 millimolar, respectively. Amytal induced a stronger inhibitory effect on scotonasty. Salicylhydroxamic acid, which inhibits the cyanide-insensitive respiration pathway, was also poorly effective when applied alone. KCN and salicylhydroxamic acid applied together increased the inhibition. Uncouplers of oxidative phosphorylation were very effective: 2,4-dinitrophenol and carbonylcyanide-m-chlorophenylhydrazone inhibited the scotonastic movements at concentrations higher than 10 μm and 1 μm, respectively. Although uncouplers reduced the photonastic movements at higher concentrations, they promoted leaflet opening at other concentrations in an unexpected way. PMID:16665004

  7. Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study

    PubMed Central

    Goodwin, P C; Wright, C C; Allan, C; Crowther, L; Darley, C; Heap, A; Paul, E; White, L; Rushton, A

    2015-01-01

    Objective To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards. Design A mixed methods approach utilising the Delphi technique and focus groups. Setting Five spinal centres across the UK. Participants Panel members included 23 physiotherapists, 11 patients and 17 spinal surgeons. Intervention Three rounds of questionnaires including open and closed questions and attendance at a clinician/patient focus group. Results Response rates of 85%, 26% and 35% were achieved for the Delphi rounds. Ten clinicians and six patients participated in the focus groups. Consensus for leaflet sections was achieved in round 1 and content in round 3. The focus groups informed further revisions. Conclusions A consensually agreed, Information Standard compliant, patient lumbar discectomy leaflet was produced containing: (1) normal spine anatomy; (2) anatomy disc herniation and surgery; (3) back protection strategies and (4) frequently asked questions. Illustrations of exercises enable tailoring to the individual patient. PMID:25762227

  8. Myocardial perfusion imaging using contrast echocardiography.

    PubMed

    Pathan, Faraz; Marwick, Thomas H

    2015-01-01

    Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality. PMID:25817740

  9. Estimating a regional ventilation-perfusion index

    PubMed Central

    Muller, P A; Li, T; Isaacson, D; Newell, J C; Saulnier, G J; Kao, Tzu-Jen; Ashe, Jeffrey

    2015-01-01

    This is a methods paper, where an approximation to the local ventilation-perfusion ratio is derived. This approximation, called the ventilation-perfusion index since it is not exactly the physiological ventilation-perfusion ratio, is calculated using conductivity reconstructions obtained using electrical impedance tomography. Since computation of the ventilation-perfusion index only requires knowledge of the internal conductivity, any conductivity reconstruction method may be used. The method is explained, and results are presented using conductivities obtained from two EIT systems, one using an iterative method and the other a linearization method. PMID:26006279

  10. The Predictive Value of Mitral Leaflet Motion and Thickness Index Scores on Early Restenosis after Mitral Balloon Valvuloplasty

    PubMed Central

    Akin, Mustafa; Sagcan, Abdi; Nalbantgil, Sanem; Ozerkan, Filiz; Akilli, Azem; Yavuzgil, Oguz; Zoghi, Mehdi

    2004-01-01

    The purpose of this study was to investigate whether there is any association between mitral leaflet motion (LMI) and leaflet thickness index (LTI) scores and the rate of restenosis 3 months after successful mitral balloon valvuloplasty. The study population consisted of 46 patients with symptomatic rheumatic mitral stenosis who underwent balloon valvuloplasty (37 women, 9 men; mean age, 36 ± 9 years). Two-dimensional and Doppler echocardiography were performed in all patients on the day before, immediately after, and 3 months after valvuloplasty. The severity of restriction of leaflet motion and the severity of leaflet thickening were classified into grades of mild (a score of 0), moderate (a score of 1), and severe (a score of 2). Subvalvular disease and commissural involvement were homogeneous in all patients. Before and immediately after mitral balloon valvuloplasty, there were no significant differences in mitral valve area among the groups with different LMI and LTI scores. However, at 3 months after valvuloplasty, reduction in mitral valve area was more significant in patients who had higher pre-procedural LMI and LTI scores (P < 0.05). The rates of early restenosis were 0 with a total score of 0, 14.2% with a total score of 1–2, and 32% with a total score of 3. In conclusion, quantitative assessment of LMI and LTI scores by 2-dimensional echocardiography may be helpful in predicting early restenosis after mitral balloon valvuloplasty. Early reduction in mitral valve area is significant in patients who have higher total LMI and LTI scores. PMID:15562845

  11. Asymmetric distribution of charged lipids between the leaflets of a vesicle bilayer induced by melittin and alamethicin

    SciTech Connect

    Qian, Shuo; Heller, William T

    2011-01-01

    Cellular membranes are complex mixtures of lipids, proteins, and other small molecules that provide functional, dynamic barriers between the cell and its environment, as well as between environments within the cell. The lipid composition of the membrane is highly specific and controlled in terms of both content and lipid localization. The membrane structure results from the complex interplay between the wide varieties of molecules present. Here, small-angle neutron scattering and selective deuterium labeling were used to probe the impact of the membrane-active peptides melittin and alamethicin on the structure of lipid bilayers composed of a mixture of the lipids dimyristoyl phosphatidylglycerol (DMPG) and chain-perdeuterated dimyristoyl phosphatidylcholine (DMPC). We found that both peptides enriched the outer leaflet of the bilayer with the negatively charged DMPG, creating an asymmetric distribution of lipids. The level of enrichment is peptide concentration-dependent and is stronger for melittin than it is for alamethicin. The enrichment between the inner and outer bilayer leaflets occurs at very low peptide concentrations and increases with peptide concentration, including when the peptide adopts a membrane-spanning, pore-forming state. The results suggest that these membrane-active peptides may have a secondary stressful effect on target cells at low concentrations that results from a disruption of the lipid distribution between the inner and outer leaflets of the bilayer that is independent of the formation of transmembrane pores.

  12. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy

    PubMed Central

    Smith, Radford; cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  13. Descending projections of the hamster intergeniculate leaflet: relationship to the sleep/arousal and visuomotor systems

    NASA Technical Reports Server (NTRS)

    Morin, Lawrence P.; Blanchard, Jane H.

    2005-01-01

    The intergeniculate leaflet (IGL), homolog of the primate pregeniculate nucleus, modulates circadian rhythms. However, its extensive anatomical connections suggest that it may regulate other systems, particularly those for visuomotor function and sleep/arousal. Here, descending IGL-efferent pathways are identified with the anterograde tracer, Phaseolus vulgaris leucoagglutinin, with projections to over 50 brain stem nuclei. Projections of the ventral lateral geniculate are similar, but more limited. Many of the nuclei with IGL afferents contribute to circuitry governing visuomotor function. These include the oculomotor, trochlear, anterior pretectal, Edinger-Westphal, and the terminal nuclei; all layers of the superior colliculus, interstitial nucleus of the medial longitudinal fasciculus, supraoculomotor periaqueductal gray, nucleus of the optic tract, the inferior olive, and raphe interpositus. Other target nuclei are known to be involved in the regulation of sleep, including the lateral dorsal and pedunculopontine tegmentum. The dorsal raphe also receives projections from the IGL and may contribute to both sleep/arousal and visuomotor function. However, the locus coeruleus and medial vestibular nucleus, which contribute to sleep and eye movement regulation and which send projections to the IGL, do not receive reciprocal projections from it. The potential involvement of the IGL with the sleep/arousal system is further buttressed by existing evidence showing IGL-efferent projections to the ventrolateral preoptic area, dorsomedial, and medial tuberal hypothalamus. In addition, the great majority of all regions receiving IGL projections also receive input from the orexin/hypocretin system, suggesting that this system contributes not only to the regulation of sleep, but to eye movement control as well.

