Sample records for maintain cardiac output

  1. Predictors of low cardiac output syndrome after coronary artery bypass

    Microsoft Academic Search

    Vivek Rao; Joan Ivanov; Richard D. Weisel; John S. Ikonomidis; George T. Christakis; Tirone E. David

    1996-01-01

    The purpose of this study was to identify patients at risk for the development of low cardiac output syndrome after coronary artery bypass. Low cardiac output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm

  2. Mathematics and the Heart: Understanding Cardiac Output

    ERIC Educational Resources Information Center

    Champanerkar, Jyoti

    2013-01-01

    This paper illustrates a biological application of the concepts of relative change and area under a curve, from mathematics. We study two biological measures "relative change in cardiac output" and "cardiac output", which are predictors of heart blockages and other related ailments. Cardiac output refers to the quantity of…

  3. Cardiac output monitoring in horses.

    PubMed

    Shih, Andre

    2013-04-01

    Cardiac output (CO) is the volume of blood pumped out by the heart in 1 minute. Monitoring of CO can guide therapy and improve clinical outcome in critically ill patients and during anesthesia. Although there is increasing research into clinically useful methods of monitoring CO in equine patients, there are limitations to the available methods. There are 4 basic methods of measuring CO: (1) indicator methods, (2) a derivation of the Fick principle, (3) arterial pulse wave analysis, and (4) imaging diagnostic techniques. This article discusses the importance of CO, available technology, and challenges of monitoring CO in equine medicine. PMID:23498050

  4. Cardiac output measurement in children: comparison of the Ultrasound Cardiac Output Monitor with thermodilution cardiac output measurement

    Microsoft Academic Search

    Walter Knirsch; Oliver Kretschmar; Maren Tomaske; Kathrina Stutz; Nicole Nagdyman; Christian Balmer; Achim Schmitz; Dominique Béttex; Felix Berger; Urs Bauersfeld; Markus Weiss

    2008-01-01

    Objective  To compare the assessment of cardiac output (CO) in children using the noninvasive Ultrasound Cardiac Output Monitor (USCOM)\\u000a with the invasive pulmonary artery catheter (PAC) thermodilution cardiac output measurement.\\u000a \\u000a \\u000a \\u000a Design and setting  Prospective observational study in a tertiary center for pediatric cardiology of a university children's hospital.\\u000a \\u000a \\u000a \\u000a Patients  Twenty-four pediatric patients with congenital heart disease without shunt undergoing cardiac catheterization under general\\u000a anesthesia.\\u000a \\u000a \\u000a \\u000a Measurements

  5. Cardiac output monitoring devices: an analytic review.

    PubMed

    Porhomayon, Jahan; El-Solh, Ali; Papadakos, Peter; Nader, Nader Djalal

    2012-04-01

    To evaluate cardiac output (CO), both invasive and semi-invasive monitors are used in critical care medicine. The pulmonary artery catheter is an invasive tool to assess CO with the major criticism that the level of its invasiveness is not supported by an improvement in patients' outcomes. The interest in a lesser invasive techniques is high. Therefore, alternative techniques have been developed recently, and are used frequently in critical care medicine. Cardiac output can be monitored continuously by different devices that analyze the stroke volume and CO. The purpose of this review is to understand these new technologies and their applications and limitations. PMID:22147648

  6. Cardiac output monitoring by pressure recording analytical method in cardiac surgery

    Microsoft Academic Search

    Pierpaolo Giomarelli; Bonizella Biagioli; Sabino Scolletta

    2004-01-01

    Objective: A less-invasive method has been developed that may provide an alternative to monitor cardiac output from arterial pressure: beat-to-beat values of cardiac output can be obtained by pressure recording analytical method (PRAM). The purpose of this study was to assess the reliability of cardiac output determination by PRAM in cardiac surgery. Methods: Cardiac output was measured in 28 patients

  7. Cardiac output monitoring by pressure recording analytical method in cardiac surgery

    Microsoft Academic Search

    Pierpaolo Giomarelli; Bonizella Biagioli; Sabino Scolletta; Viale Bracci

    2010-01-01

    Objective: A less-invasive method has been developed that may provide an alternative to monitor cardiac output from arterial pressure: beat-to-beat values of cardiac output can be obtained by pressure recording analytical method (PRAM). The purpose of this study was to assess the reliability of cardiac output determination by PRAM in cardiac surgery. Methods: Cardiac output was measured in 28 patients

  8. Clinical validation of the non-invasive cardiac output monitor USCOM-1A in critically ill patients

    Microsoft Academic Search

    L. E. M. van Lelyveld-Haas; A. R. H. van Zanten; G. F. Borm; D. H. T. Tjan

    2008-01-01

    BACKGROUND AND OBJECTIVE: Cardiac output is frequently monitored to maintain and improve cardiac function with the primary goal of adequate tissue perfusion. The pulmonary artery catheter is considered to be the gold standard although several non-invasive devices are being introduced and gaining attention. To evaluate the accuracy of the ultrasonic cardiac output monitor (USCOM)-1A (Pty Ltd, Coffs Harbour, NSW, Australia),

  9. Cardiac output monitoring: basic science and clinical application: Cardiac output monitoring

    Microsoft Academic Search

    S. Jhanji; J. Dawson; R. M. Pearse

    2008-01-01

    Summary Derangements in the circulation are a common feature of sepsis, trauma, major surgery and other critical illnesses. Detailed evaluation of the circulation is therefore an essential aspect of the clinical management of such patients. The use of cardiac output monitoring technology is an increasingly important aspect of evaluating patients in the operating theatre, critical care unit and elsewhere. There

  10. Newer methods of cardiac output monitoring.

    PubMed

    Mehta, Yatin; Arora, Dheeraj

    2014-09-26

    Cardiac output (CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter (PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use. PMID:25276302

  11. Impedance cardiography for monitoring changes in cardiac output.

    PubMed

    Parashar, Rachna; Bajpai, Manish; Goyal, Manish; Singh, Shraddha; Tiwari, Sunita; Narayan, V S

    2012-01-01

    Impedance Cardiography (ICG) is a non invasive method useful for continuous monitoring of cardiac output but, it still has not found wide usage for measuring cardiac output in clinics and research. Most studies focused on comparing the cardiac output measured at rest with reference methods. In the present study we evaluated the validity of ICG against Doppler Echocardiography (DE) in measuring cardiac output changes that occur during static exercise. Cardiac output of 30 healthy males between 18-26 yrs of age was measured during supine rest, during and 5 min after completion of 3 minute static exercise by ICG and DE. The increase in cardiac output during exercise measured with ICG and DE does not differ significantly (1.04 +/- 0.72 L/min and 1.05 +/- 1.24 L/min respectively) and has significantly high correlation (r = 0.76, P < 0.001). The bias and limits of agreement are (-0.01 +/- 0.83) in acceptable limits. The pooled means of cardiac output measured by ICG and DE do not differ significantly and bears a significant correlation (r = 0.812, P < 0.001). The bias (d +/- s) calculated is 0.15 +/- 0.64 L/min. ICG could provide valid information regarding the relative changes in cardiac output. PMID:23387239

  12. [Development of cardiac output monitoring system based on thermodilution method].

    PubMed

    Ye, Jilun; Jiang, Yun; Luo, Sai; Wang, Fan; Zhang, Xu

    2014-09-01

    Cardiac output (CO) monitoring is a crucial part of the hemodynamic status monitoring. So far, thermodilution method, which is clinically recognized as the gold standard method to monitor cardiac output, still has irreplaceable advantages. This paper mainly introduces the use of platform for cardiac output measurement based on thermodilution method, mainly including three parts: the hardware platform, software design and algorithm process. A large amount of test data of this system has been got by CO simulator testing in the laboratory and preliminary clinical tests in the hospital. The testing result showed that using the proposed system can achieve good accuracy and repeatability. PMID:25597080

  13. The cardiac output from blood pressure algorithms trial

    E-print Network

    Sun, James X.

    Objective: The value of different algorithms that estimate cardiac output (CO) by analysis of a peripheral arterial blood pressure (ABP) waveform has not been definitively identified. In this investigation, we developed a ...

  14. The Effect of Signal Quality on Six Cardiac Output Estimators

    E-print Network

    Mark, Roger Greenwood

    The effect of signal quality on the accuracy of cardiac output (CO) estimation from arterial blood pressure (ABP) was evaluated using data from the MIMIC II database. Thermodilution CO (TCO) was the gold standard. A total ...

  15. Bioimpedance and bioreactance methods for monitoring cardiac output.

    PubMed

    Jakovljevic, Djordje G; Trenell, Michael I; MacGowan, Guy A

    2014-12-01

    Noninvasive continuous cardiac output monitoring may have wide clinical applications in anaesthesiology, emergency care and cardiology. It can improve outcomes, establish diagnosis, guide therapy and help risk stratification. The present article describes the theory behind the two noninvasive continuous monitoring methods for cardiac output assessment such as bioimpedance and bioreactance. The review discusses the advantages and disadvantages of these methods and highlights the recent method comparison studies. The use of bioimpedance and bioreactance to estimate cardiac output under haemodynamic challenges is also discussed. In particular, the article focuses on performance of the two methods in the assessment of fluid responsiveness using passive leg raising test and cardiac output response to exercise stress testing. PMID:25480768

  16. Continuous cardiac output monitoring by peripheral blood pressure waveform analysis

    Microsoft Academic Search

    R. Mukkamala; A. T. Reisner; H. M. Hojman; Roger G. Mark; Richard J. Cohen

    2003-01-01

    We introduce a novel technique for continuously monitoring changes in cardiac output (CO) by mathematical analysis of a single peripheral arterial blood pressure (ABP) waveform. In contrast to all previous techniques, our technique analyzes ABP variations over time scales greater than a cardiac cycle in which wave reflections are attenuated. To validate the technique, we performed six swine experiments in

  17. Testing the safety of baxter continuous cardiac output monitoring system

    Microsoft Academic Search

    Peter R. Lichtenthal; Donovan Gordan

    1996-01-01

    The safety of a new continuous cardiac output monitoring system, recently introduced by Baxter Healthcare Corporation's Edwards\\u000a Critical-Care Division, was evaluated in normal sheep. The study compared the biocompatibility and safety of the Vigilance®\\u000a CCO Monitoring System, which employs a continuous cardiac output (CCO) catheter with Baxter Edwards' standard Paceport™ pulmonary\\u000a artery catheter.\\u000a \\u000a The CCO catheter, which monitors hemodynamic pressures

  18. Feasibility of cardiac output estimation by ultrasonic cardiac output monitoring in the prehospital setting.

    PubMed

    Duchateau, François-Xavier; Gauss, Tobias; Burnod, Alexis; Ricard-Hibon, Agnès; Juvin, Philippe; Mantz, Jean

    2011-12-01

    The possible benefits of ultrasonic cardiac output monitoring (USCOM) in emergency medicine practice could be significant if evaluated in a goal-directed protocol. The aim of this study was to perform a feasibility study in a physician-staffed prehospital emergency medicine system. This study enrolled a convenient sample of 50 patients with circulatory distress. Main criteria were visualization of acceptable curves and obtaining interpretable values. Acceptable curves and interpretable values (main criterion) were obtained for 35 patients (70%). In case of failure, the patient was very often dyspneic (80 vs. 23%, when the technique was successful, P<0.001). Mean duration of USCOM examination was 105 ± 60 s. The acceptable success rate for a new technique we observed and the high easy-to-use score suggests that the use of USCOM is feasible in prehospital emergency medicine. PMID:21572333

  19. Noninvasive cardiac output monitoring (NICOM): a clinical validation

    Microsoft Academic Search

    Pierre Squara; Dominique Denjean; Philippe Estagnasie; Alain Brusset; Jean Claude Dib; Claude Dubois

    2007-01-01

    Objective  To evaluate the clinical utility of a new device for continuous noninvasive cardiac output monitoring (NICOM) based on chest\\u000a bio-reactance compared with cardiac output measured semi-continuously by thermodilution using a pulmonary artery catheter\\u000a (PAC-CCO).\\u000a \\u000a \\u000a \\u000a Design  Prospective, single-center study.\\u000a \\u000a \\u000a \\u000a Setting  Intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients  Consecutive adult patients immediately after cardiac surgery.\\u000a \\u000a \\u000a \\u000a Interventions  Cardiac output measurements obtained from NICOM and thermodilution were simultaneously recorded minute by minute and

  20. [Various methods for monitoring cardiac output in intensive care patients].

    PubMed

    Palsgaard Møller, Thea; Perner, Anders; Bülow, Hans-Henrik

    2012-09-01

    This article presents a mini medical technology evaluation of three less invasive monitoring techniques for monitoring cardiac output, CardioQ, ECOM and PiCCO, with focus on validation, usability and costs in intensive care. In conclusion, when identifying patients with low cardiac output, we suggest starting with simple screening tools (e.g. CardioQ or central venous O2 saturation), and when in doubt, upgrade to better validated, yet more time-consuming techniques (e.g. PiCCO using thermodilution). Also consults should be made to other intensive care units in terms of the practical implementation of the monitors. PMID:22944325

  1. Pulse Contour Analysis for Cardiac Output Monitoring in Cardiac Surgery for Congenital Heart Disease

    Microsoft Academic Search

    Aman Mahajan; Afshin Shabanie; Judi Turner; Michael J. Sopher; Jure Marijic

    2003-01-01

    Conventional methods of cardiac output monitoring usingpulmonaryarterycathetersmaynotbefeasiblein patients with congenital heart disease because of pa- tients' small size or aberrant anatomy. We studied the accuracy of a new device, which uses pulse contour analysis to measure continuous cardiac output, in chil- dren and adults undergoing congenital heart surgery. Sixteenpatients,medianages7yrold,wereincludedin this prospective study. One-hundred-ninety-one data points were obtained in the pre-

  2. Assessment of cardiac output by the Doppler ultrasound technique alone

    Microsoft Academic Search

    N E Haites; F M McLennan; D H Mowat; J M Rawles

    1985-01-01

    The normal range of aortic blood velocity was established in 140 healthy adults, using a non-invasive Doppler ultrasound technique. Integration of the area under the velocity-time curve for each heart beat gave stroke distance, which, when multiplied by heart rate, gave minute distance. Stroke distance and minute distance are an indication of stroke volume and cardiac output respectively and both

  3. Hemodynamics of conscious unrestrained baboons, including cardiac output.

    PubMed

    Maclean, J M; Phippard, A F; Thompson, J F; Gillin, A G; Horvath, J S; Duggin, G G; Tiller, D J

    1990-06-01

    A method is described for comprehensive hemodynamic study of undisturbed baboons (Papio hamadryas) that incorporates cardiac output measurement by thermodilution. Instrumentation includes arterial, aortic, and central venous catheterization by a surgical technique that does not require entry to peritoneal or thoracic cavities. It provides a means for right atrial indicator delivery with aortic temperature recording of thermodilution curves. Accuracy was confirmed by comparison to measurement by Swan-Ganz catheters. Diurnal variations of systemic arterial pressure in long-term study of conscious baboons were shown to result from significant increases in cardiac output by day (P less than 0.001), despite concomitant falls in systemic vascular resistance. The cardiac output values obtained were 0.13 l.min-1.kg-1 at night and 0.16 l.min-1.kg-1 by day. Comparison of these results to previous reports of cardiac output in baboons highlights the inadequacies of methods that require physical restraint or anesthesia. This technique also leaves the baboons intact for subsequent breeding or experimental use after catheter removal without the need for further surgery. PMID:2384419

  4. Continuous cardiac output monitoring by peripheral blood pressure waveform analysis

    Microsoft Academic Search

    Ramakrishna Mukkamala; Andrew T. Reisner; Horacio M. Hojman; Roger G. Mark; Richard J. Cohen

    2006-01-01

    A clinical method for monitoring cardiac output (CO) should be continuous, minimally invasive, and accurate. However, none of the conventional CO measurement methods possess all of these characteristics. On the other hand, peripheral arterial blood pressure (ABP) may be measured reliably and continuously with little or no invasiveness. We have developed a novel technique for continuously monitoring changes in CO

  5. Feasibility of preclinical cardiac output and systemic vascular resistance in HEMS in thoracic pain—the ultrasonic cardiac output monitor

    Microsoft Academic Search

    K. Knobloch; V. Hubrich; P. Rohmann; M. Lupkemann; T. Gerich; C. Krettek; R. Phillips

    2006-01-01

    BackgroundCardiac output (CO) and systemic vascular resistance (SVR) are important hemodynamic parameters in emergency patients and for clinical early goal-directed therapy. This study evaluated the feasibility of CO and SVR determination using preclinical continuous wave Doppler ultrasound in a helicopter emergency medical service (HEMS) on emergency patients presenting with or without thoracic pain as a pilot observational study.

  6. Rapid cardiac-output measurement with ungated spiral phase contrast

    Microsoft Academic Search

    Jong B. Park; Bob S. Hu; Steven M. Conolly; Krishna S. Nayak; Dwight G. Nishimura

    2006-01-01

    An ungated spiral phase-contrast (USPC) method was used to measure cardiac output (CO) rapidly and conveniently. The USPC method, which was originally designed for small periph- eral vessels, was modified to assess CO by measuring flow in the ascending aorta (AA). The modified USPC used a 12-inter- leaf spiral trajectory to acquire full-image data every 283 ms with 2-mm spatial

  7. Measurement of cardiac output from dynamic pulmonary circulation time CT

    SciTech Connect

    Yee, Seonghwan, E-mail: Seonghwan.Yee@Beaumont.edu [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan 48073 (United States)] [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan 48073 (United States); Scalzetti, Ernest M. [Department of Radiology, SUNY Upstate Medical University, Syracuse, New York 13210 (United States)] [Department of Radiology, SUNY Upstate Medical University, Syracuse, New York 13210 (United States)

    2014-06-15

    Purpose: To introduce a method of estimating cardiac output from the dynamic pulmonary circulation time CT that is primarily used to determine the optimal time window of CT pulmonary angiography (CTPA). Methods: Dynamic pulmonary circulation time CT series, acquired for eight patients, were retrospectively analyzed. The dynamic CT series was acquired, prior to the main CTPA, in cine mode (1 frame/s) for a single slice at the level of the main pulmonary artery covering the cross sections of ascending aorta (AA) and descending aorta (DA) during the infusion of iodinated contrast. The time series of contrast changes obtained for DA, which is the downstream of AA, was assumed to be related to the time series for AA by the convolution with a delay function. The delay time constant in the delay function, representing the average time interval between the cross sections of AA and DA, was determined by least square error fitting between the convoluted AA time series and the DA time series. The cardiac output was then calculated by dividing the volume of the aortic arch between the cross sections of AA and DA (estimated from the single slice CT image) by the average time interval, and multiplying the result by a correction factor. Results: The mean cardiac output value for the six patients was 5.11 (l/min) (with a standard deviation of 1.57 l/min), which is in good agreement with the literature value; the data for the other two patients were too noisy for processing. Conclusions: The dynamic single-slice pulmonary circulation time CT series also can be used to estimate cardiac output.

  8. Response Time of the Opti-Q Continuous Cardiac Output Pulmonary Artery Catheter in the Urgent Mode to a Step Change in Cardiac Output

    Microsoft Academic Search

    Lawrence J. Goldstein

    1999-01-01

    Objectives.This study was conducted to determine the response timeof the Opti-Q continuous cardiac output (CCO) device to a step change incardiac. Design.Prospective study. Setting.University hospitalanimal lab. Model.Female sheep. Interventions.In ten animals,cardiac output was altered suddenly by opening and closing a peripheralarteriovenous shunt to test the response time of the CCO system.Measurements and main results.Cardiac output was measured continuouslyby thermodilution and

  9. Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit

    Microsoft Academic Search

    H. L. Tan; M. Pinder; R. Parsons; B. Roberts; P. V. van Heerden

    2005-01-01

    Methods. We conducted a prospective study in the 18-bed intensive care unit of a 600-bed tertiary referral hospital. Twenty-four mechanically ventilated patients were studied immediately following cardiac surgery. We evaluated the USCOM monitor by comparing its output with paired measurements obtained by the standard thermodilution technique using a pulmonary artery catheter. Results. Forty paired measurements were obtained in 22 patients.

  10. Significant role of estrogen in maintaining cardiac mitochondrial functions.

    PubMed

    Rattanasopa, Chutima; Phungphong, Sukanya; Wattanapermpool, Jonggonnee; Bupha-Intr, Tepmanas

    2015-03-01

    Increased susceptibility to stress-induced myocardial damage is a significant concern in addition to decreased cardiac performance in postmenopausal females. To determine the potential mechanisms underlying myocardial vulnerability after deprivation of female sex hormones, cardiac mitochondrial function is determined in 10-week ovariectomized rats (OVX). Significant mitochondrial swelling in the heart of OVX rats is observed. This structural alteration can be prevented with either estrogen or progesterone supplementation. Using an isolated mitochondrial preparation, a decrease in ATP synthesis by complex I activation in an OVX rat is completely restored by estrogen, but not progesterone. At basal activation, reactive oxygen species (ROS) production from the mitochondria is not affected by the ovariectomy. However, after incubated in the presence of either high Ca(2+) or antimycin-A, there is a significantly higher mitochondrial ROS production in the OVX sample compared to the control. This increased stress-induced ROS production is not observed in the preparation isolated from the hearts of OVX rats with estrogen or progesterone supplementation. However, deprivation of female sex hormones has no effect on the protein expression of electron transport chain complexes, mitofusin 2, or superoxide dismutase 2. Taken together, these findings suggest that female sex hormones, estrogen and progesterone, play significant regulatory roles in maintaining normal mitochondrial properties by stabilizing the structural assembly of mitochondria as well as attenuating mitochondrial ROS production. Estrogen, but not progesterone, also plays an important role in modulating mitochondrial ATP synthesis. PMID:25448746

  11. [New aspects of minimally invasive cardiac output monitoring].

    PubMed

    Hofer, Christoph K; Schmid, Ursina; Zollinger, Andreas

    2012-02-01

    The variety of minimally invasive cardiac output (CO) monitoring devices is growing rendering it difficult to keep track of new developments. In this article technical principles, limitations and validation procedures considering new aspects are reviewed. An integrated approach for their use is proposed since no single device can comply with all clinical needs. CO should be interpreted in combination with clinical information and other hemodynamic parameters. It's evident that not the monitor per se, but only the protocol / therapy based on the hemodynamic data can improve patients outcome. PMID:22402849

  12. Cardiac output monitoring by echocardiography: should we pass on Swan-Ganz catheters?

    PubMed Central

    Perrino, A. C.

    1993-01-01

    Transesophageal echocardiography offers a noninvasive technique for the continuous monitoring of cardiac performance. The combination of 2-dimensional echocardiography and Doppler velocitometry provide assessment of cardiac anatomy, valve function and, ventricular loading conditions. Although transesophageal echocardiography has become accepted for perioperative monitoring, it is typically used in conjunction with Swan-Ganz catheterization. To supplant Swan-Ganz catheters, an echocardiographic technique to monitor cardiac output is necessary. Despite considerable effort to achieve this goal, a satisfactory technique has been difficult to realize. This paper discusses the role of cardiac output monitoring in perioperative care and critically examines echocardiographic techniques for cardiac output monitoring. Images Figure 4 Figure 7 Figure 10 PMID:7825341

  13. Partial CO2 Rebreathing Indirect Fick Technique for Non-Invasive Measurement of Cardiac Output

    Microsoft Academic Search

    Dinesh G. Haryadi; Joseph A. Orr; Kai Kuck; Scott McJames; Dwayne R. Westenskow

    2000-01-01

    Objective.Evaluation in animals of a non-invasive and continuous cardiac output monitoring system based on partial carbon-dioxide (CO2) rebreathing indirect Fick technique. Methods.We have developed a non-invasive cardiac output (NICO) monitoring system, based on the partial rebreathing method. The partial\\u000a rebreathing technique employs a differential form of the Fick equation for calculating cardiac output (QT) using non-invasive measurements. Changes in CO2

  14. Maximal Cardiac Output Determines 6 Minutes Walking Distance in Pulmonary Hypertension

    PubMed Central

    Deboeck, Gaël; Taboada, Dolores; Hagan, Guy; Treacy, Carmen; Page, Kathy; Sheares, Karen; Naeije, Robert; Pepke-Zaba, Joanna

    2014-01-01

    Purpose The 6 minutes walk test (6MWT) is often shown to be the best predictor of mortality in pulmonary hypertension (PH) probably because it challenges the failing heart to deliver adequate cardiac output. We hypothesised that the 6MWT elicits maximal cardiac output as measured during a maximal cardiopulmonary exercise testing (CPET). Methods 18 patients with chronic thromboembolic pulmonary hypertension (n?=?12) or pulmonary arterial hypertension (n?=?6) and 10 healthy subjects performed a 6MWT and CPET with measurements of cardiac output (non invasive rebreathing device) before and directly after exercise. Heart rate was measured during 6MWT with a cardiofrequence meter. Results Cardiac output and heart rate measured at the end of the 6MWT were linearly related to 6MW distance (mean±SD: 490±87 m). Patients with a high NT-pro-BNP achieve a maximum cardiac output during the 6MWT, while in normal subjects and in patients with a low-normal NT-proBNP, cardiac output at the end of a 6MWT was lower than achieved at maximum exercise during a CPET. In both cases, heart rate is the major determinant of exercise-induced increase in cardiac output. However, stroke volume increased during CPET in healthy subjects, not in PH patients. Conclusion Maximal cardiac output is elicited by 6MWT in PH patients with failing right ventricle. Cardiac output increase is dependent on chronotropic response in patients with PH. PMID:24647561

  15. Arterial pressure waveform derived cardiac output FloTrac/Vigileo system (third generation software): comparison of two monitoring sites with the thermodilution cardiac output.

    PubMed

    Vasdev, Sumit; Chauhan, Sandeep; Choudhury, Minati; Hote, Millind P; Malik, Madhur; Kiran, Usha

    2012-04-01

    The present study was conducted to study the effect of monitoring site, radial or femoral, for arterial pressure waveform derived cardiac output using FloTrac/Vigileo system with third generation software version 3.02 during cardiac surgery. The cardiac output derived from the two sites was also compared to the pulmonary artery catheter (PAC) derived cardiac output to reevaluate the relation between them using the newer software. The effect of cardiopulmonary bypass (CPB) was also studied by doing the sub analysis before and after bypass. Forty patients undergoing coronary artery bypass surgery with cardiopulmonary bypass were enrolled in the study. Cardiac output derived from radial artery (RADCO), femoral artery (FEMCO) using FloTrac/Vigileo system with third generation software version 3.02 and cardiac output using pulmonary artery catheter (PACCO) at predefined nine time points were recorded. Three hundred and forty two cardiac output data triplets were analysed. The Bland-Altman analysis of RADCO and FEMCO revealed a mean bias of -0.28 with percentage error of 20%. The pre CPB precision of both RADCO and FEMCO was 1.25 times as that of PACCO. The post CPB precision of FEMCO was 1.2 times of PACCO while that of RADCO was 1.7 times of PACCO. The third generation of FloTrac/Vigileo system shows good correlation between the radial and femoral derived cardiac outputs in both pre and post bypass periods. The newer software correlates better to PAC derived cardiac output in the post bypass period for femoral artery than radial artery. PMID:22350311

  16. Continuous cardiac output monitoring by peripheral blood pressure waveform analysis.

    PubMed

    Mukkamala, Ramakrishna; Reisner, Andrew T; Hojman, Horacio M; Mark, Roger G; Cohen, Richard J

    2006-03-01

    A clinical method for monitoring cardiac output (CO) should be continuous, minimally invasive, and accurate. However, none of the conventional CO measurement methods possess all of these characteristics. On the other hand, peripheral arterial blood pressure (ABP) may be measured reliably and continuously with little or no invasiveness. We have developed a novel technique for continuously monitoring changes in CO by mathematical analysis of a peripheral ABP waveform. In contrast to the previous techniques, our technique analyzes the ABP waveform over time scales greater than a cardiac cycle in which the confounding effects of complex wave reflections are attenuated. The technique specifically analyzes 6-min intervals of ABP to estimate the pure exponential pressure decay that would eventually result if pulsatile activity abruptly ceased (i.e., after the high frequency wave reflections vanish). The technique then determines the time constant of this exponential decay, which equals the product of the total peripheral resistance and the nearly constant arterial compliance, and computes proportional CO via Ohm's law. To validate the technique, we performed six acute swine experiments in which peripheral ABP waveforms and aortic flow probe CO were simultaneously measured over a wide physiologic range. We report an overall CO error of 14.6%. PMID:16532772

  17. Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.