  14. On the Presence of Affine Fibril and Fiber Kinematics in the Mitral Valve Anterior Leaflet

    PubMed Central

    Lee, Chung-Hao; Zhang, Will; Liao, Jun; Carruthers, Christopher A.; Sacks, Jacob I.; Sacks, Michael S.

    2015-01-01

    In this study, we evaluated the hypothesis that the constituent fibers follow an affine deformation kinematic model for planar collagenous tissues. Results from two experimental datasets were utilized, taken at two scales (nanometer and micrometer), using mitral valve anterior leaflet (MVAL) tissues as the representative tissue. We simulated MVAL collagen fiber network as an ensemble of undulated fibers under a generalized two-dimensional deformation state, by representing the collagen fibrils based on a planar sinusoidally shaped geometric model. The proposed approach accounted for collagen fibril amplitude, crimp period, and rotation with applied macroscopic tissue-level deformation. When compared to the small angle x-ray scattering measurements, the model fit the data well, with an r2 = 0.976. This important finding suggests that, at the homogenized tissue-level scale of ∼1 mm, the collagen fiber network in the MVAL deforms according to an affine kinematics model. Moreover, with respect to understanding its function, affine kinematics suggests that the constituent fibers are largely noninteracting and deform in accordance with the bulk tissue. It also suggests that the collagen fibrils are tightly bounded and deform as a single fiber-level unit. This greatly simplifies the modeling efforts at the tissue and organ levels, because affine kinematics allows a straightforward connection between the macroscopic and local fiber strains. It also suggests that the collagen and elastin fiber networks act independently of each other, with the collagen and elastin forming long fiber networks that allow for free rotations. Such freedom of rotation can greatly facilitate the observed high degree of mechanical anisotropy in the MVAL and other heart valves, which is essential to heart valve function. These apparently novel findings support modeling efforts directed toward improving our fundamental understanding of tissue biomechanics in healthy and diseased conditions

  15. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy.

    PubMed

    Smith, Radford; Cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  16. Long term perfusion system supporting adipogenesis

    PubMed Central

    Abbott, Rosalyn D.; Raja, Waseem K.; Wang, Rebecca Y.; Stinson, Jordan A.; Glettig, Dean L.; Burke, Kelly A.; Kaplan, David L.

    2015-01-01

    Adipose tissue engineered models are needed to enhance our understanding of disease mechanisms and for soft tissue regenerative strategies. Perfusion systems generate more physiologically relevant and sustainable adipose tissue models, however adipocytes have unique properties that make culturing them in a perfusion environment challenging. In this paper we describe the methods involved in the development of two perfusion culture systems (2D and 3D) to test their applicability for long term in vitro adipogenic cultures. It was hypothesized that a silk protein biomaterial scaffold would provide a 3D framework, in combination with perfusion flow, to generate a more physiologically relevant sustainable adipose tissue engineered model than 2D cell culture. Consistent with other studies evaluating 2D and 3D culture systems for adipogenesis we found that both systems successfully model adipogensis, however 3D culture systems were more robust, providing the mechanical structure required to contain the large, fragile adipocytes that were lost in 2D perfused culture systems. 3D perfusion also stimulated greater lipogenesis and lipolysis and resulted in decreased secretion of LDH compared to 2D perfusion. Regardless of culture configuration (2D or 3D) greater glycerol was secreted with the increased nutritional supply provided by perfusion of fresh media. These results are promising for adipose tissue engineering applications including long term cultures for studying disease mechanisms and regenerative approaches, where both acute (days to weeks) and chronic (weeks to months) cultivation are critical for useful insight. PMID:25843606

  17. Myocardial perfusion with rubidium-82. III. Theory relating severity of coronary stenosis to perfusion deficit

    SciTech Connect

    Mullani, N.A.

    1984-11-01

    The relation between the quantitative perfusion deficit, as measured by emission computerized tomography, and the severity of coronary artery stenosis is important for the noninvasive clinical evaluation of coronary artery disease in man. Positron emission tomography allows direct noninvasive measurement of myocardial perfusion and quantification of the size of the perfusion defect. Given this important imformation, a mathematical model has been derived to gauge the severity of a coronary stenosis from quantitative perfusion measurements in the normal and poststenotic regions of the heart. The theoretical basis is presented for relating regional myocardial perfusion and regional perfusion resistance to total, coronary blood flow and resistance at normal resting flow and during maximal coronary vasodilation. The concept of perfusion reserve is presented as a clinical measure of the severity of a stenosis.

  18. Neuropsychological Correlates of Brain Perfusion SPECT in Patients with Macrophagic Myofasciitis

    PubMed Central

    Van Der Gucht, Axel; Aouizerate, Jessie; Evangelista, Eva; Chalaye, Julia; Gherardi, Romain K.; Ragunathan-Thangarajah, Nilusha; Bachoud-Levi, Anne-Catherine; Authier, François-Jérôme

    2015-01-01

    Background Patients with aluminum hydroxide adjuvant-induced macrophagic myofasciitis (MMF) complain of arthromyalgias, chronic fatigue and cognitive deficits. This study aimed to characterize brain perfusion in these patients. Methods Brain perfusion SPECT was performed in 76 consecutive patients (aged 49±10 y) followed in the Garches-Necker-Mondor-Hendaye reference center for rare neuromuscular diseases. Images were acquired 30 min after intravenous injection of 925 MBq 99mTc-ethylcysteinate dimer (ECD) at rest. All patients also underwent a comprehensive battery of neuropsychological tests, within 1.3±5.5 mo from SPECT. Statistical parametric maps (SPM12) were obtained for each test using linear regressions between each performance score and brain perfusion, with adjustment for age, sex, socio-cultural level and time delay between brain SPECT and neuropsychological testing. Results SPM analysis revealed positive correlation between neuropsychological scores (mostly exploring executive functions) and brain perfusion in the posterior associative cortex, including cuneus/precuneus/occipital lingual areas, the periventricular white matter/corpus callosum, and the cerebellum, while negative correlation was found with amygdalo-hippocampal/entorhinal complexes. A positive correlation was also observed between brain perfusion and the posterior associative cortex when the time elapsed since last vaccine injection was investigated. Conclusions Brain perfusion SPECT showed a pattern of cortical and subcortical changes in accordance with the MMF-associated cognitive disorder previously described. These results provide a neurobiological substrate for brain dysfunction in aluminum hydroxide adjuvant-induced MMF patients. PMID:26030650