    PubMed Central

    Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

    1998-01-01

    OBJECTIVE: To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement. BACKGROUND DATA: Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output. METHODS: Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay. RESULTS: Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels. CONCLUSION: Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage. PMID:9445118

  18. Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients.

    PubMed

    Rödig, G; Prasser, C; Keyl, C; Liebold, A; Hobbhahn, J

    1999-04-01

    We have analysed the clinical agreement between two methods of continuous cardiac output measurement pulse contour analysis (PCCO) and a continuous thermodilution technique (CCO), were both compared with the intermittent bolus thermodilution technique (BCO). Measurements were performed in 26 cardiac surgical patients (groups 1 and 2, 13 patients each, with an ejection fraction > 45% and < 45%, respectively) at 12 selected times. During operation, mean differences (bias) between PCCO-BCO and CCO-BCO did not differ in either group. However, phenylephrine-induced increases in systemic vascular resistance (SVR) by approximately 60% resulted in significant differences. Significantly higher absolute bias values of PCCO-BCO compared with CCO-BCO were also found early after operation in the ICU. Thus PCCO and CCO provided comparable measurements during coronary bypass surgery. After marked changes in SVR, further calibration of the PCCO device is necessary. PMID:10472216

  19. [Estimating cardiac output. Utility in the clinical practice. Available invasive and non-invasive monitoring].

    PubMed

    García, X; Mateu, L; Maynar, J; Mercadal, J; Ochagavía, A; Ferrandiz, A

    2011-12-01

    This aim of this review is to provide a detailed review of the physiologic conditions and variables of the cardiac output, as well as review the different techniques available for its measurement. We also want to establish the clinical situations in which the measurement of cardiac output can add valuable information for the management of critically ill patients. The Fick technique, used in the beginning to calculate cardiac output, has been replaced today by thermodilution techniques (transcardiac or transpulmonary), lithium dilution, bioreactance, Doppler technique or echocardiography. Pulse wave analysis allows a continuous minimally invasive cardiac output measurement. Other methods, such bioreactance, Doppler technique or echocardiography currently provide a valid, fast and non-invasive measurement of cardiac output. PMID:21411188

  20. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine.

    PubMed

    Saugel, B; Cecconi, M; Wagner, J Y; Reuter, D A

    2015-04-01

    The determination of blood flow, i.e. cardiac output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing cardiac output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for cardiac output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing cardiac output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for 'clinically acceptable agreement' between innovative noninvasive cardiac output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous cardiac output determination with regard to signal recording, signal processing, and clinical applicability. PMID:25596280

  1. Measurement of cardiac output by use of noninvasively measured transient hemodilution curves with photoacoustic technology

    PubMed Central

    Kang, Dongyel; Huang, Qiaojian; Li, Youzhi

    2014-01-01

    We present the theoretical basis and experimental verification for cardiac output measurements using noninvasively measured hemodilution curves afforded with an indicator dilution technique and the emerging photoacoustic technology. A photoacoustic system noninvasively tracks a transient hemodilution effect induced by a bolus of isotonic saline as an indicator. As a result, a photoacoustic indicator dilution curve is obtained, which allows to estimate cardiac output from the developed algorithm. The experiments with a porcine blood circulatory phantom system demonstrated the feasibility of this technology towards the development of a noninvasive cardiac output measurement system for patient monitoring. PMID:24877007

  2. Lithium dilution cardiac output measurement in the critically ill patient: determination of precision of the technique

    Microsoft Academic Search

    M. Cecconi; D. Dawson; R. M. Grounds; A. Rhodes

    2009-01-01

    Background  Lithium dilution cardiac output by LiDCO™plus (LiDCO, Cambridge, UK) is a validated methodology for measuring cardiac output. It is used to calibrate a pulse pressure\\u000a analysis algorithm (PulseCO) for the continuous measurement of subsequent changes in this variable. The variability of measurements,\\u000a or precision, within patients of lithium dilution cardiac output has not previously been described.\\u000a \\u000a \\u000a \\u000a Material and methods  Thirty-five hemodynamically

  3. Optimising the Windkessel model for cardiac output monitoring during changes in vascular tone.

    PubMed

    Charlton, Peter; Smith, John; Camporota, Luigi; Beale, Richard; Alastruey, Jordi

    2014-01-01

    Algorithms for estimating cardiac output (CO) from the arterial blood pressure wave have been observed to be inaccurate during changes in vascular tone. Many such algorithms are based on the Windkessel model of the circulation. We investigated the optimal analytical approaches and assumptions that make up each algorithm during changes in vascular tone. Several analytical approaches and assumptions were evaluated on data from 15 critically ill patients by comparison with thermodilution measurements. We found that the most accurate algorithms assumed a constant compliance for the duration of the beat. They produced a percentage error of ±31% by maintaining the compliance and outflow terms in the Windkessel model. For any algorithm, the following assumptions gave highest accuracy: (i) outflow pressure into the microcirculation is zero; (ii) end of systole is identified using the second derivative of pressure. None of the tested algorithms reached the clinically acceptable accuracy of ±30%. PMID:25570809

  4. Cardiac output measurement using a modified carbon dioxide Fick method: comparison analysis with pulmonary artery catheter method and pulse induced contour cardiac output method

    PubMed Central

    Li, Tong; Cai, Hongliu; Pan, Hui; Pu, Qibin

    2015-01-01

    Objectives: In the present study, cardiac output in mechanically ventilated patients were determined using three methods including modified CO2-Fick (mCO2F), pulmonary artery catheter (PAC), and pulse induced contour cardiac output (PiCCO) methods and the results were compared to assess the effectiveness of mCO2F method in measuring the cardiac output. Method: Mechanically ventilated and hemodynamically unstable patients (n=39) were sedated and intubated with Swan-Ganz or PiCCO arterial catheters. At the beginning of the experiment and at 4 h after the experiment, the CO2 concentration in expiratory air was measured through a CO2 monitor and it was used further in the cardiac output calculation using mCO2F method. The cardiac output was also determined using PAC and PiCCO methods. Results: The cardiac output determined by PAC and mCO2F method was not significantly (P>0.05) different [5.53±2.85 L.min-1 (PAC) and 5.96±2.92 L.min-1 (mCO2F)] at the beginning of the experiment and [6.22±2.7 L.min-1 (PAC) and 6.36±2.35 L.min-1 (mCO2F)] at 4 h after the experiment; however, they were highly correlated (r=0.939 and 0.908, P<0.001). The cardiac output determined by PiCCO and mCO2F method was also not significantly (P>0.05) different [6.05±2.49 L.min-1 (PiCCO) and 5.44±1.64 L.min-1 (mCO2F)] at the beginning of the experiment, and [6.17±2.04 L.min-1 (PiCCO) and 5.70±1.72 L.min-1 (mCO2F)] at 4 h after the experiment; however, they were highly correlated (r=0.776 and 0.832, P<0.001). Conclusion: The mCO2F method could accurately measure the cardiac output in mechanically ventilated patients without using any expensive equipment’s and invasive procedures.

  5. Cardiac output and stroke volume estimation using a hybrid of three models

    E-print Network

    Arai, Tatsuya

    Cardiac output (CO) and stroke volume (SV) are the key hemodynamic parameters to be monitored and assessed in ambulatory and critically ill patients. The purpose of this study was to introduce and validate a new algorithm ...

  6. Continuous determination of cardiac output during exercise by the use of impedance plethysmography

    Microsoft Academic Search

    Y. Miyamoto; M. Takahashi; T. Tamura; T. Nakamura; T. Hiura; M. Mikami

    1981-01-01

    A computer-based system has been developed that enables the continuous measurement of cardiac output at rest as well as during\\u000a exercise. The respiratory and motion artefacts appearing in the first derivative of the transthoracic impedance change (dZ\\/dt)\\u000a were eliminated by adopting an ensemble averaging technique. A sufficiently high correlation was observed between cardiac\\u000a outputs determined by the impedance and CO2

  7. Non-invasive ultrasonic cardiac output monitoring in exercise testing

    Microsoft Academic Search

    Karsten Knobloch; Volker Hoeltke; Ernst Jakob; Peter M. Vogt; Rob Phillips

    2008-01-01

    BackgroundThe purpose of this study was to evaluate the relationship of breath-by-breath oxygen uptake (VO2) and CO, cardiac index (CI), stroke volume (SV) and heart rate (HR) determined by a non-invasive continuous wave (CW) Doppler-based system (USCOM) in healthy adolescent and adult athletes during exercise treadmill testing.

  8. Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation

    Microsoft Academic Search

    Giorgio Della Rocca; Maria Gabriella Costa; Cecilia Coccia; Livia Pompei; Pierangelo Di Marco; Vincenzo Vilardi; Paolo Pietropaoli

    2003-01-01

    Purpose  The PiCCO System is a relatively new device allowing intermittent cardiac output monitoring by aortic transpulmonary thermodilution\\u000a technique (Aorta intermittent) and continuous cardiac output monitoring by pulse contour analysis (Aorta continuous). The\\u000a objective of this study was to assess the level of agreement of Aorta intermittent and Aorta continuous with intermittent\\u000a (PA intermittent) and continuous cardiac output (PA continuous) measured

  9. Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring

    Microsoft Academic Search

    Sophie Marqué; Alain Cariou; Jean-Daniel Chiche; Pierre Squara

    2009-01-01

    ABSTRACT: INTRODUCTION: This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method. METHODS: Consecutive patients, requiring PAC-CCO monitoring following cardiac surgery, were also monitored by the two other devices. CO values obtained simultaneously by the

  10. Thoracic electrical bioimpedance: a non-invasive measure of cardiac output for porcine research.

    PubMed

    Broomhead, C J; Wright, S J; Kiff, K M; Withington, P S

    1998-07-01

    A comparison of two techniques for measuring cardiac output, thermodilution (TD) and thoracic electrical bioimpedance (TEB), was undertaken in a porcine model. Eight anaesthetized large white pigs were studied. A total of 436 paired measurements were performed over a range of cardiac outputs from 1.7 to 15.1 l/min as measured by thermodilution. The Pearson product moment correlation coefficient was r = 0.963 with P < 0.001. Analysis by Bland and Altman statistics revealed a mean difference (bias) of -0.02 l/min and the limits of agreement were +/- 1.6 l/min, similar to figures found in human comparative studies. These results confirm that thoracic electrical bioimpedance is a valid method of measuring cardiac output in pigs. It has significant advantages compared to thermodilution, in particular it is cheap, simple to use, non-invasive and provides continuous data. PMID:9718481

  11. Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery

    PubMed Central

    Lee, Sak; Lee, Seung Hyun; Chang, Byung-Chul

    2015-01-01

    Purpose We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery. Materials and Methods Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index ?2 L/min/m2: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints. Results Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2±4.8 days vs. 10.8±4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652±519 mL vs. 11430±463 mL, p=0.004). Conclusion NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization. PMID:26069111

  12. Doppler Ultrasound Determination of the Distribution of Human Cardiac Output: Effects of Age and Physical Stresses

    Microsoft Academic Search

    E. R. Greene; R. C. Roach

    2004-01-01

    Due to its high spatial, temporal, and dynamic resolution, noninvasive Doppler ultrasound can be used to determine the distribution of phasic cardiac output in humans. The effects of ageing and various common physical stresses on combined human major central and regional blood flows have not been reported. We tested the hypothesis that there are no significant age-related differences in steady-state

  13. Serial changes in cardiac output during normal pregnancy: a Doppler ultrasound study

    Microsoft Academic Search

    Terence G. Hennessy; Dermot MacDonald; Marie S. Hennessy; Margaret Maguire; Sean Blake; Hugh A. McCann; Declan D. Sugrue

    1996-01-01

    Objectives: To determine the direction and magnitude of change in cardiac output (CO) during pregnancy. Study design: We performed serial measurements of CO on five occasions from 24 weeks gestation to term and once during the puerperium in 26 normal pregnancies (156 measurements) using Doppler ultrasound measurement of flow velocity profiles and aortic root cross sectional area. Result: CO increased

  14. Real-time cardiac output estimation of the circulatory system under left ventricular assistance

    Microsoft Academic Search

    Makoto Yoshizawa; Hiroshi Takeda; Makoto Miura; Tomoyuki Yambe; Yoshiaki Katahira; Shin-ichi Nitta

    1993-01-01

    A method for indirect and real-time estimation of the cardiac output of the circulatory system supported by the left ventricular assist device (LVAD) is proposed. This method has low invasiveness and is useful for clinical applications of the LVAD since it needs only two measurements: the rate of blood outflow from the LVAD and the aortic pressure. The method is

  15. Changes in cardiac output during swimming and aquatic hypoxia in the air-breathing Pacific tarpon

    E-print Network

    Farrell, Anthony P.

    aorta to monitor Vb and with a fibre-optic oxygen sensor in the ABO to monitor air-breathing frequencyChanges in cardiac output during swimming and aquatic hypoxia in the air-breathing Pacific tarpon T online 1 August 2007 Abstract Pacific tarpon (Megalops cyprinoides) use a modified gas bladder as an air-breathing

  16. Exercise cardiac output following Skylab missions - The second manned Skylab mission

    NASA Technical Reports Server (NTRS)

    Buderer, M. C.; Mauldin, D. G.; Rummel, J. A.; Michel, E. L.; Sawin, C. F.

    1976-01-01

    Cardiac output was measured during preflight and postflight exercise-stress tests on the Skylab astronauts. In the postflight tests immediately following the 28-, 59-, and 84-d earth orbital missions, the astronauts exhibited an approximate 30% decrease in cardiac output coupled with an approximate 50% decrease in cardiac stroke volume during exercise. These changes were accompanied by elevated heart rates and significant increases in total systemic peripheral vascular resistance. Mean arterial pressure was unchanged. All parameters returned to normal preflight values within 30 d of the end of the orbital period. Duration of the zero-G exposure did not appear to influence either the magnitude of the hemodynamic changes or the time-course of their return to normal. These results are discussed in relation to other cardiovascular findings and possible mechanisms responsible for the observations are outlined.

  17. THE EFFECT OF EXERCISE ON THE CARDIAC OUTPUT AND BLOOD FLOW DISTRIBUTION OF THE LARGESCALE SUCKER CATOSTOMUS MACROCHEILUS

    Microsoft Academic Search

    ALAN S. KOLOK; R. MICHAEL SPOONER; ANTHONY P. FARRELL

    Summary Cardiac output (Q. ) and blood flow distribution were measured in adult largescale suckers at rest and while swimming. Cardiac output was directly measured using an ultrasonic flowprobe in f ish during the summer (16?C), fall (10?C) and winter (5?C). Largescale suckers were adept at holding station against a current without swimming and, when engaged in this behavior, they

  18. Pulse Wave Transit Time Measurements of Cardiac Output in Septic Shock Patients: A Comparison of the Estimated Continuous Cardiac Output System with Transthoracic Echocardiography

    PubMed Central

    Feissel, Marc; Aho, Ludwig Serge; Georgiev, Stefan; Tapponnier, Romain; Badie, Julio; Bruyère, Rémi; Quenot, Jean-Pierre

    2015-01-01

    Background We determined reliability of cardiac output (CO) measured by pulse wave transit time cardiac output system (esCCO system; COesCCO) vs transthoracic echocardiography (COTTE) in mechanically ventilated patients in the early phase of septic shock. A secondary objective was to assess ability of esCCO to detect change in CO after fluid infusion. Methods Mechanically ventilated patients admitted to the ICU, aged >18 years, in sinus rhythm, in the early phase of septic shock were prospectively included. We performed fluid infusion of 500ml of crystalloid solution over 20 minutes and recorded CO by EsCCO and TTE immediately before (T0) and 5 minutes after (T1) fluid administration. Patients were divided into 2 groups (responders and non-responders) according to a threshold of 15% increase in COTTE in response to volume expansion. Results In total, 25 patients were included, average 64±15 years, 15 (60%) were men. Average SAPSII and SOFA scores were 55±21.3 and 13±2, respectively. ICU mortality was 36%. Mean cardiac output at T0 was 5.8±1.35 L/min by esCCO and 5.27±1.17 L/min by COTTE. At T1, respective values were 6.63 ± 1.57 L/min for esCCO and 6.10±1.29 L/min for COTTE. Overall, 12 patients were classified as responders, 13 as non-responders by the reference method. A threshold of 11% increase in COesCCO was found to discriminate responders from non-responders with a sensitivity of 83% (95% CI, 0.52-0.98) and a specificity of 77% (95% CI, 0.46-0.95). Conclusion We show strong correlation esCCO and echocardiography for measuring CO, and change in CO after fluid infusion in ICU patients. PMID:26126112

  19. Embryonic and adult-derived resident cardiac macrophages are maintained through distinct mechanisms at steady state and during inflammation

    PubMed Central

    Epelman, Slava; Lavine, Kory J.; Beaudin, Anna E.; Sojka, Dorothy K.; Carrero, Javier A.; Calderon, Boris; Brija, Thaddeus; Gautier, Emmanuel L.; Ivanov, Stoyan; Satpathy, Ansuman T.; Schilling, Joel D.; Schwendener, Reto; Sergin, Ismail; Razani, Babak; Forsberg, E. Camilla; Yokoyama, Wayne; Unanue, Emil R.; Colonna, Marco; Randolph, Gwendalyn J.; Mann, Douglas L.

    2014-01-01

    Summary Cardiac macrophages are crucial for tissue repair after cardiac injury but have not been well characterized. Here we identify four populations of cardiac macrophages. At steady state, resident macrophages were primarily maintained through local proliferation. However, after macrophage depletion or during cardiac inflammation, Ly6chi monocytes contributed to all four macrophage populations, whereas resident macrophages also expanded numerically through proliferation. Genetic fate mapping revealed that yolk-sac and fetal monocyte progenitors gave rise to the majority of cardiac macrophages, and the heart was among a minority of organs in which substantial numbers of yolk-sac macrophages persisted in adulthood. CCR2 expression and dependence distinguished cardiac macrophages of adult monocyte versus embryonic origin. Transcriptional and functional data revealed that monocyte-derived macrophages coordinate cardiac inflammation, while playing redundant but lesser roles in antigen sampling and efferocytosis. These data highlight the presence of multiple cardiac macrophage subsets, with different functions, origins and strategies to regulate compartment. PMID:24439267

  20. Continuous minimally invasive peri-operative monitoring of cardiac output by pulmonary capnotracking: comparison with thermodilution and transesophageal echocardiography.

    PubMed

    Peyton, Philip J

    2012-04-01

    A number of technologies are available for minimally-invasive cardiac output measurement in patients during surgery but remain little used. A system has been developed based on CO(2) elimination (VCO(2)) by the lungs for use in ventilated patients, which can be fully integrated into a modern anesthesia/monitoring platform, and provides semi-automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO(2) and end-tidal CO(2) concentration with each breath. A baseline measurement of non-shunt cardiac output was made during a brief change in ventilator rate, according to the differential CO(2) Fick approach. Continuous breath-by-breath monitoring of cardiac output was then performed from measurement of VCO(2), using a derivation of the Fick equation applied to pulmonary CO(2) elimination. Automated recalibration was done periodically and data was processed and cardiac output displayed in real time. Measurements were compared with simultaneous measurements by bolus thermodilution in 77 patients undergoing cardiac surgery or liver transplantation. Overall mean bias [sd] for agreement in cardiac output measurement was -0.1 [1.2] L/min, percentage error +44.2%, r = 0.92. Concordance in measurement of changes of at least 15% in cardiac output was 80%. The method followed sudden changes in cardiac output due to arrythmias and run onto cardiopulmonary bypass in real time. The accuracy and precision were comparable to other clinical techniques. The method is relatively seamless and largely automated and has potential for continuous, cardiac output monitoring in ventilated patients during anesthesia and critical care. PMID:22350312

  1. Beat-by-beat analysis of cardiac output and blood pressure responses to short-term barostimulation in different body positions

    NASA Astrophysics Data System (ADS)

    Hildebrandt, Wulf; Schütze, Harald; Stegemann, J.

    Rapid quantification of the human baro-reflex control of heart rate has been achieved on a beat-by-beat basis using a neck-chamber with quick ECG-triggered pressure changes. Referring to recent findings on heart rate and stroke volume, the present study uses this technique to compare cardiac output as well as blood pressure changes in supine and upright position to investigate feedback effects and to confirm postural reflex modifications not revealed by RR-interval changes. A suction profile starting at +40 mmHg and running 7 steps of pressure decrease down to -65 mmHg was examined in 0° and 90° tilting position while beat-by-beat recordings were done of heart rate, stroke volume (impedance-cardiography) and blood pressure (Finapres tm) (n=16). The percentual heart rate decrease failed to be significantly different between positions. A suction-induced stroke volume increase led to a cardiac output almost maintained when supine and significantly increased when upright. A decrease in all blood pressure values was found during suction, except for systolic values in upright position which increased. Conclusively, (a) it is confirmed that different inotropy accounts for the seen gravitational effect on the cardiac output not represented by heart rate; (b) identical suction levels in different positions lead to different stimuli at the carotid receptor. This interference has to be considered in microgravity studies by beat-by-beat measurement of cardiac output and blood pressure.

  2. Dynamic asymmetries of cardiac output transients in response to muscular exercise in man.

    PubMed Central

    Yoshida, T; Whipp, B J

    1994-01-01

    1. We determined the kinetics of cardiac output (Q) with respect to oxygen uptake (VO2) at the on- and off-transients of constant-load exercise. Six subjects performed constant-load exercise which consisted of 5 min rest, 5 min one-legged pedalling at 50 W and a 5 min recovery period. 2. The transient responses were characterized by first-order kinetics. There was no significant difference between the time constants for VO2 (tau VO2) at the on- (33.9 +/- 3.5 s, mean +/- S.E.M.) and off-transient (37.2 +/- 2.9 s). The time constant for Q (tau Q, 29.4 +/- 3.2 s) was consistently shorter than tau VO2 at the on-transient. However, tau Q was appreciably longer at the off-transient (44.3 +/- 3.6 s) than the on-transient. 3. The results support the contention that the time constant for the on-transient of Q is appreciably faster than that for VO2 and hence there seems little justification for the notion that the time constants for the kinetics of VO2 are determined by the limitations of blood flow in the transient. The asymmetry of Q kinetics, with the off-transient tau Q being appreciably slower than the on-transient tau Q, serves to maintain a sufficiently high oxygen flow to the muscle during recovery from exercise at a time when the muscle oxygen uptake remains high. PMID:7869250

  3. Peripartum cardiomyopathy: postpartum decompensation and use of non-invasive cardiac output monitoring.

    PubMed

    Lorello, G; Cubillos, J; McDonald, M; Balki, M

    2014-02-01

    The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction <20%. Cardiac status was monitored using NICOM™ during labor and delivery. The baseline values were: cardiac output 5.3 L/min, total peripheral resistance 1549 dynes.sec/cm(5), stroke volume 42.1 mL and stroke volume variation 18%. She received early epidural analgesia during labor, titrated slowly with a loading dose of 0.0625% bupivacaine 10 mL and fentanyl 25 ?g, followed by patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 ?g/mL, infusion at 10 mL/h, bolus dose 5 mL and lockout interval 10 min). After epidural drug administration, total peripheral resistance decreased, cardiac output increased, and satisfactory analgesia was obtained. She had an uneventful vaginal delivery with a forceps-assisted second stage after prophylactic administration of furosemide 20 mg. NICOM™ was discontinued after delivery. Fifteen hours post-delivery, the patient developed cardiogenic shock, which resolved after aggressive therapy with inotropes and furosemide. NICOM™ can be used to guide treatment during labor and delivery in patients with critical peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients. PMID:24360329

  4. Pressure Pulse Contour-derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient

    Microsoft Academic Search

    Donald P. Bernstein

    2008-01-01

    Background  The pressure pulse contour method for measuring stroke volume (SV) and cardiac output (CO) has come of age. Various methods\\u000a have been proposed, but at this time no single technique has shown clear superiority over the others. This commentary and\\u000a review discusses the various methods, and particularly the pressure recording analytical method (PRAM). Dissection of the\\u000a method shows that vascular

  5. Continuous intraoperative noninvasive cardiac output monitoring using a new thoracic bioimpedance device

    Microsoft Academic Search

    Duraiyah Thangathurai; Christopher Charbonnet; Peter Roessler; Charles C. J. Wo; Maged Mikhail; Roland Yoshida; William C. Shoemaker

    1997-01-01

    Objectives: To compare a new noninvasive bioimpedance device with the standard thermodilution method during the intraoperative period in high-risk patients undergoing oncological surgery.Design: Prospectively collected data with retrospective analysis.Setting: The study was undertaken at a university hospital, single institution.Participants: Twenty-three selected adults undergoing extensive, ablative oncological surgery.Interventions: Simultaneous measurements of cardiac output by a new bioimpedance method and the standard

  6. [Application of pulse contour cardiac output monitoring technique in hemodynamic monitoring in critical patients].

    PubMed

    Fang, He; Zheng, Xingfeng; Xia, Zhaofan

    2014-08-01

    Pulse contour cardiac output (PiCCO) monitoring is a new type of invasive hemodynamic monitoring technology, which is more and more often applied in perioperative period and the patients suffering from multiple injuries, septic shock, and extensive burn. With PiCCO one is able to monitor patients' hemodynamic indexes safely, timely, accurately, and continuously to provide reference for judgment of patients' condition and proper quality and quantity of fluid administration. This technique has a good prospect in clinical application. PMID:25429813

  7. Flow velocity profile of the pulmonary artery measured by the continuous cardiac output monitoring catheter

    Microsoft Academic Search

    Keiko Miyasaka; Masao Takata; Katsuyuki Miyasaka MO

    1993-01-01

    The KATS catheter (continuous arterial thermodeprivation system catheter) measures the blood flow velocity of the pulmonary\\u000a artery (PA) by thermodeprivation which enables continuous determination of cardiac output. The accuracy of this system may\\u000a depend on the degree of uniformity of flow velocity in the PA, because small movements of the catheter within the PA are inevitable\\u000a with a beating heart.

  8. [Application of pulse contour cardiac output monitoring technique in hemodynamic monitoring in critical patients].

    PubMed

    Fang, He; Zheng, Xingfeng; Xia, Zhaofan

    2014-08-01

    Pulse contour cardiac output (PiCCO) monitoring is a new type of invasive hemodynamic monitoring technology, which is more and more often applied in perioperative period and the patients suffering from multiple injuries, septic shock, and extensive burn. With PiCCO one is able to monitor patients' hemodynamic indexes safely, timely, accurately, and continuously to provide reference for judgment of patients' condition and proper quality and quantity of fluid administration. This technique has a good prospect in clinical application. PMID:25508030

  9. Cardiac output monitoring during off-pump coronary artery bypass grafting

    Microsoft Academic Search

    Matthew P Grow; Amrik Singh; Neal W Fleming; Nilas Young; Mitchell Watnik

    2004-01-01

    Objective: To evaluate and compare monitors of cardiac output during repositioning and stabilization of the heart for off-pump coronary artery bypass (OPCAB) surgery.Design: Prospective, observational, clinical study.Setting: University teaching hospital.Participants: Consecutive patients scheduled to undergo elective OPCAB (n = 19).Interventions: Monitoring, induction, and anesthesia followed a routine protocol for coronary artery bypass patients. This included the use of transesophageal echocardiography

  10. [Noninvasive measurement of cardiac output by pulsed Doppler echocardiography. Correlation with thermodilution].

    PubMed

    Dericbourg, C; Tribouilloy, C; Kugener, H; Avinee, P; Rey, J L; Lesbre, J P

    1990-02-01

    Cardiac output was measured simultaneously by pulsed Doppler echocardiography and thermodilution in 22 patients, 18 of whom also underwent atrial pacing at different rates to give a total of 42 different measurements. The aortic diameter was measured firstly at the aortic ring at the level of insertion of the aortic cusps and then at the point of maximum separation of the valve cups in the left parasternal long-axis view. The aortic velocities were recorded in the apical 5-chamber view immediately below the level of the aortic valve. The correlations obtained at the aortic ring (R1) and at the point of maximum separation of the valve cusps (R2) were 0.77 (y = 0.67x + 1.17: standard error = 0.81 l/m) and 0.64 (y = 0.56x + 0.87; standard error = 1.01 l/mn) respectively. The correlations were much better when 7 technically unsatisfactory measurements were excluded (R2 = 0.76: y = 0.59x + 0.74: standard error = 0.79 l/mn) (R1 = 0.87: y = 0.72x + 1.04: standard error = 0.65 l/mn). THe correlations of stroke volume measured at aortic ring level also improved from r = 0.82 (y = 0.75x + 7.29: standard error = 8.9 ml) to r = 0.89 (y = 0.78x + 7.38: standard error = 7.3 ml). The measurement of cardiac output by pulsed Doppler echocardiography in the aortic root seems to be reliable. The correlations of the values of stroke volume and cardiac output with the thermodilution method are good, allowing detection of beat-to-beat variations of cardiac output, in suitable patients in the hands of experienced operators. PMID:2106860

  11. Measurement of cardiac output using near-infrared heating of blood

    NASA Astrophysics Data System (ADS)

    Curley, Michael G.; Hamilton, Patrick S.; Walsh, Joseph T., Jr.

    1997-05-01

    Thermodilution-based cardiac output measurements are made using iced saline or blood heated by resistive heating as a dilutable indicator. Because near-infrared irradiation penetrates sufficiently deeply into blood, it can safely deposit up to six times the energy of a resistive heater, improving the accuracy of the measurements while continuously monitoring cardiac output. We have developed a prototype system using 980 nm diode lasers to irradiate blood through a diffuser. This system was tested using an optical blood phantom and was compared to iced-saline injection and resistive heating. Three flow estimates were made at each of 18 combinations of stroke rate, stroke volume, and systole/diastole ratios. Accuracy was determined by the quality of the fit between the estimated flows and the actual flow. Reproducibility was determined by the normalized standard deviation. Results: Measurements made by saline injection were the most accurate (R2 equals 0.982) and reproducible (NSD equals 2.8%). Power limitations on the resistive heating to ensure a safe blood temperature limited its accuracy (R2 equals 0.537) and reproducibility (NSD equals 18.1%). Laser-based heating showed reasonable accuracy and reproducibility (R2 equals 0.950, NSD equals 7.8%). Laser heating thus represents a potentially more accurate alternative to saline injection for cardiac output measurement than does resistive heating.

  12. End-tidal CO2 for prediction of cardiac output following weaning from cardiopulmonary bypass.

    PubMed

    Baraka, Anis S; Aouad, Marie T; Jalbout, Maya I; Kaddoum, Roland N; Khatib, Mohammad F; Haroun-Bizri, Sania T

    2004-09-01

    This prospective study included 32 patients undergoing cardiopulmonary bypass (CPB) for elective coronary artery bypass grafting correlates the respiratory end-tidal CO2 (ETCO2) during partial separation from CPB with cardiac output (CO) following weaning from CPB. After induction of general anesthesia, a pulmonary artery catheter was inserted for measurement of cardiac output by thermodilution. Patients were monitored using a 5-lead ECG, pulse oximeter, invasive blood pressure monitoring, rectal temperature probe, and end-tidal capnography. At the end of surgery, patients were weaned from CPB in a stepwise fashion. Respiratory ETCO2 and in-line venous oximetry were continuously monitored during weaning. The ETCO2 was recorded at quarter pump flow and after complete weaning from CPB. Following weaning from CPB, CO was measured by thermodilution. The CO values were correlated with the ETCO2 during partial bypass and following weaning from bypass. Regression analysis of ETCO2 at quarter-flow and post-bypass CO showed significant correlation (r = 0.57, p < .001). Also, regression analysis of ETCO2 after complete weaning from bypass and post-bypass CO showed significant correlation (r = 0.6, p = .002). The correlation between ETCO2 and CO showed that an ETCO2 >30 mm Hg during partial CPB will always predict an adequate CO following weaning from CPB. An ETCO2 <30 mm Hg may denote either a low or a normal cardiac output and hence other predictive parameters such as SvO2 must be added. PMID:15559744

  13. Validation and application of single breath cardiac output determinations in man

    NASA Technical Reports Server (NTRS)

    Loeppky, J. A.; Fletcher, E. R.; Myhre, L. G.; Luft, U. C.

    1986-01-01

    The results of a procedure for estimating cardiac output by a single-breath technique (Qsb), obtained in healthy males during supine rest and during exercise on a bicycle ergometer, were compared with the results on cardiac output obtained by the direct Fick method (QF). The single breath maneuver consisted of a slow exhalation to near residual volume following an inspiration somewhat deeper than normal. The Qsb calculations incorporated an equation of the CO2 dissociation curve and a 'moving spline' sequential curve-fitting technique to calculate the instantaneous R from points on the original expirogram. The resulting linear regression equation indicated a 24-percent underestimation of QF by the Qsb technique. After applying a correction, the Qsb-QF relationship was improved. A subsequent study during upright rest and exercise to 80 percent of VO2(max) in 6 subjects indicated a close linear relationship between Qsb and VO2 for all 95 values obtained, with slope and intercept close to those in published studies in which invasive cardiac output measurements were used.

  14. Cardiac Output and Performance during a Marathon Race in Middle-Aged Recreational Runners

    PubMed Central

    Billat, Véronique L.; Petot, Hélène; Landrain, Morgan; Meilland, Renaud; Koralsztein, Jean Pierre; Mille-Hamard, Laurence

    2012-01-01

    Purpose. Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV) and cardiac output (CO) to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance) and/or CO, per meter (i.e., cardiac cost). Methods. We measured the SV, heart rate (HR), CO, and running speed of 14 recreational runners in an incremental, maximal laboratory test and then during a real marathon race (mean performance: 3?hr 30?min ± 45?min). Results. Our data revealed that HR, SV and CO were all in a high but submaximal steady state during the marathon (87.0 ± 1.6%, 77.2 ± 2.6%, and 68.7 ± 2.8% of maximal values, respectively). Marathon performance was inversely correlated with an upward drift in the CO/speed ratio (mL of CO × m?1) (r = ?0.65, P < 0.01) and positively correlated with the runner's ability to complete the race at a high percentage of the speed at maximal SV (r = 0.83, P < 0.0002). Conclusion. Our results showed that marathon performance is inversely correlated with cardiac cost and positively correlated with cardiac endurance. The CO response could be a benchmark for race performance in recreational marathon runners. PMID:22645458

  15. Impedance cardiography by use of a spot-electrode array to track changes in cardiac output in anesthetized dogs.

    PubMed

    Kiesler, T W; Voorhees, W D; Wessale, J L; Pham, C K

    1990-06-01

    Transthoracic impedance cardiography is a noninvasive method to determine changes in cardiac output on the basis of the cardiac-induced impedance change measured across the thorax. In this report, we describe a new, easily applied, tetrapolar spot-electrode configuration for use in canine transthoracic impedance cardiography. The array is a convenient alternative to use of the traditional circumferential band-electrode array which, in the dog, is prohibitive because of the extensive skin preparation required. The spot-electrode array was used to compare changes in cardiac output measured by transthoracic impedance cardiography, with changes measured by a reference indicator-dilution technique. A spot-electrode array, composed of 4 standard ECG electrodes, was used to measure transthoracic impedance in 10 anesthetized dogs. Variations in cardiac output were produced by controlled hemorrhage (200- to 250-ml increments). Simultaneous reference measurements of cardiac output were made before hemorrhage (control) and at each level of hemorrhage, using the saline-dilution method. The beat-by-beat impedance changes were measured by use of a Minnesota impedance cardiograph, which also recorded the first derivative of impedance (dZ/dt). An index of cardiac output was defined as the product of the maximal value of the first time derivative of impedance, ejection time, and heart rate for each beat during inscription of a saline-dilution curve. The average of the beat-by-beat indices was calculated and then normalized relative to the initial control value. Linear regression analysis was performed to evaluate the correlation of the index of cardiac output with the reference cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2351600

  16. Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring

    PubMed Central

    Napoli, Anthony M.

    2012-01-01

    Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations. PMID:21860802

  17. A pilot assessment of the FloTrac TM cardiac output monitoring system

    Microsoft Academic Search

    Helen Ingrid Opdam; Li Wan; Rinaldo Bellomo

    2007-01-01

    Objective  To compare measurement of cardiac output (CO) by means of the FloTracTM CO monitor with the pulmonary artery catheter (PAC).\\u000a \\u000a \\u000a \\u000a Design  Prospective observational study.\\u000a \\u000a \\u000a \\u000a Setting  Intensive care unit of a tertiary hospital.\\u000a \\u000a \\u000a \\u000a Patients  Six post-operative cardiac surgery patients with existing arterial cannulas and PACs.\\u000a \\u000a \\u000a \\u000a Interventions  Attachment of the FloTracTM CO monitor and transducer to an existing arterial cannula. Simultaneous measurements of CO, indexed to body

  18. Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring.

    PubMed

    Napoli, Anthony M

    2012-01-01

    Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations. PMID:21860802

  19. Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia

    Microsoft Academic Search

    Garry M. Steil; Olive S. Eckstein; Julie Caplow; Michael S. D. Agus; Brian K. Walsh; Jackson Wong

    2011-01-01

    Objective  To assess the combination of a non-invasive blood oxygen content (CaO2) monitor and a non-invasive cardiac output (CO) monitor to continuously measure oxygen delivery (DO2; DO2 = CaO2 × CO).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  DO2 was assessed during blood transfusions in an infant with acute hemolytic anemia following admission (~48 h). CaO2 was measured by Pulse Co-Oximetry, which also provides estimates of hemoglobin (Hgb) concentration and percent

  20. Continuous cardiac output monitoring after cardiopulmonary bypass: a comparison with bolus thermodilution measurement

    Microsoft Academic Search

    Karim Bendjelid; Nicolas Schütz; Peter M. Suter; Jacques-Andre Romand

    2006-01-01

    Objective  The interchangeability of continuous measurement of \\u000acardiac output (CO) with the traditional bolus method in patients after \\u000acardiopulmonary bypass (CPB) is uncertain.Design  Prospective observational clinical study.Setting  A 20-bed surgical ICU at a university \\u000ahospital.Patients  Fourteen deeply sedated, ventilated, post-cardiac surgery \\u000apatients, all equipped with a pulmonary artery catheter.Interventions  Six hours after the end of the CPB, 56 simultaneous \\u000abolus and continuous measurements were compared by a linear regression

  1. Flow-regulated extracorporeal arteriovenous tubing loop for cardiac output measurements by ultrasound velocity dilution: validation in post-cardiac surgery intensive care unit patients.

    PubMed

    Eremenko, Alexsandr A; Safarov, Perviz N

    2010-01-01

    Assessment of cardiac output (CO) is crucial in the management of the critically ill, especially in post cardiac surgery intensive care unit (ICU) patients. In this study, we validated CO measured by the novel ultrasound dilution (COUD) with those measured by pulmonary artery (PA) thermodilution (COTD) in 26 adult post cardiac surgery patients. For COUD, blood was circulated through an extracorporeal arteriovenous (AV) loop from the radial artery catheter to the introducer of PA catheter for 5-8 minutes. Three to four injections of 25 ml body temperature isotonic saline were performed into the venous limb of the AV loop. For COTD, five injections of 10 ml ice cold saline were performed. A total of 77 COUD and COTD measurement sets were compared. Cardiac output measured by thermodilution ranged from 3.28 to 9.4 L/min, whereas COUD ranged from 2.85 to 10.1 L/min. The correlation between the methods was found to be r = 0.91, COUD = 0.93(COTD) + 0.42 L/min. Bias and precision (mean difference ± 2SDs) was -0.004 ± 1.34 L/min between the two methods. The percentage error (2SD/mean) was 22.2%, which is below the clinically acceptable limit (<30%). Cardiac output measured by ultrasound dilution and thermodilution methods agreed well in post cardiac surgery ICU patients and hence can be interchangeably used. PMID:21245798

  2. NOTE: Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies

    NASA Astrophysics Data System (ADS)

    van Gemert, Martin J. C.; Umur, Asli; van den Wijngaard, Jeroen P. H. M.; Van Bavel, Ed; Vandenbussche, Frank P. H. A.; Nikkels, Peter G. J.

    2005-02-01

    An acardiac twin pregnancy is a rare but serious complication of monochorionic twinning and consists of an acardiac twin and a pump twin. The acardiac twin is a severely malformed fetus that lacks most organs, particularly a heart, but grows during pregnancy because it is perfused by the developmentally normal pump twin via a set of arterioarterial and venovenous placental anastomoses. Pump twins die intrauterine or neonatally in about 50% of the cases. Because the effects of an acardiac mass on the pump twin's development are incompletely known, methods for outcome prognosis are currently not available. We sought to derive simple relations for the pump twin's excess cardiac output and decreased oxygenation and to use available clinical cases for a preliminary test of the model. As a method, we used a theoretical flow model to represent the fetoplacental circulation of an acardiac twin pregnancy and estimated blood deoxygenation and reoxygenation following perfusion of the two bodies and placentas, respectively. The results show the pump twin's excess cardiac output and decrease of venous oxygen saturation to depend on the ratio of pump twin to acardiac twin umbilical blood flow, whose ratio can be measured by ultrasonography. The clinical cases show a decreasing umbilical flow ratio with gestation. In conclusion, prospective serial study is necessary to test whether measurement of umbilical flow ratios allows monitoring the pump twin's pathophysiologic development, possibly resulting in a guideline for prognosis of pump twin survival.

  3. Rapamycin Attenuated Cardiac Hypertrophy Induced by Isoproterenol and Maintained Energy Homeostasis via Inhibiting NF-?B Activation

    PubMed Central

    Chen, Xi; Zeng, Siyu; Zou, Jian; Chen, Yanfang; Yue, Zhongbao; Gao, Ying; Zhang, Luankun; Cao, Weiwei; Liu, Peiqing

    2014-01-01

    Rapamycin, also known as sirolimus, is an immunosuppressant drug used to prevent rejection organ (especially kidney) transplantation. However, little is known about the role of Rapa in cardiac hypertrophy induced by isoproterenol and its underlying mechanism. In this study, Rapa was administrated intraperitoneally for one week after the rat model of cardiac hypertrophy induced by isoproterenol established. Rapa was demonstrated to attenuate isoproterenol-induced cardiac hypertrophy, maintain the structure integrity and functional performance of mitochondria, and upregulate genes related to fatty acid metabolism in hypertrophied hearts. To further study the implication of NF-?B in the protective role of Rapa, cardiomyocytes were pretreated with TNF-? or transfected with siRNA against NF-?B/p65 subunit. It was revealed that the upregulation of extracellular circulating proinflammatory cytokines induced by isoproterenol was able to be reversed by Rapa, which was dependent on NF-?B pathway. Furthermore, the regression of cardiac hypertrophy and maintaining energy homeostasis by Rapa in cardiomyocytes may be attributed to the inactivation of NF-?B. Our results shed new light on mechanisms underlying the protective role of Rapa against cardiac hypertrophy induced by isoproterenol, suggesting that blocking proinflammatory response by Rapa might contribute to the maintenance of energy homeostasis during the progression of cardiac hypertrophy. PMID:25045214

  4. Rapamycin attenuated cardiac hypertrophy induced by isoproterenol and maintained energy homeostasis via inhibiting NF-?B activation.

    PubMed

    Chen, Xi; Zeng, Siyu; Zou, Jian; Chen, Yanfang; Yue, Zhongbao; Gao, Ying; Zhang, Luankun; Cao, Weiwei; Liu, Peiqing

    2014-01-01

    Rapamycin, also known as sirolimus, is an immunosuppressant drug used to prevent rejection organ (especially kidney) transplantation. However, little is known about the role of Rapa in cardiac hypertrophy induced by isoproterenol and its underlying mechanism. In this study, Rapa was administrated intraperitoneally for one week after the rat model of cardiac hypertrophy induced by isoproterenol established. Rapa was demonstrated to attenuate isoproterenol-induced cardiac hypertrophy, maintain the structure integrity and functional performance of mitochondria, and upregulate genes related to fatty acid metabolism in hypertrophied hearts. To further study the implication of NF-?B in the protective role of Rapa, cardiomyocytes were pretreated with TNF-? or transfected with siRNA against NF-?B/p65 subunit. It was revealed that the upregulation of extracellular circulating proinflammatory cytokines induced by isoproterenol was able to be reversed by Rapa, which was dependent on NF-?B pathway. Furthermore, the regression of cardiac hypertrophy and maintaining energy homeostasis by Rapa in cardiomyocytes may be attributed to the inactivation of NF-?B. Our results shed new light on mechanisms underlying the protective role of Rapa against cardiac hypertrophy induced by isoproterenol, suggesting that blocking proinflammatory response by Rapa might contribute to the maintenance of energy homeostasis during the progression of cardiac hypertrophy. PMID:25045214

  5. Pulmonary carbon dioxide elimination for cardiac output monitoring in peri-operative and critical care patients: history and current status.

    PubMed

    Peyton, Philip J

    2013-01-01

    Minimally invasive measurement of cardiac output as a central component of advanced haemodynamic monitoring has been increasingly recognised as a potential means of improving perioperative outcomes in patients undergoing major surgery. Methods based upon pulmonary carbon dioxide elimination are among the oldest techniques in this field, with comparable accuracy and precision to other techniques. Modern adaptations of these techniques suitable for use in the perioperative and critical are environment are based on the differential Fick approach, and include the partial carbon dioxide rebreathing method. The accuracy and precision of this approach to cardiac output measurement has been shown to be similar to other minimally invasive techniques. This paper reviews the underlying principles and evolution of the method, and future directions including recent adaptations designed to deliver continuous breath-by-breath monitoring of cardiac output. PMID:23778012

  6. Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration

    PubMed Central

    Prasser, Christopher; Bele, Sylvia; Keyl, Cornelius; Schweiger, Stefan; Trabold, Benedikt; Amann, Matthias; Welnhofer, Julia; Wiesenack, Christoph

    2007-01-01

    Background Several techniques have been discussed as alternatives to the intermittent bolus thermodilution cardiac output (COPAC) measurement by the pulmonary artery catheter (PAC). However, these techniques usually require a central venous line, an additional catheter, or a special calibration procedure. A new arterial pressure-based cardiac output (COAP) device (FloTrac™, Vigileo™; Edwards Lifesciences, Irvine, CA, USA) only requires access to the radial or femoral artery using a standard arterial catheter and does not need an external calibration. We validated this technique in critically ill patients in the intensive care unit (ICU) using COPAC as the method of reference. Methods We studied 20 critically ill patients, aged 16 to 74 years (mean, 55.5 ± 18.8 years), who required both arterial and pulmonary artery pressure monitoring. COPAC measurements were performed at least every 4 hours and calculated as the average of 3 measurements, while COAP values were taken immediately at the end of bolus determinations. Accuracy of measurements was assessed by calculating the bias and limits of agreement using the method described by Bland and Altman. Results A total of 164 coupled measurements were obtained. Absolute values of COPAC ranged from 2.80 to 10.80 l/min (mean 5.93 ± 1.55 l/min). The bias and limits of agreement between COPAC and COAP for unequal numbers of replicates was 0.02 ± 2.92 l/min. The percentage error between COPAC and COAP was 49.3%. The bias between percentage changes in COPAC (?COPAC) and percentage changes in COAP (?COAP) for consecutive measurements was -0.70% ± 32.28%. COPAC and COAP showed a Pearson correlation coefficient of 0.58 (p < 0.01), while the correlation coefficient between ?COPAC and ?COAP was 0.46 (p < 0.01). Conclusion Although the COAP algorithm shows a minimal bias with COPAC over a wide range of values in an inhomogeneous group of critically ill patients, the scattering of the data remains relative wide. Therefore, the used algorithm (V 1.03) failed to demonstrate an acceptable accuracy in comparison to the clinical standard of cardiac output determination. PMID:17996086

  7. Improved noninvasive method for measurement of cardiac output and evaluation of left-sided cardiac valve incompetence

    SciTech Connect

    Kelbaek, H.

    1989-05-01

    A time-saving method was developed to label red blood cells in vitro with /sup 99m/Tc while avoiding centrifugation. After tin incubation, extracellular tin was oxidized by sodium hypochlorite, and EDTA was added for stabilizing the complex prior to /sup 99m/Tc incubation. Labeling yields were 95%, and in vivo decay showed a high stability with a mean biologic half-life of eleven hours. The first-passage radionuclide technique for determination of cardiac output using the above-mentioned tracer was evaluated by using the left ventricle as area-of-interest with individual background correction after complete mixing of the tracer. This technique showed a high level of agreement with invasive methods. By combining this method for measurement of the forward stroke volume with the multigated equilibrium principle for determination of the total left ventricular stroke volume using similar background corrections, an exact evaluation of regurgitation fractions was obtained. In patients with aortic and mitral valve disease the noninvasive radionuclide technique gave similar but probably more accurate results as compared with contrast aortography and ventriculography. The radionuclide technique may be suitable for monitoring and selecting patients for surgical treatment.

  8. Reference values for total blood volume and cardiac output in humans

    SciTech Connect

    Williams, L.R. [Indiana Univ., South Bend, IN (United States). Division of Liberal Arts and Sciences] [Indiana Univ., South Bend, IN (United States). Division of Liberal Arts and Sciences

    1994-09-01

    Much research has been devoted to measurement of total blood volume (TBV) and cardiac output (CO) in humans but not enough effort has been devoted to collection and reduction of results for the purpose of deriving typical or {open_quotes}reference{close_quotes} values. Identification of normal values for TBV and CO is needed not only for clinical evaluations but also for the development of biokinetic models for ultra-short-lived radionuclides used in nuclear medicine (Leggett and Williams 1989). The purpose of this report is to offer reference values for TBV and CO, along with estimates of the associated uncertainties that arise from intra- and inter-subject variation, errors in measurement techniques, and other sources. Reference values are derived for basal supine CO and TBV in reference adult humans, and differences associated with age, sex, body size, body position, exercise, and other circumstances are discussed.

  9. Noninvasive photoacoustic measurement of the composite indicator dilution curve for cardiac output estimation

    PubMed Central

    Kang, DongYel; Huang, Qiaojian; Li, Youzhi

    2015-01-01

    Recently, the measurement of indicator dilution curves using a photoacoustic (PA) technology was reported, which showed promising results on the noninvasive estimation of cardiac output (CO) that is an important hemodynamic parameter useful in various clinical situations. However, in clinical practice, measuring PA indicator dilution curves from an arterial blood vessel requires an ultrasound transducer array capable of focusing on the targeted artery. This causes several challenges on the clinical translation of the PA indicator dilution method, such as high sensor cost and complexity. In this paper, we theoretically derived that a composite PA indicator dilution curve simultaneously measured from both arterial and venous blood vessels can be used to estimate CO correctly. The ex-vivo and in-vivo experimental results with a flat ultrasound transducer verified the developed theory. We believe this new concept would overcome the main challenges on the clinical translation of the noninvasive PA indicator dilution technology. PMID:25780743

  10. Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring

    PubMed Central

    Marqué, Sophie; Cariou, Alain; Chiche, Jean-Daniel; Squara, Pierre

    2009-01-01

    Introduction This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method. Methods Consecutive patients, requiring PAC-CCO monitoring following cardiac surgery, were also monitored by the two other devices. CO values obtained simultaneously by the three systems were recorded continuously on a minute-by-minute basis. Results Continuous recording was performed on 29 patients, providing 12,099 simultaneous measurements for each device (417 ± 107 per patient). In stable conditions, correlations of NICOM and Vigileo with PAC-CCO were 0.77 and 0.69, respectively. The bias was -0.01 ± 0.84 for NICOM and -0.01 ± 0.81 for Vigileo (NS). NICOM relative error was less than 30% in 94% of the patients and less than 20% in 79% vs. 91% and 79% for the Vigileo, respectively (NS). The variability of measurements around the trend line (precision) was not different between the three methods: 8 ± 3%, 8 ± 4% and 8 ± 3% for PAC-CCO, NICOM and Vigileo, respectively. CO changes were 7.2 minutes faster with Vigileo and 6.9 minutes faster with NICOM (P < 0.05 both systems vs. PAC-CCO, NS). Amplitude of changes was not significantly different than thermodilution. Finally, the sensitivity and specificity for predicting significant CO changes were 0.91 and 0.95 respectively for the NICOM and 0.86 and 0.92 respectively for the Vigileo. Conclusions This study showed that the NICOM and Vigileo devices have similar monitoring capabilities in post-operative cardiac surgery patients. PMID:19454009

  11. Pulse contour cardiac output system use in pediatric orthotopic liver transplantation: preliminary report of nine patients.

    PubMed

    Torgay, A; Pirat, A; Akpek, E; Zeyneloglu, P; Arslan, G; Haberal, M

    2005-09-01

    Anesthetic management of orthotopic liver transplantation (OLT) in pediatric patients is challenging in terms of intraoperative bleeding, fluid management, and hemodynamic monitoring. The pulse contour cardiac output (PiCCO) system, a relatively new device based on the single-indicator transaortic thermodilution technique, may be useful for intraoperative hemodynamic monitoring in pediatric patients. This is a preliminary report of PiCCO use in nine children (aged 9.8 +/- 4.7 years) undergoing OLT. Hemodynamic volumetric parameters monitored by the PiCCO system were mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), and stroke volume variability (SVV). All parameters were recorded at anesthesia induction (T0), at the end of the anhepatic phase (Tanhepatic), and at the end of operation (Tend). The PiCCO system revealed similar MAP, CI, EVLWI, SVV, and SVRI values at all measurement intervals. Despite similar central venous pressure measurements, ITBVI values indicated significantly lower values at Tanhepatic than at T0 (627 +/- 160 mL/m2 and 751 +/- 151 mL/m2, respectively, P = .013). There were no PiCCO catheter-related complications in any patient. These findings demonstrate that the PiCCO system is a safe, continuous, multiparameter invasive monitoring device for use in pediatric patients undergoing OLT. This system may provide valuable data during pediatric OLT and appears to be a promising monitoring tool in these patients. PMID:16213339

  12. Influence of levosimendan, pimobendan, and milrinone on the regional distribution of cardiac output in anaesthetized dogs.

    PubMed Central

    Pagel, P. S.; Hettrick, D. A.; Warltier, D. C.