  19. Effects of some anesthetic agents on skin microcirculation evaluated by laser Doppler perfusion imaging in mice

    PubMed Central

    2013-01-01

    Background Anesthetic agents alter microcirculation, influencing tissue oxygenation and delivery of vital substrates. Laser Doppler perfusion imaging is a widespread technique in the field of microvascular research that can evaluate noninvasively and in real time the effects of environmental conditions, physical manipulations, diseases and treatments on peripheral perfusion. This study aims to evaluate laser Doppler perfusion imaging as a means to detect changes in skin microcirculation induced by some popular anesthetic agents in a murine model. Twenty-four age- and gender-matched healthy CD1 mice were examined by laser Doppler perfusion imaging. The skin microcirculatory response was measured at the level of plantar surfaces during isoflurane anesthesia with or without subsequent dexmedetomidine or acepromazine. At the end of the procedure, dexmedetomidine was reversed by atipamezole administration. Results In all mice, skin blood flow under isoflurane anesthesia did not show significant differences over time (P = 0.1). The serial perfusion pattern and values following acepromazine or dexmedetomidine administration differed significantly (P < 0.05). Conclusions We standardized a reliable laser Doppler perfusion imaging protocol to non-invasively assess changes in skin microcirculation induced by anesthesia in mice, considering the advantages and drawbacks of this technique and its translational value. PMID:24341447

  20. Evaluation of pulmonary perfusion in lung regions showing isolated xenon-133 ventilation washout defects

    SciTech Connect

    Bushnell, D.L.; Sood, K.B.; Shirazi, P.; Pal, I. )

    1990-08-01

    Xenon-133 washout phase imaging is often used to help determine whether the etiology of a perfusion defect is embolic or due to pulmonary parenchymal pathology, such as chronic obstructive pulmonary disease. This study was designed to evaluate the pulmonary blood flow patterns associated with isolated defects on xenon washout images. Scintigraphic lung studies were reviewed until 100 cases with abnormal ventilation results were obtained. Ventilation abnormalities were compared with the corresponding perfusion scan results at the same anatomic site. Of the 208 individual lung regions with xenon abnormalities, 111 showed isolated washout defects (that is, with normal washin). Ninety-four of these 111 sites showed either normal perfusion or a small, nonsegmental corresponding perfusion defect. Three segmental perfusion defects were noted in association with isolated xenon retention. In each of these cases, however, the patient was felt actually to have pulmonary embolism. Thus, it is recommended that, for interpretation of scintigraphic images in the assessment of pulmonary embolism, lung pathology associated with isolated xenon retention not be considered a potential cause for large or segmental perfusion defects.

  1. Ventilation-perfusion matching in long-term microgravity

    NASA Technical Reports Server (NTRS)

    Verbandt, Y.; Wantier, M.; Prisk, G. K.; Paiva, M.; West, J. B. (Principal Investigator)

    2000-01-01

    We studied the ventilation-perfusion matching pattern in normal gravity (1 G) and short- and long-duration microgravity (microG) using the cardiogenic oscillations in the sulfur hexaflouride (SF(6)) and CO(2) concentration signals during the phase III portion of vital capacity single-breath washout experiments. The signal power of the cardiogenic concentration variations was assessed by spectral analysis, and the phase angle between the oscillations of the two simultaneously expired gases was obtained through cross-correlation. For CO(2), a significant reduction of cardiogenic power was observed in microG, with respect to 1 G, but the reduction was smaller and more variable in the case of SF(6). A shift from an in-phase condition in 1 G to an out-of-phase condition was found for both short- and long-duration microG. We conclude that, although the distribution of ventilation and perfusion becomes more homogeneous in microG, significant inhomogeneities persist and that areas of high perfusion become associated with areas of relatively lower ventilation. In addition, these modifications seem to remain constant during long-term exposure to microG.

  2. Dopaminergic Therapy Modulates Cortical Perfusion in Parkinson Disease With and Without Dementia According to Arterial Spin Labeled Perfusion Magnetic Resonance Imaging

    PubMed Central

    Lin, Wei-Che; Chen, Pei-Chin; Huang, Yung-Cheng; Tsai, Nai-Wen; Chen, Hsiu-Ling; Wang, Hung-Chen; Lin, Tsu-Kung; Chou, Kun-Hsien; Chen, Meng-Hsiang; Chen, Yi-Wen; Lu, Cheng-Hsien

    2016-01-01

    Abstract Arterial spin labeling (ASL) magnetic resonance imaging analyses allow for the quantification of altered cerebral blood flow, and provide a novel means of examining the impact of dopaminergic treatments. The authors examined the cerebral perfusion differences among 17 Parkinson disease (PD) patients, 17 PD with dementia (PDD) patients, and 17 healthy controls and used ASL-MRI to assess the effects of dopaminergic therapies on perfusion in the patients. The authors demonstrated progressive widespread cortical hypoperfusion in PD and PDD and robust effects for the dopaminergic therapies. Specifically, dopaminergic medications further decreased frontal lobe and cerebellum perfusion in the PD and PDD groups, respectively. These patterns of hypoperfusion could be related to cognitive dysfunctions and disease severity. Furthermore, desensitization to dopaminergic therapies in terms of cortical perfusion was found as the disease progressed, supporting the concept that long-term therapies are associated with the therapeutic window narrowing. The highly sensitive pharmaceutical response of ASL allows clinicians and researchers to easily and effectively quantify the absolute perfusion status, which might prove helpful for therapeutic planning. PMID:26844450

  3. Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study

    PubMed Central

    Schlumpf, Yolanda R.; Reinders, Antje A. T. S.; Nijenhuis, Ellert R. S.; Luechinger, Roger; van Osch, Matthias J. P.; Jäncke, Lutz

    2014-01-01

    Background In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the “Emotional Part” (EP) and the “Apparently Normal Part” (ANP), have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors. Methods Arterial spin labeling perfusion MRI was used to test the hypotheses that ANP and EP in DID have different perfusion patterns in response to rest instructions, and that perfusion is different in actors who were instructed to simulate ANP and EP. In a follow-up study, regional cerebral blood flow of DID patients was compared with the activation pattern of healthy non-simulating controls. Results Compared to EP, ANP showed elevated perfusion in bilateral thalamus. Compared to ANP, EP had increased perfusion in the dorsomedial prefrontal cortex, primary somatosensory cortex, and motor-related areas. Perfusion patterns for simulated ANP and EP were different. Fitting their reported role-play strategies, the actors activated brain structures involved in visual mental imagery and empathizing feelings. The follow-up study demonstrated elevated perfusion in the left temporal lobe in DID patients, whereas non-simulating healthy controls had increased activity in areas which mediate the mental construction of past and future episodic events. Conclusion DID involves dissociative part-dependent resting-state differences. Compared to ANP, EP activated brain structures involved in self-referencing and sensorimotor actions more. Actors had different perfusion patterns compared to genuine ANP and EP. Comparisons of neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of ANP and EP in DID are not due to imagination. The findings are

  4. Evaluation of a novel tetra-functional branched poly(ethylene glycol) crosslinker for manufacture of crosslinked, decellularized, porcine aortic valve leaflets.

    PubMed

    Hu, Xing-Jian; Dong, Nian-Guo; Shi, Jia-Wei; Deng, Cheng; Li, Hua-Dong; Lu, Cui-Fen

    2014-02-01

    To address concerns over limitations in the clinical use of glutaraldehyde (GA) fixation in bioprosthetic heart valves, we manufactured novel, branched poly(ethylene glycol) tetraacrylate (PEG-TA) crosslinked valve leaflets and evaluated cytotoxic, thrombogenic, hemolytic, and anticalcification effects, thermal stability, and mechanical properties, in comparison to decellularized valves (control) and GA crosslinked valves. Thermal denaturation temperatures were higher for PEG-TA valve leaflets compared to control and GA crosslinked valves (p < 0.001). Leaflet hydrolyzation rate was lower for the PEG-TA group than for GA and control groups (p < 0.05). Superior cytocompatibility was found for PEG-TA group leaflets (MTT, p < 0.01. apoptosis assay, p > 0.05). No thrombogenesis was found in platelet activation tests (p < 0.0001). Hemolysis assays showed that PEG-TA leaflets would not cause damage to blood cells (p > 0.05). Excellent anticalcification properties were confirmed by von Kossa staining, western blot, and atomic absorption spectroscopy (p < 0.0001) in a rat subcutaneous embedding model. Finally, the novel PEG-TA crosslinked material exhibits improved mechanical properties as compared to GA crosslinked materials (tensile strength, p < 0.001, Young's modulus, p < 0.001). On the basis of all results presented, it is clear that the performance characteristics of PEG-TA crosslinked valve leaflets make PEG-TA crosslinked leaflets a promising alternative for the next generation of bioprosthetic heart valve. PMID:24115395

  5. TISSUE ENGINEERING PERFUSABLE CANCER MODELS

    PubMed Central

    Fong, E.L.; Santoro, M.; Farach-Carson, M.C.; Kasper, F.K.; Mikos, A.G.

    2014-01-01

    The effect of fluid flow on cancer progression is currently not well understood, highlighting the need for perfused tumor models to close this gap in knowledge. Enabling biological processes at the cellular level to be modeled with high spatiotemporal control, microfluidic tumor models have demonstrated applicability as platforms to study cell-cell interactions, effect of interstitial flow on tumor migration and the role of vascular barrier function. To account for the multi-scale nature of cancer growth and invasion, macroscale models are also necessary. The consideration of fluid dynamics within tumor models at both the micro- and macroscopic levels may greatly improve our ability to more fully mimic the tumor microenvironment. PMID:24634812

  6. Diurnal Curve of the Ocular Perfusion Pressure

    PubMed Central

    Moreira, TCA; Bezerra, BSP; Vianello, MP; Corradi, J; Dorairaj, SK; Prata, TS

    2016-01-01

    ABSTRACT Purpose: To describe the diurnal variation of the ocular perfusion pressure (OPP) in normal, suspects and glaucoma patients. Materials and methods: Seventy-nine subjects were enrolled in a prospective study. The diurnal curve of intraocular pressure (IOP) was performed and blood pressure measurements were obtained. Each participant was grouped into one of the following based upon the clinical evaluation of the optic disk, IOP and standard achromatic perimetry (SAP): 18 eyes were classified as normal (normal SAP, normal optic disk evaluation and IOP < 21 mm Hg in two different measurements), 30 eyes as glaucoma suspect (GS) (normal SAP and mean deviation (MD), C/D ration > 0.5 or asymmetry > 0.2 and/or ocular hypertension), 31 eyes as early glaucoma (MD < -6 dB, glaucomatous optic neuropathy and SAP and MDs on SAP. Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Intraocular pressure and blood pressure measurements were taken at 6 am, 9 am, 12, 3 and 6 pm. The patients stayed in the seated position for 5 minutes prior to blood pressure measurements. Results: The mean IOP values in all groups did not follow any regular pattern. The peak IOP was found to be greater in suspect [18.70 ± 3.31 (mm Hg ± SD)] and glaucoma (18.77 ± 4.30 mm Hg) patients as compared to normal subjects (16.11 ± 2.27 mm Hg). In studying the diurnal variation of the OPP, we found lower values at 3 pm in normals (34.21 ± 2.07 mm Hg), at 9 am in suspects (54.35 ± 3.32 mm Hg) and at 12 pm in glaucoma patients (34.84 ± 1.44 mm Hg). Conclusion: Each group has a specific OPP variation during the day with the most homogeneous group being the suspect one. It is important to keep studying the IOP and OPP variation for increased comprehension of the pathophysiology of glaucomatous optic neuropathy. How to cite this article: Kanadani FN, Moreira TCA, Bezerra BSP, Vianello MP, Corradi J, Dorairaj SK, Prata TS. Diurnal Curve of the Ocular Perfusion

  7. Readability Analysis of the Package Leaflets for Biological Medicines Available on the Internet Between 2007 and 2013: An Analytical Longitudinal Study

    PubMed Central

    2016-01-01

    Background The package leaflet included in the packaging of all medicinal products plays an important role in the transmission of medicine-related information to patients. Therefore, in 2009, the European Commission published readability guidelines to try to ensure that the information contained in the package leaflet is understood by patients. Objective The main objective of this study was to calculate and compare the readability levels and length (number of words) of the package leaflets for biological medicines in 2007, 2010, and 2013. Methods The sample of this study included 36 biological medicine package leaflets that were downloaded from the European Medicines Agency website in three different years: 2007, 2010, and 2013. The readability of the selected package leaflets was obtained using the following readability formulas: SMOG grade, Flesch-Kincaid grade level, and Szigriszt’s perspicuity index. The length (number of words) of the package leaflets was also measured. Afterwards, the relationship between these quantitative variables (three readability indexes and length) and categorical (or qualitative) variables were analyzed. The categorical variables were the year when the package leaflet was downloaded, the package leaflet section, type of medicine, year of authorization of biological medicine, and marketing authorization holder. Results The readability values of all the package leaflets exceeded the sixth-grade reading level, which is the recommended value for health-related written materials. No statistically significant differences were found between the three years of study in the readability indexes, although differences were observed in the case of the length (P=.002), which increased over the study period. When the relationship between readability indexes and length and the other variables was analyzed, statistically significant differences were found between package leaflet sections (P<.001) and between the groups of medicine only with regard

  8. Specificity of systolic anterior motion of anterior mitral leaflet for hypertrophic cardiomyopathy. Prevalence in large population of patients with other cardiac diseases.

    PubMed Central

    Maron, B J; Gottdiener, J S; Perry, L W

    1981-01-01

    The value of systolic anterior motion of the anterior mitral leaflet as a diagnostic marker for hypertrophic cardiomyopathy has been questioned because of its reported occurrence in other heart diseases. To determine the true specificity of systolic anterior motion for hypertrophic cardiomyopathy, 721 echocardiograms from patients with a wide variety of cardiac diseases were reviewed for its presence or absence under basal conditions. Systolic anterior motion of the anterior mitral leaflet was present in only 22 (3.0%) of the 721 patients, giving a specificity of 97 per cent. It was most common in patients with d-transposition of the great vessels (11 of 51, or 21%). With patients having transposition of the great vessels excluded from the analysis, the prevalence of systolic anterior motion of the anterior mitral leaflet was only 1.6 per cent (specificity 98%). Of note, eight of the 11 patients with systolic anterior motion of the anterior mitral leaflet and diseases other than transposition of the great vessels had disproportionate thickening of the ventricular septum, making it exceedingly rare in a patient population with normal septal-free wall thickness ratios (prevalence 0.4%; specificity 99%). Hence, while systolic anterior motion is not pathognomonic of hypertrophic cardiomyopathy, it was an uncommon finding in a large population of patients with a variety of cardiac diseases; when present in such patients systolic anterior motion of the anterior mitral leaflet is usually associated with disproportionate septal thickening. Images PMID:7193042