    1996-01-01

    1. The distribution of cardiac output during administration of levosimendan, a new myofilament calcium sensitizer, is unknown. We examined and compared the effects of levosimendan, pimobendan, and milrinone on regional tissue perfusion by use of the radioactive microsphere technique in barbiturate-anaesthetized dogs. 2. Haemodynamics and regional blood flow were determined before and during infusions of levosimendan (0.75, 1.5, and 3.0 micrograms kg-1 min-1), pimobendan (10, 20, and 40 micrograms kg-1 min-1), or milrinone (1.0, 2.0, and 4.0 micrograms kg-1 min-1). 3. All three drugs caused similar increases in heart rate, cardiac output, and left ventricular +dP/dt and decreases in end-diastolic pressure and systemic vascular resistance. No changes in subendocardial, midmyocardial, and subepicardial blood flow occurred during administration of levosimendan. However, a redistribution of blood flow from subendocardium to subepicardium was observed. Pimobendan increased midmyocardial and subepicardial blood flow and reduced the endo/epi ratio to a greater degree than levosimendan. Milrinone did not affect myocardial perfusion. 4. Levosimendan increased blood flow to the renal medulla and decreased renal medullary and cortical vascular resistance. Levosimendan increased blood flow to the small intestine and liver and reduced vascular resistance in these organs. Pimobendan increased hepatic blood flow to a greater degree than levosimendan but did not alter small intestinal perfusion. All three drugs decreased splenic blood flow to similar degrees. Levosimendan and pimobendan reduced cerebral vascular resistance. Levosimendan and milrinone reduced skeletal muscle vascular resistance. 5. The results indicate that levosimendan, pimobendan, and milrinone cause subtlety different alterations in regional tissue perfusion while producing similar haemodynamic effects. PMID:8894186

  13. The decreased oxygen uptake during progressive exercise in ischemia-induced heart failure is due to reduced cardiac output rate

    Microsoft Academic Search

    N. P. L. Rolim; K. C. Mattos; P. C. Brum; M. V. C. Baldo; H. R. Middlekauff; C. E. Negrão

    2006-01-01

    We tested the hypothesis that the inability to increase cardiac output during exercise would explain the decreased rate of oxygen uptake (VO2) in recent onset, ischemia-induced heart failure rats. Nine nor- mal control rats and 6 rats with ischemic heart failure were studied. Myocardial infarction was induced by coronary ligation. VO2 was measured during a ramp protocol test on a

  14. Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure Waveform Analysis

    Microsoft Academic Search

    Biais Matthieu; Nouette-Gaulain Karine; Cottenceau Vincent; Vallet Alain; Cochard Jean François; Revel Philippe; Sztark François

    2008-01-01

    BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo®\\/FloTrac™) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution,

  15. Reduced peripheral arterial blood flow with preserved cardiac output during submaximal bicycle exercise in elderly heart failure

    Microsoft Academic Search

    Chirapa Puntawangkoon; Dalane W Kitzman; Stephen B Kritchevsky; Craig A Hamilton; Barbara Nicklas; Xiaoyan Leng; Peter H Brubaker; W Gregory Hundley

    2009-01-01

    BACKGROUND: Older heart failure (HF) patients exhibit exercise intolerance during activities of daily living. We hypothesized that reduced lower extremity blood flow (LBF) due to reduced forward cardiac output would contribute to submaximal exercise intolerance in older HF patients. METHODS AND RESULTS: Twelve HF patients both with preserved and reduced left ventricular ejection fraction (LVEF) (aged 68 ± 10 years)

  16. Interrelationship between cardiac output and vascular resistance as determinants of effective arterial blood volume in cirrhotic patients

    Microsoft Academic Search

    Michael D Shapiro; Kathleen M Nicholls; Bertron M Groves; Rudiger Kluge; Hsaio-Min Chung; Daniel G Bichet; Robert W Schrier

    1985-01-01

    Interrelationship between cardiac output and vascular resistance as determinants of effective arterial blood volume in cirrhotic patients. The effect of head-out water immersion (HWI) in decompensated cirrhotic patients to correct sodium and water excretion has been found to be incomplete and variable. The explanation may be that the efficacy of HWI in correcting a decreased effective arterial blood volume (EABV)

  17. Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement

    Microsoft Academic Search

    J. Fortin; W. Habenbacher; A. Heller; A. Hacker; R. Grüllenbergera; J. Innerhofer; H. Passath; Ch. Wagner; G. Haitchi; D. Flotzinger; R. Pacher; P. Wach

    2006-01-01

    The report describes a method of impedance cardiography using an improved estimate of thoracic volume. The formulas and their implementation in hardware and software are explained and new shortband electrodes are described which generate a good homogeneous thoracic field. Examples of stroke volume and cardiac output curves underline the capabilities of the monitoring system “Task Force® Monitor”. In several experiments,

  18. Performance of a minimally invasive uncalibrated cardiac output monitoring system (FlotracTM\\/VigileoTM) in haemodynamically unstable patients

    Microsoft Academic Search

    F. D. Compton; B. Zukunft; C. Hoffmann; W. Zidek; J.-H. Schaefer

    2008-01-01

    Background. Early haemodynamic assessment is of particular importance in the evaluation of haemodynamically compromised patients, but is often precluded by the invasiveness and com- plexity of the established cardiac output (CO) monitoring techniques. The FloTrac TM \\/Vigileo TM system allows minimally invasive CO determination based on the arterial pressure waveform derived from any standard arterial catheter, and the algorithm underlying

  19. Acoustic output of multi-line transmit beamforming for fast cardiac imaging: a simulation study.

    PubMed

    Santos, Pedro; Tong, Ling; Ortega, Alejandra; Løvstakken, Lasse; Samset, Eigil; D'hooge, Jan

    2015-07-01

    Achieving higher frame rates in cardiac ultrasound could unveil short-lived myocardial events and lead to new insights on cardiac function. Multi-line transmit (MLT) beamforming (i.e., simultaneously transmitting multiple focused beams) is a potential approach to achieve this. However, two challenges come with it: first, it leads to cross-talk between the MLT beams, appearing as imaging artifacts, and second, it presents acoustic summation in the near field, where multiple MLT beams overlap. Although several studies have focused on the former, no studies have looked into the implications of the latter on acoustic safety. In this paper, the acoustic field of 4-MLT was simulated and compared with single-line transmit (SLT). The findings suggest that standard MLT does present potential concerns. Compared with SLT, it shows a 2-fold increase in mechanical index (MI) (from 1.0 to 2.3), a 6-fold increase in spatial-peak pulse-average intensity (I(sppa)) (from 99 to 576 W?cm(-2)) and a 12-fold increase in spatial-peak temporalaverage intensity (I(spta)) (from 119 to 1407 mW?cm(-2)). Subsequently, modifications of the transmit pulse and delay line of MLT were studied. These modifications allowed for a change in the spatio-temporal distribution of the acoustic output, thereby significantly decreasing the safety indices (MI = 1.2, I(sppa) = 92 W?cm(-2) and I(spta) = 366 mW?cm(-2)). Accordingly, they help mitigate the concerns around MLT, reducing potential tradeoffs between acoustic safety and image quality. PMID:26168178

  20. Pulmonary diffusing capacity, capillary blood volume, and cardiac output during sustained microgravity

    NASA Technical Reports Server (NTRS)

    Prisk, G. K.; Guy, Harold J. B.; Elliott, Ann R.; Deutschman, Robert A., III; West, John B.

    1993-01-01

    We measured pulmonary diffusing capacity (DL), diffusing capacity per unit lung volume, pulmonary capillary blood volume (Vc), membrane diffusing capacity (Dm), pulmonary capillary blood flow or cardiac output (Qc), and cardiac stroke volume (SV) in four subjects exposed to nine days of microgravity. DL in microgravity was elevated compared with preflight standing values and was higher than preflight supine because of the elevation of both Vc and Dm. The elevation in Vc was comparable to that measured supine in 1 G, but the increase in Dm was in sharp contrast to the supine value. We postulate that, in 0 G, pulmonary capillary blood is evenly distributed throughout the lung, providing for uniform capillary filling, leading to an increase in the surface area available for diffusion. By contrast, in the supine 1-G state, the capillaries are less evenly filled, and although a similar increase in blood volume is observed, the corresponding increase in surface area does not occur. DL and its subdivisions showed no adaptive changes from the first measurement 24 h after the start of 0 G to eight days later. Similarly, there were no trends in the postflight data, suggesting that the principal mechanism of these changes was gravitational. The increase in Dm suggests that subclinical pulmonary edema did not result from exposure to 0 G. Qc was modestly increased inflight and decreased postflight compared with preflight standing. Compared with preflight standing, SV was increased 46 percent inflight and decreased 14 percent in the 1st week postflight. There were temporal changes in Qc and SV during 0 G, with the highest values recorded at the first measurement, 24 h into the flight. The lowest values of Qc and SV occurred on the day of return.

  1. Hybrid measurement to achieve satisfactory precision in perioperative cardiac output monitoring.

    PubMed

    Peyton, P

    2014-05-01

    Advanced haemodynamic monitoring employing minimally invasive cardiac output measurement may lead to significant improvements in patient outcomes in major surgery. However, the precision (scatter) of measurement of available generic technologies has been shown to be unsatisfactory with percentage error of agreement with bolus thermodilution (% error) of 40% to 50%. Simultaneous measurement and averaging by two or more technologies may reduce random measurement scatter and improve precision. This concept, called the hybrid method, was tested by comparing accuracy and precision of measurement relative to bolus thermodilution using combinations of three component methods. Thirty patients scheduled for either elective cardiac surgery or liver transplantation were studied. Agreement with simultaneous bolus thermodilution of hybrid combinations of continuous thermodilution (QtCCO) or Vigeleo™/FloTrac™ pulse contour measurement (QtFT) with pulmonary Capnotracking (QtCO2) was assessed pre- and post-cardiopulmonary bypass or pre- and post-reperfusion of the donor liver and compared with that of the component methods alone. Hybridisation of QtCO2 (% error 42.2) and QtCCO (% error 51.3) achieved significantly better precision (% error 31.3) than the component methods (P=0.0004) and (P=0.0195). Due to poor inherent precision of QtFT (% error 82.8), hybrid combination of QtFT with QtCO2 did not result in better precision than QtCO2 alone. Hybrid measurement can approach a 30% error, which is recommended as the upper limit for acceptability. This is a practical option where at least one component method, such as Capnotracking, is automated and does not increase the cost or complexity of the measurement process. PMID:24794474

  2. Combined first pass and gated blood pool radionuclide studies in the hemodynamic-cardiac evaluation of patients with low cardiac output

    SciTech Connect

    Abi-Mansour, P.; Fouad, F.M.; Sheeler, L.R.; Bravo, E.L.; MacIntyre, W.J.; Tarazi, R.C.

    1984-01-01

    Cardiac output (CO) is frequently used in the evaluation of cardiac function but low CO does not necessarily reflect heart failure. Similarly, low ejection fraction (EF) can be present in compensated heart diseases. In order to evaluate cardiac performance in relation to systematic hemodynamics, the authors used a multifactorial approach for the determination of CO, EF, pulmonary mean transit time (MTT), ratio of cardiopulmonary volume over total blood volume (CPV/TBV as an index of venous tone) all obtained from a single injection of 99m Tc-HSA. Four different conditions associated with low CO (less than or equal to 2.1 L/min/m/sup 2/) were evaluated. The combined use of CO, EF, MTT and CPV/TBV allowed a better understanding of the myocardial and peripheral circulatory factors associated with low CO states. This is helpful in the selection and follow-up of appropriate therapeutic intervention.

  3. Clinical evaluation of the flotrac/vigileo™ system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study

    PubMed Central

    Auler, José Otavio C.; Torres, Marcelo L. A.; Cardoso, Mônica M.; Tebaldi, Thais C.; Schmidt, André P.; Kondo, Mario M.; Zugaib, Marcelo

    2010-01-01

    BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia. PMID:20835557

  4. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites

    Microsoft Academic Search

    A Krag; F Bendtsen; J H Henriksen; S Møller

    2010-01-01

    Objectives:Recent studies suggest that cardiac dysfunction precedes development of the hepatorenal syndrome. In this follow-up study, we aimed to investigate the relation between cardiac and renal function in patients with cirrhosis and ascites and the impact of cardiac systolic function on survival.Patients and design:Twenty-four patients with cirrhosis and ascites were included. Cardiac function was investigated by gated myocardial perfusion imaging

  5. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients

    Microsoft Academic Search

    Daniel De Backer; Gernot Marx; Andrew Tan; Christopher Junker; Marc Van Nuffelen; Lars Hüter; Willy Ching; Frédéric Michard; Jean-Louis Vincent

    2011-01-01

    Purpose  Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However,\\u000a concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate\\u000a the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance\\u000a (TSVR) is low.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Fifty-eight septic patients were

  6. A novel continuous cardiac output monitor based on pulse wave transit time.

    PubMed

    Sugo, Yoshihiro; Ukawa, Teiji; Takeda, Sunao; Ishihara, Hironori; Kazama, Tomiei; Takeda, Junzo

    2010-01-01

    Monitoring cardiac output (CO) is important for the management of patient circulation in an operation room (OR) or intensive care unit (ICU). We assumed that the change in pulse wave transit time (PWTT) obtained from an electrocardiogram (ECG) and a pulse oximeter wave is correlated with the change in stroke volume (SV), from which CO is derived. The present study reports the verification of this hypothesis using a hemodynamic analysis theory and animal study. PWTT consists of a pre-ejection period (PEP), the pulse transit time through an elasticity artery (T(1)), and the pulse transit time through peripheral resistance arteries (T(2)). We assumed a consistent negative correlation between PWTT and SV under all conditions of varying circulatory dynamics. The equation for calculating SV from PWTT was derived based on the following procedures. 1. Approximating SV using a linear equation of PWTT. 2. The slope and y-intercept of the above equation were determined under consideration of vessel compliance (SV was divided by Pulse Pressure (PP)), animal type, and the inherent relationship between PP and PWTT. Animal study was performed to verify the above-mentioned assumption. The correlation coefficient of PWTT and SV became r = -0.710 (p ? 0.001), and a good correlation was admitted. It has been confirmed that accurate continuous CO and SV measurement is only possible by monitoring regular clinical parameters (ECG, SpO2, and NIBP). PMID:21095971

  7. [A dye densitometry analysis method for noninvasive measurement of cardiac output based on NIRS].

    PubMed

    Lu, Meng-Meng; Wang, Hong-Xuan; Liu, Guang-Da; Xin, Gui-Jie; Yu, Yong; Zha, Yu-Tong

    2013-12-01

    Currently, there exist technology problems in cardiac output (CO) parameter detection clinically, such as invasive and complex operation, as well as possibility of infection and death for patients. In order to solve these problems, a noninvasive and continuous method based on NIRS for CO detection was presented. In this way, the concentration changing of indocyanine green (ICG) dye in the patient's arterial blood was dynamically measured and analyzed, so that the CO could be noninvasively and continuously measured according to the characteristic parameters of dye densitometry curve. While the ICG dye was injected into the patient's body by the median cubital vein, block of photoelectric pulse dye densitometry measurement system as the lower machine acquired pulse wave data and uploaded the data to upper computer. In the scheme, two specialized light sources of LED at 940 and 805 nm were used to capture the signals of sufferer's fingertip pulse wave synchronously and successively. The CO value could then be successfully calculated through drawing complete ICG concentration variation of dye dilution and excretion process and computing mean transmission time (MTT) by upper computer. Compared with the "gold standard" method of thermodilution, the maximum relative error of this method was below 9. 76%, and the mean relative error was below 4. 39%. The result indicates that the method can be used as a kind of convenient operation, noninvasive and continuous solution for clinical CO measurement. PMID:24611365

  8. Oesophageal Doppler cardiac output monitoring: a longstanding tool with evolving indications and applications.

    PubMed

    Colquhoun, Douglas A; Roche, Anthony M

    2014-12-01

    Much work has been done over the years to assess cardiac output and better grasp haemodynamic profiles of patients in critical care and during major surgery. Pulmonary artery catheterization has long been considered as the standard of care, especially in critical care environments, however this dogma has been challenged over the last 10-15 years. This has led to a greater focus on alternate, lesser invasive technologies. This review focuses on the scientific and clinical outcomes basis of oesophageal Doppler monitoring. The science underpinning Doppler shift assessment of velocity stretches back over 100 years, whereas the clinical applicability, and specifically clinical outcomes improvement can be attributed to the last 20 years. Oesophageal Doppler monitoring (ODM), and its associated protocol-guided fluid administration, has been shown to reduce complications, length of stay, and overall healthcare cost when incorporated into perioperative fluid management algorithms. However, more recent advances in enhanced recovery after surgery programs have led to similar improvements, leading the clinician to consider the role of Oesophageal Doppler Monitor to be more focused in high-risk surgery and/or the high-risk patient. PMID:25480766

  9. Cardiac Output Measurements in Septic Patients: Comparing the Accuracy of USCOM to PiCCO

    PubMed Central

    Horster, Sophia; Stemmler, Hans-Joachim; Strecker, Nina; Brettner, Florian; Hausmann, Andreas; Cnossen, Jitske; Parhofer, Klaus G.; Nickel, Thomas; Geiger, Sandra

    2012-01-01

    USCOM is an ultrasound-based method which has been accepted for noninvasive hemodynamic monitoring in various clinical conditions (USCOM, Ultrasonic cardiac output monitoring). The present study aimed at comparing the accuracy of the USCOM device with that of the thermodilution technique in patients with septicemia. We conducted a prospective observational study in a medical but noncardiological ICU of a university hospital. Septic adult patients (median age 55 years, median SAPS-II-Score 43 points) on mechanical ventilation and catecholamine support were monitored with USCOM and PiCCO (n = 70). Seventy paired left-sided CO measurements (transaortic access?=?COUS-A) were obtained. The mean COUS-A were 6.55?l/min (±2.19) versus COPiCCO 6.5?l/min (±2.18). The correlation coefficient was r = 0.89. Comparison by Bland-Altman analysis revealed a bias of ?0.36?l/min (±0.99?l/min) leading to a mean percentage error of 29%. USCOM is a feasible and rapid method to evaluate CO in septic patients. USCOM does reliably represent CO values as compared to the reference technique based on thermodilution (PiCCO). It seems to be appropriate in situations where CO measurements are most pertinent to patient management. PMID:22191019

  10. Retinal venous oxygen saturation and cardiac output during controlled hemorrhage and resuscitation.

    PubMed

    Denninghoff, Kurt R; Smith, Matthew H; Lompado, Art; Hillman, Lloyd W

    2003-03-01

    The objective was to test calibration of an eye oximeter (EOX) in a vitiligo swine eye and correlate retinal venous oxygen saturation (Srv(O(2))), mixed venous oxygen saturation (Sv(O(2))), and cardiac output (CO) during robust changes in blood volume. Ten anesthetized adult Sinclair swine with retinal vitiligo were placed on stepwise decreasing amounts of oxygen. At each oxygen level, femoral artery oxygen saturation (Sa(O(2))) and retinal artery oxygen saturation (Sra(O(2))) were obtained. After equilibration on 100% O(2), subjects were bled at 1.4 ml. kg(-1). min(-1) for 20 min. Subsequently, anticoagulated shed blood was reinfused at the same rate. During graded hypoxia, exsanguination, and reinfusion, Sra(O(2)) and Srv(O(2)) were measured by using the EOX, and CO and Sv(O(2)) were measured by using a pulmonary artery catheter. During graded hypoxia, Sra(O(2)) correlated with Sa(O(2)) (r = 0.92). Srv(O(2)) correlated with Sv(O(2)) (r = 0.89) during exsanguination and reinfusion. Sv(O(2)) and Srv(O(2)) correlated with CO during blood removal and resuscitation (r = 0.92). Use of vitiligo retinas improved the calibration of EOX measurements. In this robust hemorrhage model, Srv(O(2)) correlates with CO and Sv(O(2)) across the range of exsanguination and resuscitation. PMID:12571124

  11. May-Thurner syndrome: High output cardiac failure as a result of iatrogenic iliac fistula.

    PubMed

    Singh, Shantanu; Singh, Shivank; Jyothimallika, Juthika; Lynch, Teresa J

    2015-03-16

    May-Thurner syndrome (MTS) also termed iliocaval compression or Cockett-Thomas syndrome is a common, although rarely diagnosed, condition in which the patient has an anatomical variant wherein the right common iliac artery overlies and compresses the left common iliac vein against the fifth lumbar spine resulting in increased risk of iliofemoral deep venous thrombosis. This variant has been shown to be present in over 23% of the population but most go undetected. We present a patient with MTS who developed high output cardiac failure due to an iatrogenic iliac fistula. The patient underwent an extensive workup for a left to right shunt including MRI and arterial duplex in the vascular lab. He was ultimately found to have a 2.1 cm left common iliac artery aneurysm and history of common iliac stent. We took the patient to the operating room for aortogram with placement of an endovascular plug of the left internal iliac artery and aorto-bi-iliac stent graft placement with CO2 and IV contrast. Subsequently the patient underwent successful stent placement in the area that was compressed followed by 6 mo of anticoagulation with warfarin. The flow from the fistula decreased significantly. PMID:25789305

  12. Maintaining low BCR-ABL signaling output to restrict CML progression and enable persistence.

    PubMed

    Burchert, Andreas

    2014-03-01

    Deregulated BCR-ABL oncogenic activity leads to transformation, oncogene addiction and drives disease progression in chronic myeloid leukemia (CML). Inhibition of BCR-ABL using Abl-specific kinase inhibitors (TKI) such as imatinib induces remarkable clinical responses. However, approximately only less than 15 % of all chronic-phase CML patients will remain relapse-free after discontinuation of imatinib in deep molecular remission. It is not well understood why persisting CML cells survive under TKI therapy without developing clonal evolution and frank TKI resistance. BCR-ABL expression level may be critically involved. Whereas higher BCR-ABL expression has been described as a pre-requisite for malignant CML stem cell transformation and CML progression to blast crisis, recent evidence suggests that during persistence TKI select for CML precursors with low BCR-ABL expression. Genetic, translational and clinical evidence is discussed to suggest that TKI-induced maintenance of low BCR-ABL signaling output may be potently tumor suppressive, because it abrogates oncogenic addiction. PMID:24500518

  13. Noninvasive cardiac output and blood pressure monitoring cannot replace an invasive monitoring system in critically ill patients

    PubMed Central

    Stover, John F; Stocker, Reto; Lenherr, Renato; Neff, Thomas A; Cottini, Silvia R; Zoller, Bernhard; Béchir, Markus

    2009-01-01

    Background Monitoring of cardiac output and blood pressure are standard procedures in critical care medicine. Traditionally, invasive techniques like pulmonary artery catheter (PAC) and arterial catheters are widely used. Invasiveness bears many risks of deleterious complications. Therefore, a noninvasive reliable cardiac output (CO) and blood pressure monitoring system could improve the safety of cardiac monitoring. The aim of the present study was to compare a noninvasive versus a standard invasive cardiovascular monitoring system. Methods Nexfin HD is a continuous noninvasive blood pressure and cardiac output monitor system and is based on the development of the pulsatile unloading of the finger arterial walls using an inflatable finger cuff. During continuous BP measurement CO is calculated. We included 10 patients with standard invasive cardiac monitoring system (pulmonary artery catheter and arterial catheter) comparing invasively obtained data to the data collected noninvasively using the Nexfin HD. Results Correlation between mean arterial pressure measured with the standard arterial monitoring system and the Nexfin HD was r2 = 0.67 with a bias of -2 mmHg and two standard deviations of ± 16 mmHg. Correlation between CO derived from PAC and the Nexfin HD was r2 = 0.83 with a bias of 0.23 l/min and two standard deviations of ± 2.1 l/min; the percentage error was 29%. Conclusion Although the noninvasive CO measurement appears promising, the noninvasive blood pressure assessment is clearly less reliable than the invasively measured blood pressure. Therefore, according to the present data application of the Nexfin HD monitoring system in the ICU cannot be recommended generally. Whether such a tool might be reliable in certain critically ill patients remains to be determined. PMID:19821993

  14. Coregulation of Ion Channel Conductances Preserves Output in a Computational Model of a Crustacean Cardiac Motor Neuron

    PubMed Central

    Ball, John M.; Franklin, Clarence C.; Tobin, Anne-Elise

    2015-01-01

    Similar activity patterns at both neuron and network levels can arise from different combinations of membrane and synaptic conductance values. A strategy by which neurons may preserve their electrical output is via cell type-dependent balances of inward and outward currents. Measurements of mRNA transcripts that encode ion channel proteins within motor neurons in the crustacean cardiac ganglion recently revealed correlations between certain channel types. To determine whether balances of intrinsic currents potentially resulting from such correlations preserve certain electrical cell outputs, we developed a nominal biophysical model of the crustacean cardiac ganglion using biological data. Predictions from the nominal model showed that coregulation of ionic currents may preserve the key characteristics of motor neuron activity. We then developed a methodology of sampling a multidimensional parameter space to select an appropriate model set for meaningful comparison with variations in correlations seen in biological datasets. PMID:20573909

  15. EFFECTS OF THYROXINE AND GROWTH HORMONE TREATMENT OF DAIRY COWS ON MILK YIELD, CARDIAC OUTPUT AND MAMMARY BLOOD FLOW 1

    Microsoft Academic Search

    S. R. Davis; R. J. Collier; J. P. McNamara; H. H. Head; W. Sussman

    2010-01-01

    Four cows received thyroxine injections (T4; 20 mg\\/d) and three cows received growth hormone injec- tions (GH; 44 rag\\/d) for 4 d during successive 16-d experimental periods. Measurement was made of milk yield, protein yield, mammary tyrosine and phenylalanine uptake, blood plasma hormone concentrations, mammary blood flow and cardiac output. Milk yield increased by 25% with T4 and 21% with

  16. Predictors of Post Pericardiotomy Low Cardiac Output Syndrome in Patients With Pericardial Effusion

    PubMed Central

    Sabzi, Feridoun; Faraji, Reza

    2015-01-01

    Introduction: Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failure. Methods: During periods of five years, 423 patients in our hospital underwent pericardiotomy for decompression of effusion. The clinical characteristics of those patient with postoperative low cardiac output (B group) (14 cases) recorded and compared with other patients without this postoperative complication (A group) by test and X2. Significant variables in invariables (P?0.1) entered in logistic regression analysis and odd ratio of these significant variables obtained. Results: Idiopathic pericardial effusion, malignancy, renal failure, connective tissue disease, viral pericarditis was found in 125 patients (27%), 105 patients (25.4%), 65 patients (15.6%), 50 (17.1%) and 10 (2.4%) of patients subsequently. The factors that predict post-operative death in logistic regression analysis were malignancy, radiotherapy, constrictive pericarditis inotropic drug using IABP using, pre-operative EF and pericardial calcification. Conclusion: Certain preoperative variables such as malignancy, radiotherapy, low EF, calcified pericardium and connective tissue disease are associated with POLCOS and post-operative risk of death. This paradoxical response to pericardial decompression may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion or thicken pericardium resulting in ventricular dilatation and failure or intra operative myocardial injury due to pericardiectomy of calcified pericardium, radiation and cardiomyopathy. PMID:25859311

  17. Bioreactance Is Not Interchangeable with Thermodilution for Measuring Cardiac Output during Adult Liver Transplantation

    PubMed Central

    Han, Sangbin; Lee, Jong Hwan; Kim, Gaabsoo; Ko, Justin Sangwook; Choi, Soo Joo; Kwon, Ji Hae; Heo, Burn Young; Gwak, Mi Sook

    2015-01-01

    Background Thermodilution technique using a pulmonary artery catheter is widely used for the assessment of cardiac output (CO) in patients undergoing liver transplantation. However, the unclearness of the risk-benefit ratio of this method has led to an interest in less invasive modalities. Thus, we evaluated whether noninvasive bioreactance CO monitoring is interchangeable with thermodilution technique. Methods Nineteen recipients undergoing adult-to-adult living donor liver transplantation were enrolled in this prospective observational study. COs were recorded automatically by the two devices and compared simultaneously at 3-minute intervals. The Bland–Altman plot was used to evaluate the agreement between bioreactance and thermodilution. Clinically acceptable agreement was defined as a percentage error of limits of agreement <30%. The four quadrant plot was used to evaluate concordance between bioreactance and thermodilution. Clinically acceptable concordance was defined as a concordance rate >92%. Results A total of 2640 datasets were collected. The mean CO difference between the two techniques was 0.9 l/min, and the 95% limits of agreement were -3.5 l/min and 5.4 l/min with a percentage error of 53.9%. The percentage errors in the dissection, anhepatic, and reperfusion phase were 50.6%, 56.1%, and 53.5%, respectively. The concordance rate between the two techniques was 54.8%. Conclusion Bioreactance and thermodilution failed to show acceptable interchangeability in terms of both estimating CO and tracking CO changes in patients undergoing liver transplantation. Thus, the use of bioreactance as an alternative CO monitoring to thermodilution, in spite of its noninvasiveness, would be hard to recommend in these surgical patients. PMID:26017364

  18. Subject-specific Model Estimation of Cardiac Output and Blood Volume During Hemorrhage

    PubMed Central

    Neal, Maxwell Lewis; Bassingthwaighte, James B.

    2010-01-01

    We have developed a novel method for estimating subject-specific hemodynamics during hemorrhage. First, a mathematical model representing a closed-loop circulation and baroreceptor feedback system was parameterized to match the baseline physiology of individual experimental subjects by fitting model results to 1 min of pre-injury data. This automated parameterization process matched pre-injury measurements within 1.4 ± 1.3% SD. Tuned parameters were then used in similar open-loop models to simulate dynamics post-injury. Cardiac output (CO) estimates were obtained continuously using post-injury measurements of arterial blood pressure (ABP) and heart rate (HR) as inputs to the first open-loop model. Secondarily, total blood volume (TBV) estimates were obtained by summing the blood volumes in all the circulatory segments of a second open-loop model that used measured CO as an additional input. We validated the estimation method by comparing model CO results to flowprobe measurements in 14 pigs. Overall, CO estimates had a Bland-Altman bias of ?0.30 l/min with upper and lower limits of agreement 0.80 and ?1.40 l/min. The negative bias is likely due to overestimation of the peripheral resistance response to hemorrhage. There was no reference measurement of TBV; however, the estimates appeared reasonable and clearly predicted survival versus death during the post-hemorrhage period. Both open-loop models ran in real time on a computer with a 2.4 GHz processor, and their clinical applicability in emergency care scenarios is discussed. PMID:17846886

  19. Monitoring non-invasive cardiac output and stroke volume during experimental human hypovolaemia and resuscitation

    PubMed Central

    Reisner, A. T.; Xu, D.; Ryan, K. L.; Convertino, V. A.; Rickards, C. A.; Mukkamala, R.

    2011-01-01

    Background Multiple methods for non-invasive measurement of cardiac output (CO) and stroke volume (SV) exist. Their comparative capabilities are not clearly established. Methods Healthy human subjects (n=21) underwent central hypovolaemia through progressive lower body negative pressure (LBNP) until the onset of presyncope, followed by termination of LBNP, to simulate complete resuscitation. Measurement methods were electrical bioimpedance (EBI) of the thorax and three measurements of CO and SV derived from the arterial blood pressure (ABP) waveform: the Modelflow (MF) method, the long-time interval (LTI) method, and pulse pressure (PP). We computed areas under receiver-operating characteristic curves (ROC AUCs) for the investigational metrics, to determine how well they discriminated between every combination of LBNP levels. Results LTI and EBI yielded similar reductions in SV during progressive hypovolaemia and resuscitation (correlation coefficient 0.83) with ROC AUCs for distinguishing major LBNP (?60 mm Hg) vs resuscitation (0 mm Hg) of 0.98 and 0.99, respectively. MF yielded very similar reductions and ROC AUCs during progressive hypovolaemia, but after resuscitation, MF-CO did not return to baseline, yielding lower ROC AUCs (?ROC AUC range, ?0.18 to ?0.26, P<0.01). PP declined during hypovolaemia but tended to be an inferior indicator of specific LBNP levels, and PP did not recover during resuscitation, yielding lower ROC curves (P<0.01). Conclusions LTI, EBI, and MF were able to track progressive hypovolaemia. PP decreased during hypovolaemia but its magnitude of reduction underestimated reductions in SV. PP and MF were inferior for the identification of resuscitation. PMID:21051492

  20. A comparison of pulse contour wave analysis and ultrasonic cardiac output monitoring in the critically ill.

    PubMed

    Udy, A A; Altukroni, M; Jarrett, P; Roberts, J A; Lipman, J

    2012-07-01

    Cardiac output (CO) is a key determinant of major organ blood flow and solute delivery to drug eliminating organs. As such, CO assessment is a key covariate in understanding altered drug handling in the critically ill. Newer minimally-invasive devices are providing unique platforms for such an application, although comparison data are currently lacking. In this study we evaluated the Vigileo (Edwards Lifesciences, Irvine, CA, USA) and USCOM (USCOM Ltd, Sydney, NSW) devices in 62 critically ill patients requiring antibacterial therapy. The mean COVigileo and COUSCOM for the first paired measurements were 8.20±2.65 l/minute and 6.84±2.57 l/minute respectively (P <0.001). A significant correlation was evident in all patients (r=0.537, P <0.001) although the recorded bias was large (1.36±2.51 l/minute, limits of agreement -3.6 to±6.3 l/minute). The overall percentage error was 65%. There was an improved correlation in those admitted with sepsis (r=0.639, P <0.001), compared to trauma (r=0.373, P=0.066), although bias, precision and percentage error were similar in both subgroups. In 54 patients a second paired assessment was obtained at three hours. A weak, although significant correlation (r=0.377, P=0.005) was observed suggesting that gross trends over time were similar. In conclusion, our findings demonstrate poor agreement between these techniques suggesting that these devices are not simply interchangeable when assessing CO in a research or clinical setting. PMID:22813490

  1. Reduced cardiac output and its correlation with coronary blood flow and troponin in asphyxiated infants treated with therapeutic hypothermia.

    PubMed

    Sehgal, Arvind; Wong, Flora; Mehta, Shailender

    2012-10-01

    Perinatal asphyxia can lead to multi-organ insult which includes cardiovascular dysfunction. The objective was to study the relationship between cardiac function, perfusion and troponin. Unit database was accessed to identify infants with perinatal asphyxia over the last 2 years. Information from medical records and archived echocardiographic images was retrieved. Comparisons for echocardiographic information were made with healthy term infants. Seventeen infants with perinatal asphyxia were identified, of which three were excluded (one-33 weeks gestation, two-coagulopathy and pulmonary hypertension); 14 infants received therapeutic hypothermia. Median (range) gestation and birthweight were 39 (37-42) weeks and 3,550 (2,380-3,992) g respectively. Mean (S.D.) rectal temperature and time of echocardiogram were 33.5?±?0.5 °C and median (range) 7.7 h [3-10] respectively. Majority of infants had low biventricular outputs. Median (range) SVC flow was 29.8 ml/kg/min (13-96.2). Median (range) troponin was 0.77 ?g/L (0.17-2.6); normal???0.08 ?g/L. Markedly low coronary flows (diastolic VTI median (range) 2.1 (1.3-2.9) cm were noted compared to controls. Coronary flow had a significantly positive correlation with left ventricular output. Higher troponin levels were associated with lower aortic stroke velocity. A close association between cardiac output, perfusion and troponin was noted. A dichotomy between blood pressure and flow parameters was noted, indicating the wide variation in vascular resistance in these infants. Biventricular output, coronary and SVC flows were significantly higher in the control population. In conclusion, inter-variable relationship between cardiac output, coronary flow and troponin is an important addition to the understanding of cardiovascular impact of perinatal asphyxia. PMID:22669637

  2. Pulmonary Artery Catheter (PAC) Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM): An Ovine Cardiac Output Validation

    PubMed Central

    Phillips, Robert A.; Hood, Sally G.; Jacobson, Beverley M.; West, Malcolm J.; Wan, Li; May, Clive N.

    2012-01-01

    Background. The pulmonary artery catheter (PAC) is an accepted clinical method of measuring cardiac output (CO) despite no prior validation. The ultrasonic cardiac output monitor (USCOM) is a noninvasive alternative to PAC using Doppler ultrasound (CW). We compared PAC and USCOM CO measurements against a gold standard, the aortic flow probe (FP), in sheep at varying outputs. Methods. Ten conscious sheep, with implanted FPs, had measurements of CO by FP, USCOM, and PAC, at rest and during intervention with inotropes and vasopressors. Results. CO measurements by FP, PAC, and USCOM were 4.0 ± 1.2?L/min, 4.8 ± 1.5?L/min, and 4.0 ± 1.4?L/min, respectively, (n = 280, range 1.9?L/min to 11.7?L/min). Percentage bias and precision between FP and PAC, and FP and USCOM was ?17 and 47%, and 1 and 36%, respectively. PAC under-measured Dobutamine-induced CO changes by 20% (relative 66%) compared with FP, while USCOM measures varied from FP by 3% (relative 10%). PAC reliably detected ?30% but not +40% CO changes, as measured by receiver operating characteristic area under the curve (AUC), while USCOM reliably detected ±5% changes in CO (AUC > 0.70). Conclusions. PAC demonstrated poor accuracy and sensitivity as a measure of CO. USCOM provided equivalent measurements to FP across a sixfold range of outputs, reliably detecting ±5% changes. PMID:22649718

  3. Clinical review: Guyton - the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output

    PubMed Central

    2010-01-01

    Arthur Guyton's concepts of the determinative role of right heart filling in cardiac output continue to be controversial. This paper reviews his seminal experiments in detail and clarifies the often confusing concepts underpinning his model. One primary criticism of Guyton's model is that the parameters describing venous return had not been measured in a functioning cardiovascular system in humans. Thus, concerns have been expressed in regard to the ability of Guyton's simplistic model, with few parameters, to model the complex human circulation. Further concerns have been raised in regard to the artificial experimental preparations that Guyton used. Recently reported measurements in humans support Guyton's theoretical and animal work. PMID:21144008

  4. Effects of enalapril on changes in cardiac output and organ vascular resistances induced by alpha 1- and alpha 2-adrenoceptor agonists in pithed normotensive rats.

    PubMed Central

    MacLean, M. R.; Hiley, C. R.

    1988-01-01

    1. Cardiac output, its distribution and regional vascular resistances were determined with tracer microspheres in pithed rats in the presence of the angiotensin converting enzyme inhibitor enalapril. The effects of enalapril on the cardiovascular responses elicited by either the alpha 1-adrenoceptor agonist phenylephrine or the alpha 2-adrenoceptor agonist xylazine were determined. 2. Enalapril decreased diastolic and mean blood pressure by decreasing cardiac index and total peripheral resistance. It induced vasodilatation in the kidney, epididimides, epididimidal fat and pancreas/mesentery. Vasoconstriction in the lungs, testes and liver was evident following enalapril administration as well as a decrease in the proportion of cardiac output passing to them, whilst the pancreas and mesentery received a greater proportion of the cardiac output. All the above effects of enalapril were reversed by infusion of angiotensin II at a rate of 75 ng kg-1 min-1. 3. Xylazine increased blood pressure by increasing both cardiac output and total peripheral resistance. Enalapril did not affect the increase in cardiac output caused by xylazine but decreased the effect of the alpha 2-agonist on blood pressure by preventing the increase in total peripheral resistance. Inhibition by enalapril of xylazine-induced vasoconstriction in the kidneys, testes, fat and gastrointestinal tract contributed to the decrease in total peripheral resistance. Enalapril also inhibited xylazine-induced changes in cardiac output distribution to the liver, lungs and heart. All the above effects of enalapril were reversed by infusion of angiotensin II. 4. Enalapril decreased the sustained phase of the pressor response to an infusion of phenylephrine whilst having no effect on the initial peak pressor response to a bolus injection of phenylephrine. Phenylephrine increased both cardiac output and total peripheral resistance and enalapril abolished its effect on total peripheral resistance whilst having no effect on the increase in cardiac output. Enalapril inhibited phenylephrine-induced vasoconstriction in the testes, fat, muscle, spleen and gastrointestinal tract. Enalapril also inhibited phenylephrine-induced changes in cardiac output distribution to the lungs and liver. The infusion of angiotensin II did not fully reverse the inhibitory effect of enalapril either on the phenylephrine-induced increases in diastolic blood pressure or on the vasoconstriction in the fat, spleen and gastrointestinal tract, but did reverse all other effects of enalapril.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2899445

  5. The correlation between the first heart sound and cardiac output as measured by using digital esophageal stethoscope under anaesthesia

    PubMed Central

    Duck Shin, Young; Hoon Yim, Kyoung; Hi Park, Sang; Wook Jeon, Yong; Ho Bae, Jin; Soo Lee, Tae; Hwan Kim, Myoung; Jin Choi, Young

    2014-01-01

    Objective: The use of an esophageal stethoscope is a basic heart sounds monitoring procedure performed in patients under general anesthesia. As the size of the first heart sound can express the left ventricle function, its correlation with cardiac output should be investigated. The aim of this study was to investigate the effects of cardiac output (CO) on the first heart sound (S1) amplitude. Methods : Six male beagles were chosen. The S1 was obtained with the newly developed esophageal stethoscope system. CO was measured using NICOM, a non-invasive CO measuring device. Ephedrine and beta blockers were administered to the subjects to compare changes in figures, and the change from using an inhalation anesthetic was also compared. Results: The S1 amplitude displayed positive correlation with the change rate of CO (r = 0.935, p < 0.001). The heart rate measured using the esophageal stethoscope and ECG showed considerably close figures through the Bland-Altman plot and showed a high positive correlation (r = 0.988, p < 0,001). Conclusion: In beagles, the amplitude of S1 had a significant correlation with changes in CO in a variety of situations. PMID:24772126

  6. Effects of Dobutamine on Left Ventricular Performance, Coronary Dynamics, and Distribution of Cardiac Output in Conscious Dogs

    PubMed Central

    Vatner, Stephen F.; McRitchie, Robert J.; Braunwald, Eugene

    1974-01-01

    The effects of dobutamine ([±]-4-[2-[[3-(p-hydroxyphenyl)-1-methyl propyl] amino] ethyl] pyrocatechol hydrochloride), a new synthetic cardioactive sympathomimetic amine, were examined on direct and continuous measurements of left ventricular (LV) diameter (D), pressures (P), velocity of shortening (V), dP/dt, dP/dt/P, arterial pressure, cardiac output, and regional blood flows in the left circumflex coronary, mesenteric, renal, and iliac beds in healthy, conscious dogs. At the highest dose of dobutamine examined, 40 ?g/kg/min, the drug increased dP/dt/P from 65±3 to 128±4 s-1 and isolength velocity from 72±4 to 120±7 mm/s without affecting LV end diastolic D significantly. Mean arterial P rose from 92±2 to 104±3 mm Hg and heart rate from 78±3 to 111±7 beats/min, while LV end systolic D fell from 24.1±1.4 to 19.9±1.8 mm, reflecting a rise in stroke volume from 30±4 to 42±3 ml. Cardiac output rose from 2.41±0.23 to 4.35±0.28 liter/min, while calculated total peripheral resistance declined from 0.042±0.005 to 0.028±0.003 mm Hg/ml/min. The greatest increases in flow and decreases in calculated resistance occurred in the iliac and coronary beds, and the least occurred in the renal bed. Propranolol blocked the inotropic and beta2 dilator responses while vasoconstricting effects mediated by alpha adrenergic stimulation remained in each of the beds studied. When dobutamine was infused after a combination of practolol and phentolamine, dilatation occurred in each of the beds studied. These observations indicate that dobutamine is a potent positive inotropic agent with relatively slight effects on preload, afterload, or heart rate, and thus may be a potentially useful clinical agent. The one property of this drug which is not ideal is its tendency to cause a redistribution of cardiac output favoring the muscular beds at the expense of the kidney and visceral beds. Images PMID:4825224

  7. Evaluation of the estimated continuous cardiac output monitoring system in adults and children undergoing kidney transplant surgery: a pilot study.

    PubMed

    Terada, Takashi; Maemura, Yumi; Yoshida, Akiko; Muto, Rika; Ochiai, Ryoichi

    2014-02-01

    Evaluation of the estimated continuous cardiac output (esCCO) allows non-invasive and continuous assessment of cardiac output. However, the applicability of this approach in children has not been assessed thus far. We compared the correlation coefficient, bias, standard deviation (SD), and the lower and upper 95 % limits of agreement for esCCO and dye densitography-cardiac output (DDG-CO) measurements by pulse dye densitometry (PDD) in adults and children. On the basis of these assessments, we aimed to examine whether esCCO can be used in pediatric patients. DDG-CO was measured by pulse dye densitometry (PDD) using indocyanine green. Modified-pulse wave transit time, obtained using pulse oximetry and electrocardiography, was used to measure esCCO. Correlations between DDG-CO and esCCO in adults and children were analyzed using regression analysis with the least squares method. Differences between the two correlation coefficients were statistically analyzed using a correlation coefficient test. Bland-Altman plots were used to evaluate bias and SD for DDG-CO and esCCO in both adults and children, and 95 % limits of agreement (bias ± 1.96 SD) and percentage error (1.96 SD/mean DDG-CO) were calculated and compared. The average age of the adult patients (n = 10) was 39.3 ± 12.1 years, while the average age of the pediatric patients (n = 7) was 9.4 ± 3.1 years (p < 0.001). For adults, the correlation coefficient was 0.756; bias, -0.258 L/min; SD, 1.583 L/min; lower and upper 95 % limits of agreement for DDG-CO and esCCO, -3.360 and 2.844 L/min, respectively; and percentage error, 42.7 %. For children, the corresponding values were 0.904; -0.270; 0.908; -2.051 and 1.510 L/min, respectively; and 35.7 %. Due to the high percentage error values, we could not establish a correlation between esCCO and DDG-CO. However, the 95 % limits of agreement and percentage error were better in children than in adults. Due to the high percentage error, we could not confirm a correlation between esCCO and DDG-CO. However, the agreement between esCCO and DDG-CO seems to be higher in children than in adults. These results suggest that esCCO can also be used in children. Future studies with bigger study populations will be required to further investigate these conclusions. PMID:23963774

  8. Influence of heart motion on cardiac output estimation by means of electrical impedance tomography: a case study.

    PubMed

    Proença, Martin; Braun, Fabian; Rapin, Michael; Solà, Josep; Adler, Andy; Grychtol, Bart?omiej; Bohm, Stephan H; Lemay, Mathieu; Thiran, Jean-Philippe

    2015-06-01

    Electrical impedance tomography (EIT) is a non-invasive imaging technique that can measure cardiac-related intra-thoracic impedance changes. EIT-based cardiac output estimation relies on the assumption that the amplitude of the impedance change in the ventricular region is representative of stroke volume (SV). However, other factors such as heart motion can significantly affect this ventricular impedance change. In the present case study, a magnetic resonance imaging-based dynamic bio-impedance model fitting the morphology of a single male subject was built. Simulations were performed to evaluate the contribution of heart motion and its influence on EIT-based SV estimation. Myocardial deformation was found to be the main contributor to the ventricular impedance change (56%). However, motion-induced impedance changes showed a strong correlation (r = 0.978) with left ventricular volume. We explained this by the quasi-incompressibility of blood and myocardium. As a result, EIT achieved excellent accuracy in estimating a wide range of simulated SV values (error distribution of 0.57 ± 2.19 ml (1.02 ± 2.62%) and correlation of r = 0.996 after a two-point calibration was applied to convert impedance values to millilitres). As the model was based on one single subject, the strong correlation found between motion-induced changes and ventricular volume remains to be verified in larger datasets. PMID:26006113

  9. [Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery].

    PubMed

    Pérez Vela, J L; Martín Benítez, J C; Carrasco González, M; de la Cal López, M A; Hinojosa Pérez, R; Sagredo Meneses, V; del Nogal Saez, F

    2012-05-01

    The low cardiac output syndrome is a potential complication in cardiac surgery patients and associated with increased morbidity and mortality. This guide is to provide recommendations for the management of these patients, immediately after surgery, admitted to the ICU. The recommendations are grouped into different sections, trying to answer from the most basic concepts such as the definition to the different sections of basic and advanced monitoring and ending with the complex management of this syndrome. We propose an algorithm for initial management, as well as two other for ventricular failure (predominantly left or right). Most of the recommendations are based on expert consensus because of the lack of randomized trials of adequate design and sample size in this group of patients. The quality of evidence and strength of the recommendations were made following the GRADE methodology. The guide is presented as a list of recommendations (and level of evidence for each recommendation) for each question on the selected topic. Then for each question, we proceed to the justification of the recommendations. PMID:22445905

  10. Beta-adrenergic blockade affects initial drug distribution due to decreased cardiac output and altered blood flow distribution.

    PubMed

    Avram, Michael J; Krejcie, Tom C; Henthorn, Thomas K; Niemann, Claus U

    2004-11-01

    Beta-adrenergic receptor blockers decrease intravenous anesthetic dose requirements. The present study determined the effect of propranolol on indocyanine green and antipyrine disposition from the moment of rapid intravenous injection. Anti-pyrine is a physiological marker that distributes to a volume as large as total body water in a blood flow-dependent manner and is a pharmacokinetic surrogate for many lipophilic drugs, including intravenous anesthetics. Antipyrine and indocyanine green disposition were determined twice in five healthy adult males in this Institutional Review Board-approved study, once during propranolol infusion. After rapid indocyanine green and antipyrine injection, arterial blood samples were collected frequently for 2 min and less frequently thereafter. Plasma indocyanine green and antipyrine concentrations were measured by high-performance liquid chromatography. Indocyanine green and antipyrine disposition were characterized, using SAAM II, by a recirculatory pharmacokinetic model that describes drug disposition from the moment of injection. Parameters were compared using the paired t test. The disposition of indocyanine green demonstrated that propranolol decreased cardiac output at the expense of the fast peripheral (nonsplanchnic) intravascular circuit. The area under the antipyrine concentration versus time relationship was doubled for at least the first 3 min after injection due to both decreased cardiac output and maintenance of nondistributive blood flow at the expense of a two-thirds reduction of blood flow (intercompartmental clearance) to the rapidly equilibrating (fast, splanchnic) tissue volume. The increase in antipyrine area under the curve due to propranolol-induced alteration of initial antipyrine disposition could explain decreased intravenous anesthetic dose requirements in the presence of beta-adrenergic receptor blockade. PMID:15197245

  11. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices

    PubMed Central

    2010-01-01

    Introduction We compared the ability of two devices estimating cardiac output from arterial pressure-curve analysis to track the changes in cardiac output measured with transpulmonary thermodilution induced by volume expansion and norepinephrine in sepsis patients. Methods In 80 patients with septic circulatory failure, we administered volume expansion (40 patients) or introduced/increased norepinephrine (40 patients). We measured the pulse contour-derived cardiac index (CI) provided by the PiCCO device (CIpc), the arterial pressure waveform-derived CI provided by the Vigileo device (CIpw), and the transpulmonary thermodilution CI (CItd) before and after therapeutic interventions. Results The changes in CIpc accurately tracked the changes in CItd induced by volume expansion (bias, -0.20 ± 0.63 L/min/m2) as well as by norepinephrine (bias, -0.05 ± 0.74 L/min/m2). The changes in CIpc accurately detected an increase in CItd ? 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.878 (0.736 to 0.960) and 0.924 (0.795 to 0.983), respectively; P < 0.05 versus 0.500 for both). The changes in CIpw were less reliable for tracking the volume-induced changes in CItd (bias, -0.23 ± 0.95 L/min/m2) and norepinephrine-induced changes in CItd (bias, -0.01 ± 1.75 L/min/m2). The changes in CIpw were unable to detect an increase in CItd ? 15% induced by volume expansion and norepinephrine introduction/increase (area under ROC curves, 0.564 (0.398 to 0.720) and 0.541 (0.377 to 0.700, respectively, both not significantly different from versus 0.500). Conclusions The CIpc was reliable and accurate for assessing the CI changes induced by volume expansion and norepinephrine. By contrast, the CIpw poorly tracked the trends in CI induced by those therapeutic interventions. PMID:20537159

  12. Role of cardiac output and the autonomic nervous system in the antinatriuretic response to acute constriction of the thoracic superior vena cava.

    NASA Technical Reports Server (NTRS)

    Schrier, R. W.; Humphreys, M. H.; Ufferman, R. C.

    1971-01-01

    Study of the differential characteristics of hepatic congestion and decreased cardiac output in terms of potential afferent stimuli in the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction. An attempt is made to see if the autonomic nervous system is involved in the antinatriuretic effect of acute TIVC or thoracic superior vena cava constriction.

  13. Comparison between mixed venous oxygen saturation and thermodilution cardiac output in monitoring patients with severe heart failure treated with milrinone and dobutamine

    Microsoft Academic Search

    Stefanie Nuñez; Alan Maisel

    1998-01-01

    Purpose Although thermodilution cardiac output (COtd) is the accepted method for monitoring patients with heart failure in the intensive care unit, it is particularly inaccurate in low-flow states and in the presence of tricuspid regurgitation; in addition, it does not adequately reflect the interaction between oxygen delivery and tissue oxygen extraction. We were concerned about the underuse of mixed venous

  14. Assessment of Stroke Volume Variation Perioperatively by Using Arterial Pressure with Cardiac Output.

    PubMed

    Li, Wen-Jing; Hu, Yi-Ping; Zhu, Min-Min

    2015-07-01

    Objective To observe the sensitivity of stroke volume variation (SVV) for assessing volume change during induction period of general anesthesia.Methods Patients who underwent orthopaedic surgery under general anesthesia and mechanical ventilation were divided into two groups randomly. Patients in the group ?were subjected to progressive central hypovolemia and correction of hypovolemia sequentially; patients in the Group ? were exposed to hypervolemia alone. Each step was implemented after 5 minutes when the hemodynamics was stable. SVV and cardiac index (CI) were recorded, and Pearson's product-moment correlation was used to analyze correlation between SVV and CI.Results Forty patients were included in this study, 20 cases in each group. For group ? patients, SVV was increased significantly along with blood volume reduction, and changes in CI were negatively correlated with changes in SVV (r=-0.605, P<0.01); SVV decreased significantly along with correction of blood volume; changes in CI were negatively correlated with changes in SVV (r=-0.651, P<0.01). For group ? patients, along with blood volume increase, SVV did not change significantly; changes in CI revealed no significant correlation with changes in SVV (r=0.067, P>0.05).Conclusion SVV is a useful indicator for hypovolemia, but not for hypervolemia. PMID:26149000

  15. Cardiac output monitoring in septic shock: evaluation of the third-generation Flotrac-Vigileo.

    PubMed

    Marqué, Sophie; Gros, Antoine; Chimot, Loic; Gacouin, Arnaud; Lavoué, Sylvain; Camus, Christophe; Le Tulzo, Yves

    2013-06-01

    Continuous cardiac index (CI) monitoring is frequently used in critically ill patients. Few studies have compared the pulse contour-based device FloTrac/Vigileo to pulmonary artery thermodilution (PAC) in terms of accuracy for CI monitoring in septic shock. The aim of our study was to compare the third-generation FloTrac/Vigileo to PAC in septic shock. Eighteen patients with septic shock requiring monitoring by PAC were included in this study. We monitored CI using both FloTrac/Vigileo and continuous thermodilution (PAC-CI). Hemodynamic data were recorded every hour or every 2 min during fluid challenges. The primary endpoint was the global agreement of all CI-paired measurements determined using the Bland-Altman method adapted to replicated data. We tested the linearity of the bias by regression analysis, and compared the reactivity of the 2 techniques during fluid challenges. A receiver operating characteristic (ROC) curve analysis tested the ability of FloTrac/Vigileo to detect concordant and significative CI changes, using PAC-CI as the reference method. Overall, 1,201 paired CI measurements were recorded. The Bland-Altman analysis for global agreement of the 2 techniques showed a bias of -0.1 ± 2.1 L min(-1) m(-2) and a percentage error of 64 %. The overall correlation coefficient between PAC-CI and FloTrac/Vigileo CI was 0.47 (p < 0.01), with r(2) = 0.22. The area under the curve of the ROC curve for detecting concordant and significant changes in CI was 0.72 (0.53; 0.87). In our study, third-generation Flowtrac-Vigileo appears to be too inaccurate to be recommended for CI monitoring in septic shock. PMID:23361128

  16. Reliability of a new 4th generation FloTrac algorithm to track cardiac output changes in patients receiving phenylephrine.