  9. Luminal distension as a possible consequence of experimental intestinal perfusion

    PubMed Central

    Wingate, David; Hyams, Ashley; Phillips, Sidney

    1974-01-01

    In an experimental jejunal perfusion study, distress in healthy subjects occurred during eight out of 16 perfusions in which intestinal secretion was provoked. Calculation demonstrates the volumetric consequences of inadequate recovery of secretory perfusates, and analysis of the perfusion studies shows that distress was significantly associated with poor recovery of the perfusate. These observations are pertinent to increasing interest in the phenomenon of intestinal fluid secretion. PMID:4435588

  10. Perfusion education and training in Europe.

    PubMed

    Merkle, Frank

    2006-01-01

    Perfusion education and training varies considerably throughout Europe. Unlike in the US, where a common curriculum for perfusion education has been established, each European country has its own education system. This fact is further complicated by a multitude of national languages and cultures. Thus, perfusion education programmes vary, not only in content, but also in their academic levels. This article aims to give a comprehensive overview of the situation in each of the 20 member states of the European Board of Cardiovascular Perfusion (EBCP). The EBCP delegates were polled for a description of the process of training and education of clinical perfusionists in their respective countries. Following the initial delegate poll in 2001, an update of the material was performed in spring 2005. In summary, training of clinical perfusionists in Europe varies considerably between countries. A professional body is necessary to oversee the training process and to guarantee a minimum level of clinical competency for cardiovascular perfusionists. PMID:16485693

  11. Myocardial perfusion imaging with 201Tl.

    PubMed

    Pagnanelli, Robert A; Basso, Danny A

    2010-03-01

    The object of this review is to provide information about (201)Tl-thallous chloride in radionuclide myocardial perfusion imaging. This technique has experienced a recent resurgence because of the shortage of (99m)Tc. After reading this article, the technologist will be able to describe the properties and uptake mechanism of (201)Tl, the procedure for myocardial perfusion imaging with this agent, and the advantages and disadvantages of thallium, compared with the technetium agents. PMID:20159930

  12. Improved exercise myocardial perfusion during lidoflazine therapy

    SciTech Connect

    Shapiro, W.; Narahara, K.A.; Park, J.

    1983-11-01

    Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a study of 6 patients with severe classic angina pectoris, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise.

  13. The Impact of Fluid Inertia on In Vivo Estimation of Mitral Valve Leaflet Constitutive Properties and Mechanics.

    PubMed

    Bark, David L; Dasi, Lakshmi P

    2016-05-01

    We examine the influence of the added mass effect (fluid inertia) on mitral valve leaflet stress during isovolumetric phases. To study this effect, oscillating flow is applied to a flexible membrane at various frequencies to control inertia. Resulting membrane strain is calculated through a three-dimensional reconstruction of markers from stereo images. To investigate the effect in vivo, the analysis is repeated on a published dataset for an ovine mitral valve (Journal of Biomechanics 42(16): 2697-2701). The membrane experiment demonstrates that the relationship between pressure and strain must be corrected with a fluid inertia term if the ratio of inertia to pressure differential approaches 1. In the mitral valve, this ratio reaches 0.7 during isovolumetric contraction for an acceleration of 6 m/s(2). Acceleration is reduced by 72% during isovolumetric relaxation. Fluid acceleration also varies along the leaflet during isovolumetric phases, resulting in spatial variations in stress. These results demonstrate that fluid inertia may be the source of the temporally and spatially varying stiffness measurements previously seen through inverse finite element analysis of in vivo data during isovolumetric phases. This study demonstrates that there is a need to account for added mass effects when analyzing in vivo constitutive relationships of heart valves. PMID:26416720

  14. Design and Validation of a Novel Bioreactor to Subject Aortic Valve Leaflets to Side-Specific Shear Stress

    PubMed Central

    Sun, Ling; Rajamannan, Nalini M.; Sucosky, Philippe

    2014-01-01

    Hemodynamic stresses are presumed to play an important role in the development of calcific aortic valve disease (CAVD). The elucidation of the shear stress mechanisms involved in the pathogenesis of CAVD has been hampered by the complexity of the native unsteady and side-specific valvular flow environment. To address this gap, this article describes the design and validation of a novel device to expose leaflet samples to time-dependent side-specific shear stress. The device built on a double cone-and-plate geometry was dimensioned based on our previous single-sided shear stress device that minimizes secondary flow effects inherent to this geometry. A fluid–structure interaction (FSI) model was designed to predict the actual shear stress produced on a tissue sample mounted in the new device. Staining was performed on porcine leaflets conditioned in the new bioreactor to assess endothelial integrity and cellular apoptosis. The FSI results demonstrated good agreement between the target (native) and the actual side-specific shear stress produced on a tissue sample. No significant difference in endothelial integrity and cellular apoptosis was detected between samples conditioned for 96 h and fresh controls. This new device will enable the investigation of valvular response to normal and pathologic hemodynamics and the potential mechano-etiology of CAVD. PMID:21455792

  15. The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet

    SciTech Connect

    Liao,J.; Yang, L.; Grashow, J.; Sacks, M.

    2007-01-01

    We have recently demonstrated that the mitral valve anterior leaflet (MVAL) exhibited minimal hysteresis, no strain rate sensitivity, stress relaxation but not creep (Grashow et al., 2006, Ann Biomed Eng., 34(2), pp. 315-325; Grashow et al., 2006, Ann Biomed. Eng., 34(10), pp. 1509-1518). However, the underlying structural basis for this unique quasi-elastic mechanical behavior is presently unknown. As collagen is the major structural component of the MVAL, we investigated the relation between collagen fibril kinematics (rotation and stretch) and tissue-level mechanical properties in the MVAL under biaxial loading using small angle X-ray scattering. A novel device was developed and utilized to perform simultaneous measurements of tissue level forces and strain under a planar biaxial loading state. Collagen fibril D-period strain ({epsilon}{sub D}) and the fibrillar angular distribution were measured under equibiaxial tension, creep, and stress relaxation to a peak tension of 90 N/m. Results indicated that, under equibiaxial tension, collagen fibril straining did not initiate until the end of the nonlinear region of the tissue-level stress-strain curve. At higher tissue tension levels, {epsilon}{sub D} increased linearly with increasing tension. Changes in the angular distribution of the collagen fibrils mainly occurred in the tissue toe region. Using {epsilon}{sub D}, the tangent modulus of collagen fibrils was estimated to be 95.5{+-}25.5 MPa, which was {approx}27 times higher than the tissue tensile tangent modulus of 3.58{+-}1.83 MPa. In creep tests performed at 90 N/m equibiaxial tension for 60 min, both tissue strain and D remained constant with no observable changes over the test length. In contrast, in stress relaxation tests performed for 90 min {epsilon}{sub D} was found to rapidly decrease in the first 10 min followed by a slower decay rate for the remainder of the test. Using a single exponential model, the time constant for the reduction in collagen

  16. Hypothermic machine perfusion of the liver and the critical balance between perfusion pressures and endothelial injury.