    PubMed

    Ji, Fuhai; Li, Jian; Fleming, Neal; Rose, David; Liu, Hong

    2015-08-01

    Phenylephrine is often used to treat intra-operative hypotension. Previous studies have shown that the FloTrac cardiac monitor may overestimate cardiac output (CO) changes following phenylephrine administration. A new algorithm (4th generation) has been developed to improve performance in this setting. We performed a prospective observational study to assess the effects of phenylephrine administration on CO values measured by the 3rd and 4th generation FloTrac algorithms. 54 patients were enrolled in this study. We used the Nexfin, a pulse contour method shown to be insensitive to vasopressor administration, as the reference method. Radial arterial pressures were recorded continuously in patients undergoing surgery. Phenylephrine administration times were documented. Arterial pressure recordings were subsequently analyzed offline using three different pulse contour analysis algorithms: FloTrac 3rd generation (G3), FloTrac 4th generation (G4), and Nexfin (nf). One minute of hemodynamic measurements was analyzed immediately before phenylephrine administration and then repeated when the mean arterial pressure peaked. A total of 157 (4.6 ± 3.2 per patient, range 1-15) paired sets of hemodynamic recordings were analyzed. Phenylephrine induced a significant increase in stroke volume (SV) and CO with the FloTrac G3, but not with FloTrac G4 or Nexfin algorithms. Agreement between FloTrac G3 and Nexfin was: 0.23 ± 1.19 l/min and concordance was 51.1 %. In contrast, agreement between FloTrac G4 and Nexfin was: 0.19 ± 0.86 l/min and concordance was 87.2 %. In conclusion, the pulse contour method of measuring CO, as implemented in FloTrac 4th generation algorithm, has significantly improved its ability to track the changes in CO induced by phenylephrine. PMID:25267438

  17. Reduced peripheral arterial blood flow with preserved cardiac output during submaximal bicycle exercise in elderly heart failure

    PubMed Central

    2009-01-01

    Background Older heart failure (HF) patients exhibit exercise intolerance during activities of daily living. We hypothesized that reduced lower extremity blood flow (LBF) due to reduced forward cardiac output would contribute to submaximal exercise intolerance in older HF patients. Methods and Results Twelve HF patients both with preserved and reduced left ventricular ejection fraction (LVEF) (aged 68 ± 10 years) without large (aorta) or medium sized (iliac or femoral artery) vessel atherosclerosis, and 13 age and gender matched healthy volunteers underwent a sophisticated battery of assessments including a) peak exercise oxygen consumption (peak VO2), b) physical function, c) cardiovascular magnetic resonance (CMR) submaximal exercise measures of aortic and femoral arterial blood flow, and d) determination of thigh muscle area. Peak VO2 was reduced in HF subjects (14 ± 3 ml/kg/min) compared to healthy elderly subjects (20 ± 6 ml/kg/min) (p = 0.01). Four-meter walk speed was 1.35 ± 0.24 m/sec in healthy elderly verses 0.98 ± 0.15 m/sec in HF subjects (p < 0.001). After submaximal exercise, the change in superficial femoral LBF was reduced in HF participants (79 ± 92 ml/min) compared to healthy elderly (222 ± 108 ml/min; p = 0.002). This occurred even though submaximal stress-induced measures of the flow in the descending aorta (5.0 ± 1.2 vs. 5.1 ± 1.3 L/min; p = 0.87), and the stress-resting baseline difference in aortic flow (1.6 ± 0.8 vs. 1.7 ± 0.8 L/min; p = 0.75) were similar between the 2 groups. Importantly, the difference in submaximal exercise induced superficial femoral LBF between the 2 groups persisted after accounting for age, gender, body surface area, LVEF, and thigh muscle area (p ? 0.03). Conclusion During CMR submaximal bike exercise in the elderly with heart failure, mechanisms other than low cardiac output are responsible for reduced lower extremity blood flow. PMID:19922666

  18. Serotonin receptor blockade improves cardiac output and hypoxia in porcine ARDS.

    PubMed

    Sielaff, T D; Kellum, J M; Sugerman, H J; Kuemmerle, J F; Tatum, J L

    1987-08-01

    The effects of the serotonin receptor blocker, ketanserin, were studied in a porcine Pseudomonas adult respiratory distress syndrome model. Swine, weighing 14-30 kg, were anesthetized and ventilated with 0.5 FiO2 and 5 cm H2O positive end expiratory pressure. Three groups were studied: saline control (C, n = 9), continuous intravenous Pseudomonas aeruginosa, 5.0 X 10(8)CFU/kg/min (Ps, n = 8), and Pseudomonas and intravenous ketanserin, 0.2 mg/kg, given at 20 and 120 min after the onset of the Pseudomonas infusion (KET, n = 5). Pulmonary arterial (PAP) and systemic arterial (SAP) pressures, cardiac index (CI), thermal Cardio-Green extravascular lung water (EVLW), pulmonary albumin flux (slope index, SI), arterial blood gases, and whole blood serotonin levels were measured and pulmonary shunt and pulmonary (PVRI) and systemic (SVRI) vascular resistance indices were calculated. At 3 hr the Ps group demonstrated significant (P less than 0.05) increases in PAP (34 +/- 1 vs C 13 +/- 2 mm Hg), EVLW (14.4 +/- 2.2 vs C 4.3 +/- 1.2 ml/kg), SI (2.05 +/- 0.23 X 10(-3) vs C 0.38 +/- 0.09 X 10(-3) U/min), pulmonary shunt (67 +/- 15% vs C 9 +/- 3%), PVRI (1599 +/- 89 vs C 184 +/- 14 dyn X sec X cm-5/m2), and SVRI (4542 +/- 774 vs C 2087 +/- 129 dyn X sec X cm-5/m2) and decreases in CI (0.9 +/- 0.1 L/min/m2 vs C 2.8 +/- 0.2 L/min/m2), PaO2 (93 +/- 17 Torr vs C 203 +/- 15 Torr) and arterial blood serotonin concentration (23.5 +/- 13% decrease from basal). Treatment with ketanserin was associated with maintenance of PaO2 (KET 207 +/- 5 mm Hg vs C 203 +/- 15 mm Hg), pulmonary shunt (KET 8 +/- 3% vs C 9 +/- 3%), and CI (KET 2.3 +/- 0.1 L/min/m2 vs C 2.8 +/- 0.2 L/min/m2) at control levels and attenuated the Pseudomonas-induced increase in PVRI (873 +/- 37 vs Ps 1599 +/- 89 dyn X sec X cm-5/m2) and SVRI (2089 +/- 287 vs Ps 4542 +/- 774 dyn X sec X cm-5/m2), but did not alter the development of pulmonary edema. These data indicate that serotonin plays a role in the development of the V/Q mismatch and arterial hypoxemia observed in this model by a mechanism independent of changes in microvascular injury and permeability and was probably a result of reduced peripheral bronchiolar constriction. PMID:3626534

  19. First in vivo application and evaluation of a novel method for non-invasive estimation of cardiac output.

    PubMed

    Papaioannou, Theodore G; Soulis, Dimitrios; Vardoulis, Orestis; Protogerou, Athanase; Sfikakis, Petros P; Stergiopulos, Nikolaos; Stefanadis, Christodoulos

    2014-10-01

    Surgical or critically ill patients often require continuous assessment of cardiac output (CO) for diagnostic purposes or for guiding therapeutic interventions. A new method of non-invasive CO estimation has been recently developed, which is based on pressure wave analysis. However, its validity has been examined only in silico. Aim of this study was to evaluate in vivo the reproducibility and accuracy of the "systolic volume balance" method (SVB). Twenty two subjects underwent 2-D transthoracic echocardiography for CO measurement (reference value of CO). The application of SVB method required aortic pressure wave analysis and estimation of total arterial compliance. Aortic pulses were derived by mathematical transformation of radial pressure waves recorded by applanation tonometry. Total compliance was estimated by the "pulse pressure" method. The agreement, association, variability, bias and precision between Doppler and SVB measures of CO were evaluated by intraclass correlation coefficient (ICC), mean difference, SD of differences, percentage error (PR) and Bland-Altman analysis. SVB yielded very reproducible CO estimates (ICC=0.84, mean difference 0.27 ± 0.73 L/min, PR = 16.7%). SVB-derived CO was comparable with Doppler measurements, indicating a good agreement and accuracy (ICC = 0.74, mean difference = -0.22 ± 0.364 L/min, PR ? 15). The basic mathematical and physical principles of the SVB method provide highly reproducible and accurate estimates of CO compared with echocardiography. PMID:25108554

  20. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients

    PubMed Central

    Marx, Gernot; Tan, Andrew; Junker, Christopher; Van Nuffelen, Marc; Hüter, Lars; Ching, Willy; Michard, Frédéric; Vincent, Jean-Louis

    2010-01-01

    Purpose Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low. Methods Fifty-eight septic patients were included in this prospective observational study in four university-affiliated ICUs. Reference CO was measured by bolus pulmonary thermodilution (iCO) using 3–5 cold saline boluses. Simultaneously, CO was computed from the arterial pressure curve recorded on a computer using the second-generation (COG2) and third-generation (COG3) FloTrac software. CO was also measured by semi-continuous pulmonary thermodilution (CCO). Results A total of 401 simultaneous measurements of iCO, COG2, COG3, and CCO were recorded. The mean (95%CI) biases between COG2 and iCO, COG3 and iCO, and CCO and iCO were ?10 (?15 to ?5)% [?0.8 (?1.1 to ?0.4) L/min], 0 (?4 to 4)% [0 (?0.3 to 0.3) L/min], and 9 (6–13)% [0.7 (0.5–1.0) L/min], respectively. The percentage errors were 29 (20–37)% for COG2, 30 (24–37)% for COG3, and 28 (22–34)% for CCO. The difference between iCO and COG2 was significantly correlated with TSVR (r2 = 0.37, p < 0.0001). A very weak (r2 = 0.05) relationship was also observed for the difference between iCO and COG3. Conclusions In patients with sepsis, the third-generation FloTrac software is more accurate, as precise, and less influenced by TSVR than the second-generation software. Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-2098-8) contains supplementary material, which is available to authorized users. PMID:21153399

  1. Role of heart rate and stroke volume during muscle metaboreflex-induced cardiac output increase: differences between activation during and after exercise

    Microsoft Academic Search

    Antonio Crisafulli; Francesco Piras; Michele Filippi; Carlo Piredda; Paolo Chiappori; Franco Melis; Raffaele Milia; Filippo Tocco; Alberto Concu

    We hypothesized that the role of stroke volume (SV) in the metaboreflex-induced cardiac output (CO) increase was blunted when\\u000a the metaboreflex was stimulated by exercise muscle ischemia (EMI) compared with post-exercise muscle ischemia (PEMI), because\\u000a during EMI heart rate (HR) increases and limits diastolic filling. Twelve healthy volunteers were recruited and their hemodynamic\\u000a responses to the metaboreflex evoked by EMI,

  2. Estimation of cardiac output in a pharmacological trial using a simple method based on arterial blood pressure signal waveform: a comparison with pulmonary thermodilution and echocardiographic methods

    Microsoft Academic Search

    Jani Penttilä; Amir Snapir; Erkki Kentala; Juha Koskenvuo; Jussi Posti; Mika Scheinin; Harry Scheinin; Tom Kuusela

    2006-01-01

    Objective  Cardiac output (CO) has traditionally been measured using invasive techniques, which involve an element of risk. Thus, a reliable less-invasive method for determining CO would be very valuable for research use. We tested whether simple analysis of the arterial pulse waveform, not requiring large-vessel catheterisation or expensive equipment, could provide an estimate of CO that is accurate enough for pharmacological

  3. Derivation of cardiac output and alveolar ventilation rate based on energy expenditure measurements in healthy males and females.

    PubMed

    Brochu, Pierre; Brodeur, Jules; Krishnan, Kannan

    2012-08-01

    Physiologically based pharmacokinetic modeling and occupational exposure assessment studies often use minute ventilation rates (VE), alveolar ventilation rates (VA) and cardiac outputs (Q) that are not reflective of the physiological variations encountered during the aggregate daytime activities of individuals from childhood to adulthood. These variations of VE, VA and Q values were determined for healthy normal-weight individuals aged 5-96?years by using two types of published individual data that were measured in the same subjects (n?=?902), namely indirect calorimetry measurements and the disappearance rates of oral doses of deuterium (²H) and heavy-oxygen (¹?O) in urine monitored by gas-isotope-ratio mass spectrometry. Arteriovenous oxygen content differences (0.051-0.082?ml of O? consumed ml?¹ of blood) and ratios of the physiological dead space to the tidal volume (0.232-0.419) were determined for oxygen consumption rates (0.157-0.806?l min?¹) required by minute energy expenditures ranging from 0.76 to 3.91?kcal min?¹. Generally higher values for the 2.5th up to the 99th percentile for VE (0.132-0.774?l kg?¹ min?¹, 4.42-21.69?l m?² min?¹), VA (0.093-0.553?l kg?¹ min?¹, 3.09-15.53?l m?² min?¹), Q (0.065-0.330?l kg?¹ min?¹, 2.17 to 9.46?l m?² min?¹) and ventilation-perfusion ratios (1.12-2.16) were found in children and teenagers aged 5-<16.5?years compared with older individuals. The distributions of cardiopulmonary parameters developed in this study should be useful in facilitating a scientifically sound characterization of the inter-individual differences in the uptake and health risks of lipophilic air pollutants, particularly as they relate to younger children. PMID:21365669

  4. Continuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.

    PubMed

    Scolletta, Sabino; Miraldi, Fabio; Romano, Salvatore Mario; Muzzi, Luigi

    2011-07-01

    We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. Blood flow values displayed by the LVAD's console were also used for the comparison. Bland-Altman and linear regression analyses were applied. A total of 72 CO measurements (range 3.8-6.7 l/min) were obtained. Mean CO was 5.23±0.70 l/min for the 'hot' pulmonary thermodilution (ThD-CCO) method, 5.28±0.63 l/min for PRAM and 4.83±0.67 l/min for LVAD-CO. A high correlation (r=0.90), a good agreement (mean bias -0.04 l/min, precision ±0.38 l/min) and a low percentage of error (7.3%) were observed between PRAM-CO and ThD-CCO. A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD. PMID:21454314

  5. Patient-maintained analgesia with target-controlled alfentanil infusion after cardiac surgery: a comparison with morphine PCA

    Microsoft Academic Search

    M. R. CHECKETTS; C. J. GILHOOLY; G. N. C. KENNY

    Summary The performance of a patient-demand, target- controlled alfentanil infusion system was com- pared with that of a traditional morphine patient- controlled analgesia (PCA) pump in 120 adult patients after cardiac surgery. Patients were ran- domized to one of the two PCA systems for their postoperative analgesia in the intensive care unit and pain, nausea and sedation scores were recorded

  6. Cardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma.

    PubMed

    Wong, Jackson; Dorney, Kate; Hannon, Megan; Steil, Garry M

    2014-02-01

    The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA. The association between Abnormal CI on Initial CO recording and Abnormal ECG was analyzed by Fischer's exact test. Data are presented as mean ± SEM with mean differences reported with 95 % confidence interval; p < 0.05 was considered significant. Thirty-five children with critical asthma were analyzed. CI decreased from 6.2 ± 0.2 to 4.5 ± 0.1 [-1.6 (-0.04 to -0.37)] L/min/m(2) during hospitalization. There was no change in SI. There was a significant association between Abnormal Initial CI and Abnormal ECG (p = 0.02). In 11 children requiring prolonged hospitalization CI significantly decreased from 7.2 ± 0.5 to 4.0 ± 0.2 [-3.2 (-4.0 to -2.3)] L/min/m(2) and SI decreased from 51.2 ± 3.8 to 40.3 ± 2.0 [-11.0 (-17.6 to -4.4)] ml/beat/m(2) There was a significant decrease in CI in all children treated for critical asthma. In children that required a prolonged course of treatment, there was also a significant decrease in SI. Abnormal CI at Initial CO recording was associated with ST waves changes on ECG during hospitalization. Future studies are required to determine whether non-invasive CO monitoring can predict which patients are at risk for developing abnormal ECG. PMID:23873137

  7. Reduced heart rate and cardiac output differentially affect angiogenesis, growth, and development in early chicken embryos (Gallus domesticus).

    PubMed

    Branum, Sylvia R; Yamada-Fisher, Miho; Burggren, Warren

    2013-01-01

    An increase in both vascular circumferential tension and shear stress in the developing vasculature of the chicken embryo has been hypothesized to stimulate angiogenesis in the developing peripheral circulation chorioallantoic membrane (CAM). To test this hypothesis, angiogenesis in the CAM, development, and growth were measured in the early chicken embryo, following acute and chronic topical application of the purely bradycardic drug ZD7288. At hour 56, ZD7288 reduced heart rate (f(H)) by ~30% but had no significant effect on stroke volume (~0.19 ± 0.2 ?L), collectively resulting in a significant fall in cardiac output (CO) from ~27 ± 3 to 18 ± 2 ?L min(-1). Mean f(H) at 72 h of development was similarly significantly lowered by acute ZD7288 treatment (250 ?M) to 128 ± 0.3 beats min(-1), compared with 174.5 ± 0.3 and 174.7 ± 0.8 beats min(-1) in control and Pannett-Compton (P-C) saline-treated embryos, respectively. Chronic dosing with ZD7288-and the attendant decreases in f(H) and CO-did not change eye diameter or cervical flexion (key indicators of development rate) at 120 h but significantly reduced overall growth (wet and dry body mass decreased by 20%). CAM vessel density index (reflecting angiogenesis) measured 200-400 ?m from the umbilical stalk was not altered, but ZD7288 reduced vessel numbers-and therefore vessel density-by 13%-16% more distally (500-600 ?m from umbilical stalk) in the CAM. In the ZD7288-treated embryos, a decrease in vessel length was found within the second branch order (~300-400 ?m from the umbilical stock), while a decrease in vessel diameter was found closer to the umbilical stock, beginning in the first branch order (~200-300 ?m). Paradoxically, chronic application of P-C saline also reduced peripheral CAM vessel density index at 500 and 600 ?m by 13% and 7%, respectively, likely from washout of local angiogenic factors. In summary, decreased f(H) with reduced CO did not slow development rate but reduced embryonic growth rate and angiogenesis in the CAM periphery. This study demonstrates for the first time that different processes in the ontogeny of the early vertebrate embryo (i.e., hypertrophic growth vs. development) have differential sensitivities to altered convective blood flow. PMID:23629887

  8. Human cardiac stem cells exhibit mesenchymal features and are maintained through Akt/GSK-3{beta} signaling

    SciTech Connect

    Tateishi, Kento [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan)]|[Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan); Ashihara, Eishi [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan); Honsho, Shoken [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan)]|[Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan); Takehara, Naofumi [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan); Nomura, Tetsuyaital [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan)]|[Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan); Takahashi, Tomosaburo [Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan); Ueyama, Tomomi [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan); Yamagishi, Masaaki; Yaku, Hitoshi [Department of Cardiovascular Surgery, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan); Matsubara, Hiroaki [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan)]|[Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto 602-8566 (Japan)]. E-mail: matsubah@koto.kpu-m.ac.jp; Oh, Hidemasa [Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto 606-8507 (Japan)]. E-mail: hidemasa@kuhp.kyoto-u.ac.jp

    2007-01-19

    Recent evidence suggested that human cardiac stem cells (hCSCs) may have the clinical application for cardiac repair; however, their characteristics and the regulatory mechanisms of their growth have not been fully investigated. Here, we show the novel property of hCSCs with respect to their origin and tissue distribution in human heart, and demonstrate the signaling pathway that regulates their growth and survival. Telomerase-active hCSCs were predominantly present in the right atrium and outflow tract of the heart (infant > adult) and had a mesenchymal cell-like phenotype. These hCSCs expressed the embryonic stem cell markers and differentiated into cardiomyocytes to support cardiac function when transplanted them into ischemic myocardium. Inhibition of Akt pathway impaired the hCSC proliferation and induced apoptosis, whereas inhibition of glycogen synthase kinase-3 (GSK-3) enhanced their growth and survival. We conclude that hCSCs exhibit mesenchymal features and that Akt/GSK-3{beta} may be crucial modulators for hCSC maintenance in human heart.

  9. Effects of head-up tilt on mean arterial pressure, heart rate, and regional cardiac output distribution in aging rats 

    E-print Network

    Ramsey, Michael Wiechmann

    2006-04-12

    Many senescent individuals demonstrate an inability to regulate mean arterial pressure (MAP) in response to standing or head-up tilt; however, whether this aging effect is the result of depressed cardiac function or an ...

  10. Cardiac output measured by uncalibrated arterial pressure waveform analysis by recently released software version 3.02 versus thermodilution in septic shock.

    PubMed

    Slagt, Cornelis; de Leeuw, Marcel A; Beute, Jan; Rijnsburger, Emmy; Hoeksema, Martijn; Mulder, Jan W R; Malagon, Ignacio; Groeneveld, A B Johan

    2013-04-01

    To evaluate the 3.02 software version of the FloTrac/Vigileo™ system for estimation of cardiac output by uncalibrated arterial pressure waveform analysis, in septic shock. Nineteen consecutive patients in septic shock were studied. FloTrac/Vigileo™ measurements (COfv) were compared with pulmonary artery catheter thermodilution-derived cardiac output (COtd). The mean cardiac output was 7.7 L min(-1) and measurements correlated at r = 0.53 (P < 0.001, n = 314). In Bland-Altman plot for repeated measurements, the bias was 1.7 L min(-1) and 95 % limits of agreement (LA) were -3.0 to 6.5 L min(-1), with a %error of 53 %. The bias of COfv inversely related to systemic vascular resistance (SVR) (r = -0.54, P < 0.001). Above a SVR of 700 dyn s cm(-5) (n = 74), bias was 0.3 L min(-1) and 95 % LA were -1.6 to 2.2 L min(-1) (%error 32 %). Changes between consecutive measurements (n = 295) correlated at 0.67 (P < 0.001), with a bias of 0.1 % (95 % limits of agreement -17.5 to 17.0 %). All changes >10 % in both COtd and COfv (n = 46) were in the same direction. Eighty-five percent of the measurements were within the 30°-330° of the polar axis. COfv with the latest software still underestimates COtd at low SVR in septic shock. The tracking capacities of the 3.02 software are moderate-good when clinically relevant changes are considered. PMID:23154918

  11. Trending ability and limitations of transpulmonary thermodilution and pulse contour cardiac output measurement in cats as a model for pediatric patients.

    PubMed

    Kutter, Annette P N; Bektas, Rima N; Hofer, Christoph K; Larenza Menzies, M Paula; Bettschart-Wolfensberger, Regula

    2015-06-01

    The present study evaluated transpulmonary thermodilution (TPTD) and pulse contour cardiac output (PCCO) both measured by the PiCCO Plus™ monitor (Pulsion Medical Systems, Munich, Germany) against pulmonary artery thermodilution (PATD) in cats as a hemodynamic model for small children. A wide range of cardiac outputs (CO) was simultaneously measured. Accuracy and trending abilities were critically evaluated. Three cats were studied under isoflurane anesthesia and 160 CO measurements were performed with 3 mL ice-cold 5 % dextrose with PATD and TPTD. The results were compared with the PCCO measurement before the bolus measurement. Cardiac output was manipulated from 32 to 224 mL/kg/min by dobutamine, dopamine, phenylephrine, medetomidine and increased concentrations of isoflurane. Bland-Altman analysis, concordance and polar plot analysis were performed to assess accuracy and trending ability. TPTD was measuring constantly higher than PATD with a mean bias of 73 mL/kg/min and limits of agreement of 34-112 mL/kg/min, a concordance rate of 94 % and a mean polar angle of -5° with radial limits of agreement (RLOA) of 33°. Concordance rate of the PCCO versus PATD was 82 % with a mean polar angle of -10° and RLOA of 46° and versus TPTD 90 % with a mean polar angle of -6° and RLOA of 46°. Both tested methods constantly overestimated simultaneous PATD measurements. The small size, low flows and the relative short catheter not reaching the abdominal aorta may explain that. However TPTD tracked changes accurately opposed to a poor trending ability of the PCCO measurement. PMID:25228023

  12. The Transcriptional Coactivators, PGC-1? and ?, Cooperate to Maintain Cardiac Mitochondrial Function During the Early Stages of Insulin Resistance

    PubMed Central

    Mitra, Riddhi; Nogee, Daniel P.; Zechner, Juliet F.; Yea, Kyungmoo; Gierasch, Carrie M.; Kovacs, Attila; Medeiros, Denis M.; Kelly, Daniel P.; Duncan, Jennifer G.

    2012-01-01

    We previously demonstrated a cardiac mitochondrial biogenic response in insulin resistant mice that requires the nuclear receptor transcription factor PPAR?. We hypothesized that the PPAR? coactivator peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1?) is necessary for mitochondrial biogenesis in insulin resistant hearts and that this response was adaptive. Mitochondrial phenotype was assessed in insulin resistant mouse models in wild-type (WT) versus PGC-1? deficient (PGC-1??/?) backgrounds. Both high fat-fed (HFD) WT and 6 week-old Ob/Ob animals exhibited a significant increase in myocardial mitochondrial volume density compared to standard chow fed or WT controls. In contrast, HFD PGC-1??/? and Ob/Ob-PGC-1??/? hearts lacked a mitochondrial biogenic response. PGC-1? gene expression was increased in 6 week-old Ob/Ob animals, followed by a decline in 8 week-old Ob/Ob animals with more severe glucose intolerance. Mitochondrial respiratory function was increased in 6 week-old Ob/Ob animals, but not in Ob/Ob-PGC-1??/? mice and not in 8 week-old Ob/Ob animals, suggesting a loss of the early adaptive response, consistent with the loss of PGC-1? upregulation. Animals that were deficient for PGC-1? and heterozygous for the related coactivator PGC-1? (PGC-1??/??+/?) were bred to the Ob/Ob mice. Ob/Ob-PGC-1??/??+/? hearts exhibited dramatically reduced mitochondrial respiratory capacity. Finally, the mitochondrial biogenic response was triggered in H9C2 myotubes by exposure to oleate, an effect that was blunted with shRNA-mediated PGC-1 “knockdown”. We conclude that PGC-1 signaling is important for the adaptive cardiac mitochondrial biogenic response that occurs during the early stages of insulin resistance. This response occurs in a cell autonomous manner and likely involves exposure to high levels of free fatty acids. PMID:22080103

  13. The transcriptional coactivators, PGC-1? and ?, cooperate to maintain cardiac mitochondrial function during the early stages of insulin resistance.