    PubMed

    't Hart, N A; van der Plaats, A; Leuvenink, H G D; van Goor, H; Wiersema-Buist, J; Verkerke, G J; Rakhorst, G; Ploeg, R J

    2005-01-01

    Hypothermic machine perfusion (HMP) provides better protection against cold ischemic injury than cold storage in marginal donor kidneys. Also, in liver transplantation a switch from static cold storage to HMP could be beneficial as it would allow longer preservation times and the use of marginal donors. A critical question concerning application of HMP in liver preservation is the crucial balance between perfusion pressure and occurrence of endothelial injury. Rat livers were cold-perfused for 24 hours to study perfusion pressures for both hepatic artery and portal vein. Cold storage served as control and was compared to HMP-preserved livers using a mean arterial perfusion pressure of 25 mm Hg and a portal perfusion pressure of 4 mm Hg (25% of normothermic liver circulation) and to HMP at 50 mm Hg and 8 mm Hg perfusion, respectively (50% of normothermic liver circulation). UW solution was enriched with 14.9 micromol/L propidium iodide (PI) to stain for dead cells and with an additional 13.5 micromol/L acridine orange to stain for viable hepatocytes. A low PI-positive cell count was found using HMP at 25% of normal circulation compared to cold storage. The PI count was high for the HMP group perfused at just 50% of normal circulation compared to HMP at 25% and compared to cold storage. In summary, for liver HMP, perfusion at 25% showed complete perfusion with minimal cellular injury. HMP using perfusion pressures of 25 mm Hg for the hepatic artery and 4 mm Hg for the portal vein is feasible without induction of endothelial injury. PMID:15808634

  17. [Pulmonary ventilation/perfusion ratio].

    PubMed

    Guenard, H

    1987-01-01

    The ratios of ventilatory (V) and perfusion (Q) flow rates in the lung are to a large extent responsible for the efficiency of gas exchange. In a simplified monocompartmental model of the lung, the arterial partial pressure of a given gas (Pa) is a function of several factors: the solubility of this gas in blood, its venous and inspired partial pressures and the V/Q ratio. In a multicompartemental model, the mean arterial partial pressure of the gas is a function of the individual values of Pa in each compartment as well as the distribution of V/Q ratios in the lung and the relationship between the concentration and the partial pressure of the gas. The heterogeneity of the distribution of V/Q results from those of both V and Q. Two factors are mainly responsible for this heterogeneity: the gravity and the morphometric characteristics of bronchi and vessels. V/Q ratios are partially controlled at least in low V/Q compartments since hypoxia in these compartments leads to pulmonary arteriolar vasoconstriction. However lungs V/Q ratios range from 0.1 to 10 with a mode around 1. Age, muscular exercise, posture, accelerations, anesthesia, O2 breathing, pulmonary pathology are factors which may alter the distribution of V/Q ratios. PMID:3332289

  18. Spatial optimization in perfusion bioreactors improves bone tissue-engineered construct quality attributes.

    PubMed

    Papantoniou, Ioannis; Guyot, Yann; Sonnaert, Maarten; Kerckhofs, Greet; Luyten, Frank P; Geris, Liesbet; Schrooten, Jan

    2014-12-01

    Perfusion bioreactors have shown great promise for tissue engineering applications providing a homogeneous and consistent distribution of nutrients and flow-induced shear stresses throughout tissue-engineered constructs. However, non-uniform fluid-flow profiles found in the perfusion chamber entrance region have been shown to affect tissue-engineered construct quality characteristics during culture. In this study a whole perfusion and construct, three dimensional (3D) computational fluid dynamics approach was used in order to optimize a critical design parameter such as the location of the regular pore scaffolds within the perfusion bioreactor chamber. Computational studies were coupled to bioreactor experiments for a case-study flow rate. Two cases were compared in the first instance seeded scaffolds were positioned immediately after the perfusion chamber inlet while a second group was positioned at the computationally determined optimum distance were a steady state flow profile had been reached. Experimental data showed that scaffold location affected significantly cell content and neo-tissue distribution, as determined and quantified by contrast enhanced nanoCT, within the constructs both at 14 and 21 days of culture. However, gene expression level of osteopontin and osteocalcin was not affected by the scaffold location. This study demonstrates that the bioreactor chamber environment, incorporating a scaffold and its location within it, affects the flow patterns within the pores throughout the scaffold requiring therefore dedicated optimization that can lead to bone tissue engineered constructs with improved quality attributes. PMID:24902541

  19. Metabolic profiling during ex vivo machine perfusion of the human liver.

    PubMed

    Bruinsma, Bote G; Sridharan, Gautham V; Weeder, Pepijn D; Avruch, James H; Saeidi, Nima; Özer, Sinan; Geerts, Sharon; Porte, Robert J; Heger, Michal; van Gulik, Thomas M; Martins, Paulo N; Markmann, James F; Yeh, Heidi; Uygun, Korkut

    2016-01-01

    As donor organ shortages persist, functional machine perfusion is under investigation to improve preservation of the donor liver. The transplantation of donation after circulatory death (DCD) livers is limited by poor outcomes, but its application may be expanded by ex vivo repair and assessment of the organ before transplantation. Here we employed subnormothermic (21 °C) machine perfusion of discarded human livers combined with metabolomics to gain insight into metabolic recovery during machine perfusion. Improvements in energetic cofactors and redox shifts were observed, as well as reversal of ischemia-induced alterations in selected pathways, including lactate metabolism and increased TCA cycle intermediates. We next evaluated whether DCD livers with steatotic and severe ischemic injury could be discriminated from 'transplantable' DCD livers. Metabolomic profiling was able to cluster livers with similar metabolic patterns based on the degree of injury. Moreover, perfusion parameters combined with differences in metabolic factors suggest variable mechanisms that result in poor energy recovery in injured livers. We conclude that machine perfusion combined with metabolomics has significant potential as a clinical instrument for the assessment of preserved livers. PMID:26935866

  20. Non-negative constraint for image-based breathing gating in ultrasound hepatic perfusion data

    NASA Astrophysics Data System (ADS)

    Wu, Kaizhi; Ding, Mingyue; Chen, Xi; Deng, Wenjie; Zhang, Zhijun

    2015-12-01

    Images acquired during free breathing using contrast enhanced ultrasound hepatic perfusion imaging exhibits a periodic motion pattern. It needs to be compensated for if a further accurate quantification of the hepatic perfusion analysis is to be executed. To reduce the impact of respiratory motion, image-based breathing gating algorithm was used to compensate the respiratory motion in contrast enhanced ultrasound. The algorithm contains three steps of which respiratory kinetics extracted, image subsequences determined and image subsequences registered. The basic performance of the algorithm was to extract the respiratory kinetics of the ultrasound hepatic perfusion image sequences accurately. In this paper, we treated the kinetics extracted model as a non-negative matrix factorization (NMF) problem. We extracted the respiratory kinetics of the ultrasound hepatic perfusion image sequences by non-negative matrix factorization (NMF). The technique involves using the NMF objective function to accurately extract respiratory kinetics. It was tested on simulative phantom and used to analyze 6 liver CEUS hepatic perfusion image sequences. The experimental results show the effectiveness of our proposed method in quantitative and qualitative.