    PubMed

    Mitra, Riddhi; Nogee, Daniel P; Zechner, Juliet F; Yea, Kyungmoo; Gierasch, Carrie M; Kovacs, Attila; Medeiros, Denis M; Kelly, Daniel P; Duncan, Jennifer G

    2012-03-01

    We previously demonstrated a cardiac mitochondrial biogenic response in insulin resistant mice that requires the nuclear receptor transcription factor PPAR?. We hypothesized that the PPAR? coactivator peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1?) is necessary for mitochondrial biogenesis in insulin resistant hearts and that this response was adaptive. Mitochondrial phenotype was assessed in insulin resistant mouse models in wild-type (WT) versus PGC-1? deficient (PGC-1?(-/-)) backgrounds. Both high fat-fed (HFD) WT and 6 week-old Ob/Ob animals exhibited a significant increase in myocardial mitochondrial volume density compared to standard chow fed or WT controls. In contrast, HFD PGC-1?(-/-) and Ob/Ob-PGC-1?(-/-) hearts lacked a mitochondrial biogenic response. PGC-1? gene expression was increased in 6 week-old Ob/Ob animals, followed by a decline in 8 week-old Ob/Ob animals with more severe glucose intolerance. Mitochondrial respiratory function was increased in 6 week-old Ob/Ob animals, but not in Ob/Ob-PGC-1?(-/-) mice and not in 8 week-old Ob/Ob animals, suggesting a loss of the early adaptive response, consistent with the loss of PGC-1? upregulation. Animals that were deficient for PGC-1? and heterozygous for the related coactivator PGC-1? (PGC-1?(-/-)?(+/-)) were bred to the Ob/Ob mice. Ob/Ob-PGC-1?(-/-)?(+/-) hearts exhibited dramatically reduced mitochondrial respiratory capacity. Finally, the mitochondrial biogenic response was triggered in H9C2 myotubes by exposure to oleate, an effect that was blunted with shRNA-mediated PGC-1 "knockdown". We conclude that PGC-1 signaling is important for the adaptive cardiac mitochondrial biogenic response that occurs during the early stages of insulin resistance. This response occurs in a cell autonomous manner and likely involves exposure to high levels of free fatty acids. PMID:22080103

  14. The feasibility and applications of non-invasive cardiac output monitoring, thromboelastography and transit-time flow measurement in living-related renal transplantation surgery: results of a prospective pilot observational study

    PubMed Central

    2014-01-01

    Introduction Delayed graft function (DGF) remains a significant and detrimental postoperative phenomenon following living-related renal allograft transplantation, with a published incidence of up to 15%. Early therapeutic vasodilatory interventions have been shown to improve DGF, and modifications to immunosuppressive regimens may subsequently lessen its impact. This pilot study assesses the potential applicability of perioperative non-invasive cardiac output monitoring (NICOM), transit-time flow monitoring (TTFM) of the transplant renal artery and pre-/perioperative thromboelastography (TEG) in the early prediction of DGF and perioperative complications. Methods Ten consecutive living-related renal allograft recipients were studied. Non-invasive cardiac output monitoring commenced immediately following induction of anaesthesia and was maintained throughout the perioperative period. Doppler-based TTFM was performed during natural haemostatic pauses in the transplant surgery: immediately following graft reperfusion and following ureteric implantation. Central venous blood sampling for TEG was performed following induction of anaesthesia and during abdominal closure. Results A single incidence of DGF was seen within the studied cohort and one intra-operative (thrombotic) complication noted. NICOM confirmed a predictable trend of increased cardiac index (CI) following allograft reperfusion (mean CI - clamped: 3.17?±?0.29 L/min/m2, post-reperfusion: 3.50?±?0.35 L/min/m2; P?

  15. Assessment of left ventricular cardiac output by arterial thermodilution technique via a left atrial catheter in a patient on a right ventricular assist device.

    PubMed

    Wiesenack, Christoph; Prasser, Christopher; Liebold, Andreas; Schmid, Franz X

    2004-01-01

    Following heart transplantation (HTx) in a 49-year old male, the patient's haemodynamic situation deteriorated in the early postoperative period despite increasing doses of catecholamines. When transoesophageal echocardiography (TEE) showed a dilated right ventricle, but adequate left ventricular (LV) function, a right ventricular assist device (RVAD) was implanted to support the right ventricle of the failing graft. Evaluation of the resulting cardiac output (CO) of the left ventricle and, thus, assessment of the remaining right ventricular function in patients supported by a RVAD is of great clinical interest. In this situation, continuous measurement of LV function, enabling assessment of the remaining right ventricular function, can be performed by pulse contour analysis following initial calibration of the system by arterial thermodilution CO measurement via a left atrial catheter. PMID:15072259

  16. Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs.

    PubMed

    Xu, Da; Olivier, N Bari; Mukkamala, Ramakrishna

    2009-02-01

    We developed a technique to continuously (i.e., automatically) monitor cardiac output (CO) and left atrial pressure (LAP) by mathematical analysis of the pulmonary artery pressure (PAP) waveform. The technique is unique to the few previous related techniques in that it jointly estimates the two hemodynamic variables and analyzes the PAP waveform over time scales greater than a cardiac cycle wherein wave reflections and inertial effects cease to be major factors. First, a 6-min PAP waveform segment is analyzed so as to determine the pure exponential decay and equilibrium pressure that would eventually result if cardiac activity suddenly ceased (i.e., after the confounding wave reflections and inertial effects vanish). Then, the time constant of this exponential decay is computed and assumed to be proportional to the average pulmonary arterial resistance according to a Windkessel model, while the equilibrium pressure is regarded as average LAP. Finally, average proportional CO is determined similar to invoking Ohm's law and readily calibrated with one thermodilution measurement. To evaluate the technique, we performed experiments in five dogs in which the PAP waveform and accurate, but highly invasive, aortic flow probe CO and LAP catheter measurements were simultaneously recorded during common hemodynamic interventions. Our results showed overall calibrated CO and absolute LAP root-mean-squared errors of 15.2% and 1.7 mmHg, respectively. For comparison, the root-mean-squared error of classic end-diastolic PAP estimates of LAP was 4.7 mmHg. On future successful human testing, the technique may potentially be employed for continuous hemodynamic monitoring in critically ill patients with pulmonary artery catheters. PMID:19057003

  17. Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs

    PubMed Central

    Xu, Da; Olivier, N. Bari; Mukkamala, Ramakrishna

    2009-01-01

    We developed a technique to continuously (i.e., automatically) monitor cardiac output (CO) and left atrial pressure (LAP) by mathematical analysis of the pulmonary artery pressure (PAP) waveform. The technique is unique to the few previous related techniques in that it jointly estimates the two hemodynamic variables and analyzes the PAP waveform over time scales greater than a cardiac cycle wherein wave reflections and inertial effects cease to be major factors. First, a 6-min PAP waveform segment is analyzed so as to determine the pure exponential decay and equilibrium pressure that would eventually result if cardiac activity suddenly ceased (i.e., after the confounding wave reflections and inertial effects vanish). Then, the time constant of this exponential decay is computed and assumed to be proportional to the average pulmonary arterial resistance according to a Windkessel model, while the equilibrium pressure is regarded as average LAP. Finally, average proportional CO is determined similar to invoking Ohm's law and readily calibrated with one thermodilution measurement. To evaluate the technique, we performed experiments in five dogs in which the PAP waveform and accurate, but highly invasive, aortic flow probe CO and LAP catheter measurements were simultaneously recorded during common hemodynamic interventions. Our results showed overall calibrated CO and absolute LAP root-mean-squared errors of 15.2% and 1.7 mmHg, respectively. For comparison, the root-mean-squared error of classic end-diastolic PAP estimates of LAP was 4.7 mmHg. On future successful human testing, the technique may potentially be employed for continuous hemodynamic monitoring in critically ill patients with pulmonary artery catheters. PMID:19057003

  18. [Summary of the consensus document: "Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery"].

    PubMed

    Pérez Vela, J L; Martín Benitez, J C; Carrasco Gonzalez, M; de la Cal López, M A; Hinojosa Pérez, R; Sagredo Meneses, V; del Nogal Saez, F

    2012-05-01

    Low cardiac output syndrome is a potential complication in cardiac surgery patients and is associated with increased morbidity and mortality. This guide provides recommendations for the management of these patients, immediately after surgery and following admission to the ICU. The recommendations are grouped into different sections, addressing from the most basic concepts such as definition of the disorder to the different sections of basic and advanced monitoring, and culminating with the complex management of this syndrome. We propose an algorithm for initial management, as well as two others for ventricular failure (predominantly left or right). Most of the recommendations are based on expert consensus, due to the lack of randomized trials of adequate design and sample size in patients of this kind. The quality of evidence and strength of the recommendations were based on the GRADE methodology. The guide is presented as a list of recommendations (with the level of evidence for each recommendation) for each question on the selected topic. For each question, justification of the recommendations is then provided. PMID:22445904

  19. In emergently ventilated trauma patients, low end-tidal CO2 and low cardiac output are associated and correlate with hemodynamic instability, hemorrhage, abnormal pupils, and death

    PubMed Central

    2013-01-01

    Background In a smaller experience, the authors previously demonstrated that end-tidal carbon dioxide (PetCO2) and cardiac output (CO) had a positive association in emergently intubated trauma patients during Emergency Department resuscitation. The aim of this larger study was to reassess the relationship of PetCO2 with CO and identify patient risk-conditions influencing PetCO2 and CO values. Methods The investigation consists of acutely injured trauma patients requiring emergency tracheal intubation. The study focuses on the prospective collection of PetCO2 and noninvasive CO monitor (NICOM®) values in the Emergency Department. Results From the end of March through August 2011, 73 patients had 318 pairs of PetCO2 (mm Hg) and CO (L/min.) values. Mean data included Injury Severity Score (ISS) ?15 in 65.2%, Glasgow Coma Score of 6.4?±?4.6, hypotension in 19.0%, and death in 34.3%. With PetCO2???25 (15.9?±?8.0), systolic blood pressure was 77.0?±?69, CO was 3.2?±?3.0, cardiac arrest was 60.4%, and mortality was 84.9%. During hypotension, CO was lower with major blood loss (1.9), than without major loss (5.0; P?=?0.0008). Low PetCO2 was associated with low CO (P??20, hypotension, bradycardia, major blood loss, abnormal pupils, cardiac arrest, and death. Low CO was associated (P???0.0059) with ISS?>?20, hypotension, bradycardia, major blood loss, abnormal pupils, cardiac arrest, and death. Conclusions During emergency department resuscitation, a decline in PetCO2 correlates with decreases in noninvasive CO in emergently intubated trauma patients. Decreasing PetCO2 and declining NICOM CO are associated with hemodynamic instability, hemorrhage, abnormal pupils, and death. The study indicates that NICOM CO values are clinically discriminate and have physiologic validity. PMID:24020798

  20. A model-free method for mass spectrometer response correction. [for oxygen consumption and cardiac output calculation

    NASA Technical Reports Server (NTRS)

    Shykoff, Barbara E.; Swanson, Harvey T.

    1987-01-01

    A new method for correction of mass spectrometer output signals is described. Response-time distortion is reduced independently of any model of mass spectrometer behavior. The delay of the system is found first from the cross-correlation function of a step change and its response. A two-sided time-domain digital correction filter (deconvolution filter) is generated next from the same step response data using a regression procedure. Other data are corrected using the filter and delay. The mean squared error between a step response and a step is reduced considerably more after the use of a deconvolution filter than after the application of a second-order model correction. O2 consumption and CO2 production values calculated from data corrupted by a simulated dynamic process return to near the uncorrupted values after correction. Although a clean step response or the ensemble average of several responses contaminated with noise is needed for the generation of the filter, random noise of magnitude not above 0.5 percent added to the response to be corrected does not impair the correction severely.

  1. Cardiac output monitoring to guide fluid replacement in head and neck microvascular free flap surgery-what is current practice in the UK?

    PubMed

    Chalmers, Alison; Turner, Matthew W H; Anand, Rajiv; Puxeddu, Roberto; Brennan, Peter A

    2012-09-01

    Appropriate fluid balance is an important factor in the survival of free flaps, and recently there has been a shift towards more conservative fluid regimens. Several surgical specialties have made extensive use of the relatively non-invasive method of measuring cardiac output (CO) to optimise fluid balance during and after surgery, which has resulted in a shorter hospital stay, but little has been published in head and neck surgery. To ascertain its use in the head and neck we sent a postal questionnaire to the anaesthetic departments of 40 major head and neck units identified from the 2010 database of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Questions were asked about the number of free flaps done in the unit each year, the monitoring of central venous and arterial blood pressure (and inotrope protocols), optimal target variables, and whether CO was monitored (with type of device). Thirty-two units responded (80%). While 26 units (81%) routinely monitored central venous pressure (CVP), CO was monitored in only 3 units (9%). There was a wide range of responses in relation to optimal variables and use of inotropes. As with other specialties, it is likely that CO monitoring will become widely used in head and neck reconstructive surgery. Not only does it enhance fluid optimisation, but it may also reduce hospital stay and morbidity. Appropriate clinical studies are urgently needed to evaluate its use in our specialty. PMID:21940078

  2. Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically Ill Patients

    PubMed Central

    Van De Vijver, Katrijn; De laet, Inneke; Schoonheydt, Karen; Dits, Hilde; Bein, Berthold; Malbrain, Manu L. N. G.

    2013-01-01

    Introduction. Nexfin (Bmeye, Amsterdam, Netherlands) is a noninvasive cardiac output (CO) monitor based on finger arterial pulse contour analysis. The aim of this study was to validate Nexfin CO (NexCO) against thermodilution (TDCO) and pulse contour CO (CCO) by PiCCO (Pulsion Medical Systems, Munich, Germany). Patients and Methods. In a mix of critically ill patients (n = 45), NexCO and CCO were measured continuously and recorded at 2-hour intervals during the 8-hour study period. TDCO was measured at 0–4–8?hrs. Results. NexCO showed a moderate to good (significant) correlation with TDCO (R2 0.68, P < 0.001) and CCO (R2 0.71, P < 0.001). Bland and Altman analysis comparing NexCO with TDCO revealed a bias (± limits of agreement, LA) of 0.4 ± 2.32?L/min (with 36% error) while analysis comparing NexCO with CCO showed a bias (±LA) of 0.2 ± 2.32?L/min (37% error). NexCO is able to follow changes in TDCO and CCO during the same time interval (level of concordance 89.3% and 81%). Finally, polar plot analysis showed that trending capabilities were acceptable when changes in NexCO (?NexCO) were compared to ?TDCO and ?CCO (resp., 89% and 88.9% of changes were within the level of 10% limits of agreement). Conclusion. we found a moderate to good correlation between CO measurements obtained with Nexfin and PiCCO. PMID:24319373

  3. I-Band Titin in Cardiac Muscle Is a Three-Element Molecular Spring and Is Critical for Maintaining Thin Filament Structure

    Microsoft Academic Search

    Wolfgang A. Linke; Diane E. Rudy; Thomas Centner; Mathias Gautel; Christian Witt; Siegfried Labeit; Carol C. Gregorio

    1999-01-01

    In cardiac muscle, the giant protein titin ex- ists in different length isoforms expressed in the mole- cule's I-band region. Both isoforms, termed N2-A and N2-B, comprise stretches of Ig-like modules separated by the PEVK domain. Central I-band titin also contains isoform-specific Ig-motifs and nonmodular sequences, notably a longer insertion in N2-B. We investigated the elastic behavior of the I-band

  4. Control model of maintainability level

    Microsoft Academic Search

    Wieslaw Tarelko

    1995-01-01

    The method of building a control model of maintainability level is presented based on using regression analysis. To carry out the structure of the model, the realization system of maintainability design is taken into account. To specify model inputs, maintainability as a complexity property of technical system is considered. Maintainability attributes are accepted as model outputs which in the synthetic

  5. Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure

    PubMed Central

    Reis, José Rosino de Araújo Rocha; Cardoso, Juliano Novaes; Cardoso, Cristina Martins dos Reis; Pereira-Barretto, Antonio Carlos

    2015-01-01

    In heart failure syndrome, myocardial dysfunction causes an increase in neurohormonal activity, which is an adaptive and compensatory mechanism in response to the reduction in cardiac output. Neurohormonal activity is initially stimulated in an attempt to maintain compensation; however, when it remains increased, it contributes to the intensification of clinical manifestations and myocardial damage. Cardiac remodeling comprises changes in ventricular volume as well as the thickness and shape of the myocardial wall. With optimized treatment, such remodeling can be reversed, causing gradual improvement in cardiac function and consequently improved prognosis. PMID:25830713

  6. Cardiac Output Responses During Exercise in Volume-Expanded Heart Transplant Recipients 1 1 This work was supported by National Institutes of Health Clinical Research Center Grant RR00082 and Dr. Braith was supported by a NIH National Research Service Award (HL08777), Bethesda, Maryland

    Microsoft Academic Search

    Randy W Braith; Mary B Plunkett; Roger M Mills

    1998-01-01

    The mechanisms responsible for immediate adjustments in cardiac output at onset of exercise, in the absence of neural drive, are not well defined in heart transplant (HT) recipients. Seven male HT recipients (mean ± SD 57 ± 6 years) and 7 age-matched sedentary normal control subjects (mean age 57 ± 5 years) performed constant load cycle exercise at 40% of

  7. Cardiac Rehabilitation

    MedlinePLUS

    ... from the NHLBI on Twitter. What Is Cardiac Rehabilitation? Cardiac rehabilitation (rehab) is a medically supervised program ... be designed to meet your needs. The Cardiac Rehabilitation Team Cardiac rehab involves a long-term commitment ...

  8. The role of cardiac sympathetic innervation and skin thermoreceptors on cardiac responses during heat stress.

    PubMed

    Shibasaki, Manabu; Umemoto, Yasunori; Kinoshita, Tokio; Kouda, Ken; Ito, Tomoyuki; Nakamura, Takeshi; Crandall, Craig G; Tajima, Fumihiro

    2015-06-01

    The mechanism(s) for the changes in cardiac function during heat stress remain unknown. This study tested two unique hypotheses. First, sympathetic innervation to the heart is required for increases in cardiac systolic function during heat stress. This was accomplished by comparing responses during heat stress between paraplegics versus tetraplegics, with tetraplegics having reduced/absent cardiac sympathetic innervation. Second, stimulation of skin thermoreceptors contributes to cardiovascular adjustments that occur during heat stress in humans. This was accomplished by comparing responses during leg only heating between paraplegic versus able-bodied individuals. Nine healthy able-bodied, nine paraplegics, and eight tetraplegics participated in this study. Lower body (i.e., nonsensed area for para/tetraplegics) was heated until esophageal temperature had increased by ?1.0°C. Echocardiographic indexes of diastolic and systolic function were performed before and at the end of heat stress. The heat stress increased cardiac output in all groups, but the magnitude of this increase was attenuated in the tetraplegics relative to the able-bodied (1.3 ± 0.4 vs. 2.3 ± 1.0 l/min; P < 0.05). Diastolic function was maintained in all groups. Indexes of left atrial and ventricular systolic function were enhanced in the able-bodied, but did not change in tetraplegics, while these changes in paraplegics were attenuated relative to the able-bodied. These data suggest that the cardiac sympathetic innervation is required to achieve normal increases in cardiac systolic function during heat stress but not required to maintain diastolic function during this exposure. Second, elevated systolic function during heat stress primarily occurs as a result of increases in internal temperature, although stimulation of skin thermoreceptors may contribute. PMID:25795714

  9. Cardiac innervation and sudden cardiac death.

    PubMed

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L; Shivkumar, Kalyanam

    2015-06-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy, and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem, and higher centers), which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes to hours), and long term (days to years). This important neurovisceral/autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death. Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extracardiac neural remodeling has also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provide a rational mechanistic basis for the development of neuraxial therapies for preventing sudden cardiac death and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  10. Applications of minimally invasive cardiac output monitors

    PubMed Central

    2012-01-01

    Because of the increasing age of the population, critical care and emergency medicine physicians have seen an increased number of critically ill patients over the last decade. Moreover, the trend of hospital closures in the United States t imposes a burden of increased efficiency. Hence, the identification of devices that facilitate accurate but rapid assessments of hemodynamic parameters without the added burden of invasiveness becomes tantamount. The purpose of this review is to understand the applications and limitations of these new technologies. PMID:22531454

  11. Non-invasive cardiac output monitoring

    Microsoft Academic Search

    D. A. Hett; M. M. Jonas

    2003-01-01

    Outcomes in the management of critically ill patients may be improved using goal directed peri-operative haemodynamic monitoring. A conservative approach may no longer be acceptable but in view of the significant morbidity associated with balloon tipped flow directed pulmonary artery catheters a non-invasive approach would be preferable. In this review we consider the different non-invasive techniques available and discuss the

  12. Non-invasive cardiac output monitoring

    Microsoft Academic Search

    D. A. Hett; M. M. Jonas

    2004-01-01

    Outcomes in the management of critically ill patients may be improved using goal-directed peri-operative haemodynamic monitoring. A conservative approach may no longer be acceptable but in view of the significant morbidity associated with balloon tipped flow directed pulmonary artery catheters a non-invasive approach would be preferable. In this review we consider the different non-invasive techniques available and discuss the advantages

  13. Cardiac Catheterization

    MedlinePLUS

    ... done during a cardiac catheterization include: closing small holes inside the heart repairing leaky or narrow heart ... bandage. It's normal for the site to be black and blue, red, or slightly swollen for a ...

  14. Cardiac Sarcoidosis

    MedlinePLUS

    ... do at National Jewish Health? We provide comprehensive cardiology evaluation and consultation and non-invasive cardiac testing. ... the whole person, not just the disease. Our cardiology team works with healthcare providers from all areas ...

  15. Cardiac catheterization and angiography, 3d Ed

    SciTech Connect

    Grossman, W.

    1986-01-01

    This textbook was first published in 1974 and subsequently revised in 1980. The current edition, in seven parts and 33 chapters, has been extensively rewritten, and new chapters have been added that present recently developed techniques. The references have been updated to 1985. The purpose of this work is to provide a concise description of the major techniques employed in cardiac catheterization and angiography. Part 1 deals with the history, general principles, and practice of cardiac catheterization and angiography. In part 2, various techniques of cardiac catheterization are discussed and compared. In part 3, techniques for the determination of cardiac output, pressure, resistance, valve area, and shunt flow are described. Part 4 deals briefly with coronary angiography, cardiac ventriculography, pulmonary angiography, and aortography. In part 5, techniques for evaluating cardiac function and intracardiac electrophysiology are presented. The characteristic hemodynamic and angiographic abnormalities in specific disorders are described in part 6. Part 7 deals with special catheter techniques.

  16. Nuclear cardiac

    SciTech Connect

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques. (KRM)

  17. Quality control systems in cardiac aging.

    PubMed

    Quarles, Ellen K; Dai, Dao-Fu; Tocchi, Autumn; Basisty, Nathan; Gitari, Lemuel; Rabinovitch, Peter S

    2015-09-01

    Cardiac aging is an intrinsic process that results in impaired cardiac function, along with cellular and molecular changes. These degenerative changes are intimately associated with quality control mechanisms. This review provides a general overview of the clinical and cellular changes which manifest in cardiac aging, and the quality control mechanisms involved in maintaining homeostasis and retarding aging. These mechanisms include autophagy, ubiquitin-mediated turnover, apoptosis, mitochondrial quality control and cardiac matrix homeostasis. Finally, we discuss aging interventions that have been observed to impact cardiac health outcomes. These include caloric restriction, rapamycin, resveratrol, GDF11, mitochondrial antioxidants and cardiolipin-targeted therapeutics. A greater understanding of the quality control mechanisms that promote cardiac homeostasis will help to understand the benefits of these interventions, and hopefully lead to further improved therapeutic modalities. PMID:25702865

  18. December 2006 MAINTAINING EFFECTIVE

    E-print Network

    December 2006 MAINTAINING EFFECTIVE INFORMATION TECHNOLOGY (IT) SECURITY THROUGH TEST, TRAINING, AND EXERCISE PROGRAMS MAINTAINING EFFECTIVE INFORMATION TECHNOLOGY (IT) SECURITY THROUGH TEST, TRAINING, AND EXERCISE PROGRAMS Shirley Radack, EditorShirley Radack, Editor Computer Security DivisionComputer Security

  19. Cardiac amyloidosis.

    PubMed

    Kingman, A; Pereira, N L

    2001-05-01

    Cardiac amyloidosis should be considered in a patient with heart failure, who is normotensive with decreased left ventricular systolic function and marked left ventricular hypertrophy by echocardiogram and has decreased voltage by ECG. Furthermore, when the diagnosis of cardiac amyloid is made, it is important to classify the subtype of disease to be able to offer appropriate treatment. Contrary to traditional belief that the prognosis for patients with amyloidosis is dismal, some forms of this disease are curable and other forms are characterized by slow progression of disease. PMID:11381776

  20. Cardiac sarcoidosis

    PubMed Central

    Smedema, J.P.; Zondervan, P.E.; van Hagen, P.; ten Cate, F.J.; Bresser, P.; Doubell, A.F.; Pattynama, P.; Hoogsteden, H.C.; Balk, A.H.M.M.

    2002-01-01

    Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology. Symptomatic cardiac involvement occurs in approximately 5% of patients. The prevalence of sarcoidosis in the Netherlands is unknown, but estimated to be approximately 20 per 100,000 population (3200 patients). We report on five patients who presented with different manifestations of cardiac sarcoidosis, and give a brief review on the current management of this condition. Magnetic Resonance Imaging (MRI) can be of great help in diagnosing this condition as well as in the follow-up of the response to therapy. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:25696121

  1. Regulatory processes interacting to maintain hepatic blood flow constancy: Vascular compliance, hepatic arterial buffer response, hepatorenal reflex, liver regeneration, escape from vasoconstriction

    PubMed Central

    Lautt, W. Wayne

    2010-01-01

    Constancy of hepatic blood flow (HBF) is crucial for several homeostatic roles. The present conceptual review focuses on interrelated mechanisms that act to maintain a constant HBF per liver mass. The liver cannot directly control portal blood flow (PF); therefore, these mechanisms largely operate to compensate for PF changes. A reduction in PF leads to reduced intrahepatic distending pressure, resulting in the highly compliant hepatic vasculature passively expelling up to 50% of its blood volume, thus adding to venous return, cardiac output and HBF. Also activated immediately upon reduction of PF are the hepatic arterial buffer response and an HBF-dependent hepatorenal reflex. Adenosine is secreted at a constant rate into the small fluid space of Mall which surrounds the terminal branches of the hepatic arterioles, portal venules and sensory nerves. The concentration of adenosine is regulated by washout into the portal venules. Reduced PF reduces the washout and the accumulated adenosine causes dilation of the hepatic artery, thus buffering the PF change. Adenosine also activates hepatic sensory nerves to cause reflex renal fluid retention, thus increasing circulating blood volume and maintaining cardiac output and PF. If these mechanisms are not able to maintain total HBF, the hemodynamic imbalance results in hepatocyte proliferation, or apoptosis, by a shear stress/nitric oxide-dependent mechanism, to adjust total liver mass to match the blood supply. These mechanisms are specific to this unique vascular bed and provide an excellent example of multiple integrative regulation of a major homeostatic organ. PMID:17854463

  2. Potential and natural output

    Microsoft Academic Search

    Giorgio Primiceri; Alejandro Justiniano

    2009-01-01

    We estimate a DSGE model with imperfectly competitive products and labor markets, and sticky prices and wages. We use the model to back out two counterfactual objects: potential output, i.e. the level of output that would prevail under perfect competition, and natural output, i.e. the level of output that would prevail with flexible prices and wages. We find that potential

  3. Aging Impairs Myocardial Fatty Acid and Ketone Oxidation and Modifies Cardiac Functional and Metabolic Responses to Insulin in Mice

    SciTech Connect

    Hyyti, Outi M.; Ledee, Dolena; Ning, Xue-Han; Ge, Ming; Portman, Michael A.