  1. Metabolic profiling during ex vivo machine perfusion of the human liver

    PubMed Central

    Bruinsma, Bote G.; Sridharan, Gautham V.; Weeder, Pepijn D.; Avruch, James H.; Saeidi, Nima; Özer, Sinan; Geerts, Sharon; Porte, Robert J.; Heger, Michal; van Gulik, Thomas M.; Martins, Paulo N.; Markmann, James F.; Yeh, Heidi; Uygun, Korkut

    2016-01-01

    As donor organ shortages persist, functional machine perfusion is under investigation to improve preservation of the donor liver. The transplantation of donation after circulatory death (DCD) livers is limited by poor outcomes, but its application may be expanded by ex vivo repair and assessment of the organ before transplantation. Here we employed subnormothermic (21 °C) machine perfusion of discarded human livers combined with metabolomics to gain insight into metabolic recovery during machine perfusion. Improvements in energetic cofactors and redox shifts were observed, as well as reversal of ischemia-induced alterations in selected pathways, including lactate metabolism and increased TCA cycle intermediates. We next evaluated whether DCD livers with steatotic and severe ischemic injury could be discriminated from ‘transplantable’ DCD livers. Metabolomic profiling was able to cluster livers with similar metabolic patterns based on the degree of injury. Moreover, perfusion parameters combined with differences in metabolic factors suggest variable mechanisms that result in poor energy recovery in injured livers. We conclude that machine perfusion combined with metabolomics has significant potential as a clinical instrument for the assessment of preserved livers. PMID:26935866

  2. Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography

    PubMed Central

    Wen, Joanne C.; Zhang, Qinqin; Xin, Chen; Gupta, Divakar; Mudumbai, Raghu C.; Johnstone, Murray A.; Wang, Ruikang K.; Chen, Philip P.

    2016-01-01

    Purpose To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. Design Cross-sectional, observational study. Subjects Twenty-eight normal, 30 POAG, and 31 NTG subjects. Methods One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. Main Outcome Measures Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. Results Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. Conclusions Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for

  3. Effects of Steroid Hormones on Sex Differences in Cerebral Perfusion

    PubMed Central

    Ghisleni, Carmen; Bollmann, Steffen; Biason-Lauber, Anna; Poil, Simon-Shlomo; Brandeis, Daniel; Martin, Ernst; Michels, Lars; Hersberger, Martin; Suckling, John

    2015-01-01

    Sex differences in the brain appear to play an important role in the prevalence and progression of various neuropsychiatric disorders, but to date little is known about the cerebral mechanisms underlying these differences. One widely reported finding is that women demonstrate higher cerebral perfusion than men, but the underlying cause of this difference in perfusion is not known. This study investigated the putative role of steroid hormones such as oestradiol, testosterone, and dehydroepiandrosterone sulphate (DHEAS) as underlying factors influencing cerebral perfusion. We acquired arterial spin labelling perfusion images of 36 healthy adult subjects (16 men, 20 women). Analyses on average whole brain perfusion levels included a multiple regression analysis to test for the relative impact of each hormone on the global perfusion. Additionally, voxel-based analyses were performed to investigate the sex difference in regional perfusion as well as the correlations between local perfusion and serum oestradiol, testosterone, and DHEAS concentrations. Our results replicated the known sex difference in perfusion, with women showing significantly higher global and regional perfusion. For the global perfusion, DHEAS was the only significant predictor amongst the steroid hormones, showing a strong negative correlation with cerebral perfusion. The voxel-based analyses revealed modest sex-dependent correlations between local perfusion and testosterone, in addition to a strong modulatory effect of DHEAS in cortical, subcortical, and cerebellar regions. We conclude that DHEAS in particular may play an important role as an underlying factor driving the difference in cerebral perfusion between men and women. PMID:26356576

  4. GPU-accelerated voxelwise hepatic perfusion quantification.

    PubMed

    Wang, H; Cao, Y

    2012-09-01

    Voxelwise quantification of hepatic perfusion parameters from dynamic contrast enhanced (DCE) imaging greatly contributes to assessment of liver function in response to radiation therapy. However, the efficiency of the estimation of hepatic perfusion parameters voxel-by-voxel in the whole liver using a dual-input single-compartment model requires substantial improvement for routine clinical applications. In this paper, we utilize the parallel computation power of a graphics processing unit (GPU) to accelerate the computation, while maintaining the same accuracy as the conventional method. Using compute unified device architecture-GPU, the hepatic perfusion computations over multiple voxels are run across the GPU blocks concurrently but independently. At each voxel, nonlinear least-squares fitting the time series of the liver DCE data to the compartmental model is distributed to multiple threads in a block, and the computations of different time points are performed simultaneously and synchronically. An efficient fast Fourier transform in a block is also developed for the convolution computation in the model. The GPU computations of the voxel-by-voxel hepatic perfusion images are compared with ones by the CPU using the simulated DCE data and the experimental DCE MR images from patients. The computation speed is improved by 30 times using a NVIDIA Tesla C2050 GPU compared to a 2.67 GHz Intel Xeon CPU processor. To obtain liver perfusion maps with 626 400 voxels in a patient's liver, it takes 0.9 min with the GPU-accelerated voxelwise computation, compared to 110 min with the CPU, while both methods result in perfusion parameters differences less than 10(-6). The method will be useful for generating liver perfusion images in clinical settings. PMID:22892645

  5. FATTY ACID CHAIN-ELONGATION IN PERFUSED RAT HEART: SYNTHESIS OF STEAROYLCARNITINE FROM PERFUSED PALMITATE

    PubMed Central

    Kerner, Janos; Minkler, Paul E.; Lesnefsky, Edward J.; Hoppel, Charles L.

    2009-01-01

    Rat hearts perfused for up to 60 min in the working mode with palmitate, but not with glucose, resulted in substantial formation of palmitoylcarnitine and stearoylcarnitine. To test whether lipolysis of endogenous lipids was responsible for the increased stearoylcarnitine content or whether some of the perfused palmitate underwent chain elongation, hearts were perfused with hexadecanoic-16,16,16-d3 acid (M+3). The pentafluorophenacyl ester of deuterium labeled stearoylcarnitine had an M+3 (639.4 m/z) compared to the unlabeled M+0 (636.3 m/z) consistent with a direct chain elongation of the perfused palmitate. Furthermore, the near equal isotope enrichment of palmitoyl- (90.2 ± 5.8 %) and stearoylcarnitine (78.0 ± 7.1 %) suggest that both palmitoyl- and stearoyl-CoA have ready access to mitochondrial carnitine palmitoyltransferase and that most of the stearoylcarnitine is derived from the perfused palmitate. PMID:17761175

  6. Jejunal Perfusion of Simple and Conjugated Folates in Tropical Sprue

    PubMed Central

    Corcino, José J.; Reisenauer, Ann M.; Halsted, Charles H.

    1976-01-01

    Absorption of labeled simple 3′,5′,9′-3H pteroylmonoglutamate, ([3H]PG-1) and conjugated pteroyl-μ[14C]glutamyl-γ-hexaglutamate, ([14C]PG-7) folates was assessed in six patients with tropical sprue, before and after 6 mo of treatment, utilizing jejunal perfusion and urinary recovery techniques. Degradation products of [14C]PG-7 which were produced during perfusion were identified by DEAE-cellulose column chromatography. Jejunal mucosal activities of folate conjugase, lactase, sucrase, and maltase were measured in every patient. Malabsorption of both [3H]PG-1 and [14C]PG-7 was found in every untreated patient, with significant improvement after therapy. The urinary excretion of 3H and 14C paralleled the luminal disappearance of both isotopes. The chromatographic patterns of intraluminal degradation products of [14C]PG-7 obtained during perfusion did not differ from those previously found in normal subjects and were similar in studies performed before and after treatment. The activity of folate conjugase was increased in the mucosa of the untreated patients when compared to the post-treatment levels while the activities of mucosal lactase, sucrase, and maltase were originally low and increased significantly after therapy. These observations suggest that folate conjugase originates at a different mucosal locus than the brush border disaccharidases, and are consistent with previous evidence that folate conjugase is an intracellular enzyme. The present studies have demonstrated unequivocal malabsorption of both simple and conjugated folates in tropical sprue. In tropical sprue, folate malabsorption is the reflection of impaired folate transport and not of impaired hydrolysis. PMID:16695965

  7. Optical Coherence Tomography Angiography of Optic Disc Perfusion in Glaucoma

    PubMed Central

    Jia, Yali; Wei, Eric; Wang, Xiaogang; Zhang, Xinbo; Morrison, John C.; Parikh, Mansi; Lombardi, Lori H.; Gattey, Devin M.; Armour, Rebecca L.; Edmunds, Beth; Kraus, Martin F.; Fujimoto, James G.; Huang, David

    2014-01-01

    Purpose To compare optic disc perfusion between normal and glaucoma subjects using optical coherence tomography (OCT) angiography and detect optic disc perfusion changes in glaucoma. Design Observational, cross-sectional study. Participants Twenty-four normal subjects and 11 glaucoma patients were included. Methods One eye of each subject was scanned by a high-speed 1050 nm wavelength swept-source OCT instrument. The split-spectrum amplitude-decorrelation angiography algorithm (SSADA) was used to compute three-dimensional optic disc angiography. A disc flow index was computed from four registered scans. Confocal scanning laser ophthalmoscopy (cSLO) was used to measure disc rim area, and stereo photography was used to evaluate cup/disc ratios. Wide field OCT scans over the discs were used to measure retinal nerve fiber layer (NFL) thickness. Main Outcome Measurements Variability was assessed by coefficient of variation (CV). Diagnostic accuracy was assessed by sensitivity and specificity. Comparisons between glaucoma and normal groups were analyzed by Wilcoxon rank-sum test. Correlations between disc flow index, structural assessments, and visual field (VF) parameters were assessed by linear regression. Results In normal discs, a dense microvascular network was visible on OCT angiography. This network was visibly attenuated in glaucoma subjects. The intra-visit repeatability, inter-visit reproducibility, and normal population variability of the optic disc flow index were 1.2%, 4.2%, and 5.0% CV respectively. The disc flow index was reduced by 25% in the glaucoma group (p = 0.003). Sensitivity and specificity were both 100% using an optimized cutoff. The flow index was highly correlated with VF pattern standard deviation (R2 = 0.752, p = 0.001). These correlations were significant even after accounting for age, cup/disc area ratio, NFL, and rim area. Conclusions OCT angiography, generated by the new SSADA algorithm, repeatably measures optic disc perfusion. OCT

  8. Pulmonary perfusion during anesthesia and mechanical ventilation.

    PubMed

    Hedenstierna, G

    2005-06-01

    Cardiac output and the pulmonary perfusion can be affected by anesthesia and by mechanical ventilation. The changes contribute to impeded oxygenation of the blood. The major determinant of perfusion distribution in the lung is the relation between alveolar and pulmonary capillary pressures. Perfusion increases down the lung, due to hydrostatic forces. Since atelectasis is located in dependent lung regions, perfusion of non-ventilated lung parenchyma is common, producing shunt of around 8-10% of cardiac output. In addition, non-gravitational inhomogeneity of perfusion, that can be greater than the gravitational inhomogeneity, adds to impeded oxygenation of blood. Essentially all anaesthetics exert some, although mild, cardiodepressant action with one exception, ketamine. Ketamine may also increase pulmonary artery pressure, whereas other agents have little effect on pulmonary vascular tone. Mechanical ventilation impedes venous return and pushes blood flow downwards to dependent lung regions, and the effect may be striking with higher levels of PEEP. During one-lung anesthesia, there is shunt blood flow both in the non-ventilated and the ventilated lung, and shunt can be much larger in the ventilated lung than thought of. Recruitment manoeuvres shall be directed to the ventilated lung and other physical and pharmacological measures can be taken to manipulate blood flow in one lung anesthesia. PMID:15886595

  9. Perfusion harmonic imaging of the human brain

    NASA Astrophysics Data System (ADS)

    Metzler, Volker H.; Seidel, Guenter; Wiesmann, Martin; Meyer, Karsten; Aach, Til

    2003-05-01

    The fast visualisation of cerebral microcirculation supports diagnosis of acute cerebrovascular diseases. However, the commonly used CT/MRI-based methods are time consuming and, moreover, costly. Therefore we propose an alternative approach to brain perfusion imaging by means of ultrasonography. In spite of the low signal/noise-ratio of transcranial ultrasound and the high impedance of the skull, flow images of cerebral blood flow can be derived by capturing the kinetics of appropriate contrast agents by harmonic ultrasound image sequences. In this paper we propose three different methods for human brain perfusion imaging, each of which yielding flow images indicating the status of the patient's cerebral microcirculation by visualising local flow parameters. Bolus harmonic imaging (BHI) displays the flow kinetics of bolus injections, while replenishment (RHI) and diminution harmonic imaging (DHI) compute flow characteristics from contrast agent continuous infusions. RHI measures the contrast agents kinetics in the influx phase and DHI displays the diminution kinetics of the contrast agent acquired from the decay phase. In clinical studies, BHI- and RHI-parameter images were found to represent comprehensive and reproducible distributions of physiological cerebral blood flow. For DHI it is shown, that bubble destruction and hence perfusion phenomena principally can be displayed. Generally, perfusion harmonic imaging enables reliable and fast bedside imaging of human brain perfusion. Due to its cost efficiency it complements cerebrovascular diagnostics by established CT/MRI-based methods.

  10. Non-photic manipulations induce expression of Fos protein in the suprachiasmatic nucleus and intergeniculate leaflet in the rat.

    PubMed

    Edelstein, K; Amir, S

    1995-09-01

    Expression of Fos protein in the suprachiasmatic nucleus (SCN) and intergeniculate leaflet (IGL) is considered a cellular correlate of light-induced phase-shift of circadian rhythms in rodents. Non-photic stimuli also induce phase shifts, but their effects on Fos expression have not been established. We examined induction of Fos protein in SCN and IGL regions, in response to cage change, intraperitoneal saline injection, and restraint stress. Fos immunoreactivity was observed in SCN and IGL regions, with greater expression observed in IGL during the light phase of the light-dark cycle. Results suggest that cells in SCN and IGL respond to several types of non-photic manipulations and that expression of Fos in these regions is not light-specific. PMID:8535846