    2010-07-02

    Aging presumably initiates shifts in substrate oxidation mediated in part by changes in insulin sensitivity. Similar shifts occur with cardiac hypertrophy and may contribute to contractile dysfunction. We tested the hypothesis that aging modifies substrate utilization and alters insulin sensitivity in mouse heart when provided multiple substrates. In vivo cardiac function was measured with microtipped pressure transducers in the left ventricle from control (4–6 mo) and aged (22–24 mo) mice. Cardiac function was also measured in isolated working hearts along with substrate and anaplerotic fractional contributions to the citric acid cycle (CAC) by using perfusate containing 13C-labeled free fatty acids (FFA), acetoacetate, lactate, and unlabeled glucose. Stroke volume and cardiac output were diminished in aged mice in vivo, but pressure development was preserved. Systolic and diastolic functions were maintained in aged isolated hearts. Insulin prompted an increase in systolic function in aged hearts, resulting in an increase in cardiac efficiency. FFA and ketone flux were present but were markedly impaired in aged hearts. These changes in myocardial substrate utilization corresponded to alterations in circulating lipids, thyroid hormone, and reductions in protein expression for peroxisome proliferator-activated receptor (PPAR)? and pyruvate dehydrogenase kinase (PDK)4. Insulin further suppressed FFA oxidation in the aged. Insulin stimulation of anaplerosis in control hearts was absent in the aged. The aged heart shows metabolic plasticity by accessing multiple substrates to maintain function. However, fatty acid oxidation capacity is limited. Impaired insulin-stimulated anaplerosis may contribute to elevated cardiac efficiency, but may also limit response to acute stress through depletion of CAC intermediates.

  4. Maintaining an Arthropod Collection

    NSDL National Science Digital Library

    This article, part of Biodiversity Counts, provides insight into what it takes to maintain an arthropod collection. The article contains advice to students for setting up and maintaining a small-scale collection, including what tools are needed, safe alternatives to chemicals for killing and preserving specimens and some of the techniques the museum uses to protect specimens that students may want to adopt.

  5. Cardiac Arrhythmias

    Microsoft Academic Search

    William J. Bonney; Ra-id Abdulla

    \\u000a An initial and crucial step in managing any child with a cardiac arrhythmia is to determine the hemodynamic stability of the\\u000a child. A healthy pink color of skin\\/mucosa, brisk capillary refill, good peripheral pulses, normal blood pressure, and absence\\u000a of respiratory distress are all reassuring signs that the hemodynamic status of the child is normal or near normal. Stable\\u000a hemodynamics

  6. Working Group Report Extracorporeal circulation in non-cardiac surgery

    Microsoft Academic Search

    Dietrich E. Birnbaum

    Summary Tradition and experience of cardiopulmonary bypass in the hand of cardiac surgeons led to several spin-offs of this extracorporeal technique. Acute organ support is realized for situations of failing cardiac output, circulatory arrest respectively, of pulmonary failure and of drowning. Extracorporeal circulation is a promising adjunct to aim in better surgical technique and treatment in neurosurgery, thoracic aortic surgery,

  7. Fuzzy Controller for Automatic Drug Infusion in Cardiac Patients

    Microsoft Academic Search

    M. Logesh Kumar; R. Harikumar; A. Keerthi Vasan; V. K. Sudhaman

    2009-01-01

    Control of mean arterial blood pressure and cardiac output is highly desirable in certain operative procedures and in post cardiac operation. This paper emphasizes on a fuzzy controller to control these two variables within the present limits by administering three drugs dopamine, Sodium Nitro Prusside and Phenylephrine which perform the function of increasing heartbeat rate, decreases, increases blood pressure respectively.

  8. Increase in cardiac myosin heavy-chain (MyHC) alpha protein isoform in hibernating ground squirrels, with echocardiographic visualization of ventricular wall hypertrophy and prolonged contraction.

    PubMed

    Nelson, O Lynne; Rourke, Bryan C

    2013-12-15

    Deep hibernators such as golden-mantled ground squirrels (Callospermophilus lateralis) have multiple challenges to cardiac function during low temperature torpor and subsequent arousals. As heart rates fall from over 300 beats min(-1) to less than 10, chamber dilation and reduced cardiac output could lead to congestive myopathy. We performed echocardiography on a cohort of individuals prior to and after several months of hibernation. The left ventricular chamber exhibited eccentric and concentric hypertrophy during hibernation and thus calculated ventricular mass was ~30% greater. Ventricular ejection fraction was mildly reduced during hibernation but stroke volumes were greater due to the eccentric hypertrophy and dramatically increased diastolic filling volumes. Globally, the systolic phase in hibernation was ~9.5 times longer, and the diastolic phase was 28× longer. Left atrial ejection generally was not observed during hibernation. Atrial ejection returned weakly during early arousal. Strain echocardiography assessed the velocity and total movement distance of contraction and relaxation for regional ventricular segments in active and early arousal states. Myocardial systolic strain during early arousal was significantly greater than the active state, indicating greater total contractile movement. This mirrored the increased ventricular ejection fraction noted with early arousal. However, strain rates were slower during early arousal than during the active period, particularly systolic strain, which was 33% of active, compared with the rate of diastolic strain, which was 67% of active. As heart rate rose during the arousal period, myocardial velocities and strain rates also increased; this was matched closely by cardiac output. Curiously, though heart rates were only 26% of active heart rates during early arousal, the cardiac output was nearly 40% of the active state, suggesting an efficient pumping system. We further analyzed proportions of cardiac myosin heavy-chain (MyHC) isoforms in a separate cohort of squirrels over 5 months, including time points before hibernation, during hibernation and just prior to emergence. Hibernating individuals were maintained in both a 4°C cold room and a 20°C warm room. Measured by SDS-PAGE, relative percentages of cardiac MyHC alpha were increased during hibernation, at both hibernacula temperatures. A potential increase in contractile speed, and power, from more abundant MyHC alpha may aid force generation at low temperature and at low heart rates. Unlike many models of cardiomyopathies where the alpha isoform is replaced by the beta isoform in order to reduce oxygen consumption, ground squirrels demonstrate a potential cardioprotective mechanism to maintain cardiac output during torpor. PMID:24072796

  9. Increase in cardiac myosin heavy-chain (MyHC) alpha protein isoform in hibernating ground squirrels, with echocardiographic visualization of ventricular wall hypertrophy and prolonged contraction

    PubMed Central

    Nelson, O. Lynne; Rourke, Bryan C.

    2013-01-01

    SUMMARY Deep hibernators such as golden-mantled ground squirrels (Callospermophilus lateralis) have multiple challenges to cardiac function during low temperature torpor and subsequent arousals. As heart rates fall from over 300 beats min?1 to less than 10, chamber dilation and reduced cardiac output could lead to congestive myopathy. We performed echocardiography on a cohort of individuals prior to and after several months of hibernation. The left ventricular chamber exhibited eccentric and concentric hypertrophy during hibernation and thus calculated ventricular mass was ~30% greater. Ventricular ejection fraction was mildly reduced during hibernation but stroke volumes were greater due to the eccentric hypertrophy and dramatically increased diastolic filling volumes. Globally, the systolic phase in hibernation was ~9.5 times longer, and the diastolic phase was 28× longer. Left atrial ejection generally was not observed during hibernation. Atrial ejection returned weakly during early arousal. Strain echocardiography assessed the velocity and total movement distance of contraction and relaxation for regional ventricular segments in active and early arousal states. Myocardial systolic strain during early arousal was significantly greater than the active state, indicating greater total contractile movement. This mirrored the increased ventricular ejection fraction noted with early arousal. However, strain rates were slower during early arousal than during the active period, particularly systolic strain, which was 33% of active, compared with the rate of diastolic strain, which was 67% of active. As heart rate rose during the arousal period, myocardial velocities and strain rates also increased; this was matched closely by cardiac output. Curiously, though heart rates were only 26% of active heart rates during early arousal, the cardiac output was nearly 40% of the active state, suggesting an efficient pumping system. We further analyzed proportions of cardiac myosin heavy-chain (MyHC) isoforms in a separate cohort of squirrels over 5 months, including time points before hibernation, during hibernation and just prior to emergence. Hibernating individuals were maintained in both a 4°C cold room and a 20°C warm room. Measured by SDS-PAGE, relative percentages of cardiac MyHC alpha were increased during hibernation, at both hibernacula temperatures. A potential increase in contractile speed, and power, from more abundant MyHC alpha may aid force generation at low temperature and at low heart rates. Unlike many models of cardiomyopathies where the alpha isoform is replaced by the beta isoform in order to reduce oxygen consumption, ground squirrels demonstrate a potential cardioprotective mechanism to maintain cardiac output during torpor. PMID:24072796

  10. Maintaining Plant Genebanks

    NSDL National Science Digital Library

    Brian R. Shmaefsky (Kingwood College; )

    2003-06-02

    This lesson explores the benefits and problems of maintaining plant genebanks globally. Students can plan a genebank or agricultural cryopreservation business venture, write a biography about a famous botanist, present views at a genebank symposium for developing nations and more!

  11. Maintain Combustion Systems 

    E-print Network

    Fletcher, R. J.

    1979-01-01

    Energy is consumed, and wasted, in liberal amounts in the combustion processes which supply heat energy to boilers and process heaters. Close attention to combustion systems can be extremely beneficial: Optimum air to fuel ratios, i.e., maintaining...

  12. Modes of induced cardiac arrest: hyperkalemia and hypocalcemia - Literature review

    PubMed Central

    de Oliveira, Marcos Aurélio Barboza; Brandi, Antônio Carlos; dos Santos, Carlos Alberto; Botelho, Paulo Henrique Husseini; Cortez, José Luis Lasso; Braile, Domingo Marcolino

    2014-01-01

    The entry of sodium and calcium play a key effect on myocyte subjected to cardiac arrest by hyperkalemia. They cause cell swelling, acidosis, consumption of adenosine triphosphate and trigger programmed cell death. Cardiac arrest caused by hypocalcemia maintains intracellular adenosine triphosphate levels, improves diastolic performance and reduces oxygen consumption, which can be translated into better protection to myocyte injury induced by cardiac arrest. PMID:25372919

  13. Single Inductor Dual Output Buck Converter 

    E-print Network

    Eachempatti, Haritha

    2010-07-14

    of value 3V. The main focus areas are low cross regulation between the outputs and supply of completely independent load current levels while maintaining desired values (1.2V,1.5V) within well controlled ripple levels. Dynamic hysteresis control is used...

  14. Cardiac aquaporins.

    PubMed

    Rutkovskiy, Arkady; Valen, Guro; Vaage, Jarle

    2013-11-01

    Aquaporins are a group of proteins with high-selective permeability for water. A subgroup called aquaglyceroporins is also permeable to glycerol, urea and a few other solutes. Aquaporin function has mainly been studied in the brain, kidney, glands and skeletal muscle, while the information about aquaporins in the heart is still scarce. The current review explores the recent advances in this field, bringing aquaporins into focus in the context of myocardial ischemia, reperfusion, and blood osmolarity disturbances. Since the amount of data on aquaporins in the heart is still limited, examples and comparisons from better-studied areas of aquaporin biology have been used. The human heart expresses aquaporin-1, -3, -4 and -7 at the protein level. The potential roles of aquaporins in the heart are discussed, and some general phenomena that the myocardial aquaporins share with aquaporins in other organs are elaborated. Cardiac aquaporin-1 is mostly distributed in the microvasculature. Its main role is transcellular water flux across the endothelial membranes. Aquaporin-4 is expressed in myocytes, both in cardiac and in skeletal muscle. In addition to water flux, its function is connected to the calcium signaling machinery. It may play a role in ischemia-reperfusion injury. Aquaglyceroporins, especially aquaporin-7, may serve as a novel pathway for nutrient delivery into the heart. They also mediate toxicity of various poisons. Aquaporins cannot influence permeability by gating, therefore, their function is regulated by changes of expression-on the levels of transcription, translation (by microRNAs), post-translational modification, membrane trafficking, ubiquitination and subsequent degradation. Studies using mice genetically deficient for aquaporins have shown rather modest changes in the heart. However, they might still prove to be attractive targets for therapy directed to reduce myocardial edema and injury caused by ischemia and reperfusion. PMID:24158693

  15. Maintaining Medicinal Plant Germplasm

    Technology Transfer Automated Retrieval System (TEKTRAN)

    For all plant genetic resources collections, including medicinal plant germplasm, maintaining the genetic integrity of material held ex situ is of major importance. This holds true for all intended end uses of the material whether it is as a source for crop improvement, medical research, as voucher...

  16. Software complexity and maintainability

    Microsoft Academic Search

    Rajiv D. Banker; Srikant M. Datar; Dani Zweig

    1989-01-01

    This paper examines the relationships between software complexity and software maintainability in commercial software environments. Models are proposed for estimating the economic impacts of software complexity and for identifying the factors which affect a system's complexity. Empirical work currently under way has shown these models to be implementable.

  17. Maintaining DACUM Quality.

    ERIC Educational Resources Information Center

    Norton, Robert E.

    This document discusses the importance of maintaining the quality of DACUM (Developing a Curriculum) occupational analyses and presents a 2-page checklist detailing DACUM quality performance criteria. The introduction to the checklist discusses various "infractions" discovered during an analyses of some curriculum/program developers' attempts to…

  18. Input-Output Analysis

    Microsoft Academic Search

    Ronald E. Miller; Peter D. Blair

    This 2009 edition of Ronald Miller and Peter Blair's classic textbook is an essential reference for students and scholars in the input-output research and applications community. The book has been fully revised and updated to reflect important developments in the field since its original publication. New topics covered include SAMs (and extended input-output models) and their connection to input-output data,

  19. Role of breathing in cardiac performance: experimental and mathematical models

    NASA Astrophysics Data System (ADS)

    Tran, Binh Q.; Hoffman, Eric A.

    1999-05-01

    Due to the close proximity of the heart and lungs within a closed chest environment, we expect breathing to affect various cardiac performance parameters and hence cardiac output. We present an integrative approach to study heart-lung interactions, combining a mathematical formulation of the circulation system with imaging techniques using echo-planar magnetic resonance imaging (EPI) and dynamic x-ray CT (EBCT). We hypothesize that appropriate synchronization of mechanical ventilation to cardiac-cycle specific events can improve cardiac function, i.e. stroke volume (SV) and cardiac output (CO). Computational and experimental results support the notion that heart-lung interaction, leading to altered cardiac output associated with inspiration/expiration, is not directly associated with lung inflation/deflation and thus is felt to be more influenced by pleural pressure changes. The mathematical model of the circulation demonstrates the importance of cardiac-cycle specific timing of ventilation on cardiac function and matches with experimentally observed relationships found in animal models studied via EBCT and human studies using EPI. Results show that positive pressure mechanical ventilation timed to systolic events may increase SV and CO by up to 30%, mainly by increased filling of the ventricles during diastole. Similarly, negative pressure (spontaneous) respiration has its greatest effect on ventricular diastolic filling. Cardiac-gated mechanical ventilation may provide sufficient cardiac augmentation to warrant further investigation as a minimally-invasive technique for temporary cardiac assist. Through computational modeling and advanced imaging protocols, we were able to uniquely study heart-lung interactions within the intact milieu of the never-invaded thorax.

  20. Nuclear power plant maintainability.

    PubMed

    Seminara, J L; Parsons, S O

    1982-09-01

    In the mid-1970s a general awareness of human factors engineering deficiencies associated with power plant control rooms took shape and the Electric Power Research Institute (EPRI) awarded the Lockheed Corporation a contract to review the human factors aspects of five representative operational control rooms and their associated simulators. This investigation revealed a host of major and minor deficiencies that assumed unforeseen dimensions in the post- Three Mile Island accident period. In the course of examining operational problems (Seminara et al, 1976) and subsequently the methods for overcoming such problems (Seminara et al, 1979, 1980) indications surfaced that power plants were far from ideal in meeting the needs of maintenance personnel. Accordingly, EPRI sponsored an investigation of the human factors aspects of power plant maintainability (Seminara, 1981). This paper provides an overview of the maintainability problems and issues encountered in the course of reviewing five nuclear power plants. PMID:15676441

  1. Cardiac Output, Rates of Change and Accumulation: Unit Overview

    NSDL National Science Digital Library

    Created by Illuminations: Resources for Teaching Mathematics, this unit plan contains four lessons that explore rates of change and accumulation in the context of the amount of blood being pumped by the heart. The measurement is done from a discrete perspective, but can be easily generalized to a continuous perspective that includes use of integral calculus. The individual lessons are titled: make a conjecture, gather data, analyze the data and reflecting on your work. The author states the goal of this lesson as: "[The] rich exploration of rates of change and accumulation in context."

  2. Thermal dilution and ultrasound: alternative techniques for measuring cardiac output.

    PubMed

    1988-01-01

    We evaluated 5 TD CO units, 4 modules and 1 stand-alone, from 5 manufacturers. All units are rated Acceptable. Most of the test results met our accuracy and precision criteria; other results that demonstrated a small margin of error were still clinically useful. The utility of the TD method depends largely on proper technique, as well as the volume and temperature of the injection, number of injections, and the type of probe used. Purchasing decisions should be based primarily on the compatibility of the proposed TD units with existing physiologic monitors and whether a module or a stand-alone unit is more appropriate. PMID:3078918

  3. Reproducibility of linear cardiac output measurement by Doppler ultrasound alone

    Microsoft Academic Search

    F M McLennan; N E Haites; J D Mackenzie; M K Daniel; J M Rawles

    1986-01-01

    Inclusion of a pig aorta in an artificial circulation with pulsed blood flow allowed correlation of minute distance, measured in the aorta by Doppler ultrasound, and absolute blood flow, measured by timed blood-volume collection. The correlation coefficient was 0.99 with a standard error of prediction that was 5.4% of the minute distance predicted at a standard flow rate of 5

  4. Effects of perhexiline-induced fuel switch on the cardiac proteome and metabolome

    PubMed Central

    Yin, Xiaoke; Dwyer, Joseph; Langley, Sarah R.; Mayr, Ursula; Xing, Qiuru; Drozdov, Ignat; Nabeebaccus, Adam; Shah, Ajay M.; Madhu, Basetti; Griffiths, John; Edwards, Lindsay M.; Mayr, Manuel

    2013-01-01

    Perhexiline is a potent anti-anginal drug used for treatment of refractory angina and other forms of heart disease. It provides an oxygen sparing effect in the myocardium by creating a switch from fatty acid to glucose metabolism through partial inhibition of carnitine palmitoyltransferase 1 and 2. However, the precise molecular mechanisms underlying the cardioprotective effects elicited by perhexiline are not fully understood. The present study employed a combined proteomics, metabolomics and computational approach to characterise changes in murine hearts upon treatment with perhexiline. According to results based on difference in-gel electrophoresis, the most profound change in the cardiac proteome related to the activation of the pyruvate dehydrogenase complex. Metabolomic analysis by high-resolution nuclear magnetic resonance spectroscopy showed lower levels of total creatine and taurine in hearts of perhexiline-treated mice. Creatine and taurine levels were also significantly correlated in a cross-correlation analysis of all metabolites. Computational modelling suggested that far from inducing a simple shift from fatty acid to glucose oxidation, perhexiline may cause complex rebalancing of carbon and nucleotide phosphate fluxes, fuelled by increased lactate and amino acid uptake, to increase metabolic flexibility and to maintain cardiac output. This article is part of a Special Issue entitled "Focus on Cardiac Metabolism". PMID:23277191

  5. Does PKM? maintain memory?

    PubMed Central

    Kwapis, Janine L.; Helmstetter, Fred J.

    2013-01-01

    Work on the long-term stability of memory has identified a potentially critical role for protein kinase Mzeta (PKM?) in maintaining established memory. PKM?, an autonomously active isoform of PKC, is hypothesized to sustain those changes that occurred during memory formation in order to preserve the memory engram over time. Initial studies investigating the role of PKM? were largely successful in demonstrating a role for the kinase in memory maintenance; disrupting PKM? activity with ?-inhibitory peptide (ZIP) was successful in disrupting a variety of established associations in a number of key brain regions. More recent work, however, has questioned both the role of PKM? in memory maintenance and the effectiveness of ZIP as a specific inhibitor of PKM? activity. Here, we outline the research both for and against the idea that PKM? is a memory maintenance mechanism and discuss how these two lines of research can be reconciled. We conclude by proposing a number of studies that would help to clarify the role of PKM? in memory and define other mechanisms the brain may use to maintain memory. PMID:24076105

  6. The relationship between power output and endurance: a brief review

    Microsoft Academic Search

    R. Hugh Morton; David J. Hodgson

    1996-01-01

    It is well established that for work requiring high power output, endurance time is short, and that low power outputs can be maintained for long periods. Parameters describing this relationship are important in characterising work performance and the capacity of humans as a source of mechanical power. The purpose of this paper is to provide a brief review of the

  7. Visualization of Model Output

    NSDL National Science Digital Library

    Visualization of output from mathematical or statistical models is one of the best ways to introduce introductory geoscience students to the results and behavior of sophisticated models. Example of good sites ...

  8. Reagan: Maintain Antarctic program

    NASA Astrophysics Data System (ADS)

    Richman, Barbara T.

    President Ronald Reagan has decided that the United States should maintain an ‘active and influential presence’ in Antarctica to support the nation's interests. Following a review of a study by the Antarctica Policy Group, Reagan issued a memorandum, dated February 5, to the heads of 14 government agencies, including the National Science Foundation (NSF), the Office of Science and Technology Policy, and the Office of Management and Budget.The U.S. presence in Antarctica ‘shall include the conduct of scientific activities in major disciplines; year-round occupation of the South Pole and two coastal stations; and availability of related necessary logistics support,’ wrote the President. In addition, NSF should continue to budget for the entire U.S. program in Antarctica. Short-term programs by other agencies require the recommendation of the Antarctica Policy Group and should be coordinated within the framework of NSF logistics support.

  9. Cardiac arrest management

    Microsoft Academic Search

    Richard V. Aghababian; Gregory Mears; Joseph P. Ornato; Peter J. Kudenchuk

    2001-01-01

    Approximately 1,000 people in the United States suffer cardiac arrest each day, most often as a complication of acute myocardial infarction (AMI) with accompanying ventricular fibrillation or unstable ventricular tachycardia. Increasing the number of patients who survive cardiac arrest and minimizing the clinical sequelae associated with cardiac arrest in those who do survive are the objectives of emergency medical personnel.

  10. Titin-mediated control of cardiac myofibrillar function.

    PubMed

    Hanft, Laurin M; Greaser, Marion L; McDonald, Kerry S

    2014-06-15

    According to the Frank-Starling relationship, ventricular pressure or stroke volume increases with end-diastolic volume. This is regulated, in large part, by the sarcomere length (SL) dependent changes in cardiac myofibrillar force, loaded shortening, and power. Consistent with this, both cardiac myofibrillar force and absolute power fall at shorter SL. However, when Ca(2+) activated force levels are matched between short and long SL (by increasing the activator [Ca(2+)]), short SL actually yields faster loaded shortening and greater peak normalized power output (PNPO). A potential mechanism for faster loaded shortening at short SL is that, at short SL, titin becomes less taut, which increases the flexibility of the cross-bridges, a process that may be mediated by titin's interactions with thick filament proteins. We propose a more slackened titin yields greater myosin head radial and azimuthal mobility and these flexible cross-bridges are more likely to maintain thin filament activation, which would allow more force-generating cross-bridges to work against a fixed load resulting in faster loaded shortening. We tested this idea by measuring SL-dependence of power at matched forces in rat skinned cardiac myocytes containing either N2B titin or a longer, more compliant N2BA titin. We predicted that, in N2BA titin containing cardiac myocytes, power-load curves would not be shifted upward at short SL compared to long SL (when force is matched). Consistent with this, peak normalized power was actually less at short SL versus long SL (at matched force) in N2BA-containing myocytes (N2BA titin: ?PNPO (Short SL peak power minus long SL peak power)=-0.057±0.049 (n=5) versus N2B titin: ?PNPO=+0.012±0.012 (n=5). These findings support a model whereby SL per se controls mechanical properties of cross-bridges and this process is mediated by titin. This myofibrillar mechanism may help sustain ventricular power during periods of low preloads, and perhaps a breakdown of this mechanism is involved in impaired function of failing hearts. PMID:24269766

  11. Role of breathing in cardiac performance: experimental and mathematical models

    Microsoft Academic Search

    Binh Q. Tran; Eric A. Hoffman

    1999-01-01

    Due to the close proximity of the heart and lungs within a closed chest environment, we expect breathing to affect various cardiac performance parameters and hence cardiac output. We present an integrative approach to study heart-lung interactions, combining a mathematical formulation of the circulation system with imaging techniques using echo-planar magnetic resonance imaging (EPI) and dynamic x-ray CT (EBCT). We

  12. Temperature maintained battery system

    SciTech Connect

    Newman, W.A.

    1980-10-21

    A chassis contains a battery charger connected to a multi-cell battery. The charger receives direct current from an external direct current power source and has means to automatically selectively charge the battery in accordance with a preselected charging program relating to temperature adjusted state of discharge of the battery. A heater device is positioned within the chassis which includes heater elements and a thermal switch which activates the heater elements to maintain the battery above a certain predetermined temperature in accordance with preselected temperature conditions occurring within the chassis. A cooling device within the chassis includes a cooler regulator, a temperature sensor, and peltier effect cooler elements. The cooler regulator activates and deactivates the peltier cooler elements in accordance with preselected temperature conditions within the chassis sensed by the temperature sensor. Various vehicle function circuitry may also be positioned within the chassis. The contents of the chassis are positioned to form a passage proximate the battery in communication with an inlet and outlet in the chassis to receive air for cooling purposes from an external source.

  13. Controlled Cardiac Computed Tomography

    PubMed Central

    Wang, Chenglin; Liu, Ying; Wang, Ge

    2006-01-01

    Cardiac computed tomography (CT) has been a hot topic for years because of the clinical importance of cardiac diseases and the rapid evolution of CT systems. In this paper, we propose a novel strategy for controlled cardiac CT that may effectively reduce image artifacts due to cardiac and respiratory motions. Our approach is radically different from existing ones and is based on controlling the X-ray source rotation velocity and powering status in reference to the cardiac motion. We theoretically show that by such a control-based intervention the data acquisition process can be optimized for cardiac CT in the cases of periodic and quasiperiodic cardiac motions. Specifically, we formulate the corresponding coordination/control schemes for either exact or approximate matches between the ideal and actual source positions, and report representative simulation results that support our analytic findings. PMID:23165017

  14. Diodes stabilize LED output

    NASA Technical Reports Server (NTRS)

    Deters, R. A.

    1977-01-01

    Small-signal diodes are placed in series with light-emitting diodes (LED's) to stabilize LED output against temperature fluctuations. Simple inexpensive method compensates for thermal fluctuations over a broad temperature range. Requiring few components, technique is particularly useful where circuit-board space is limited.

  15. Input/Output Trends.

    ERIC Educational Resources Information Center

    Mitchell, J.

    This paper discusses batch processing; and on-line, time-sharing operations, and their associate input/output equipment. Special emphasis is placed on electronic display equipment. It concludes that future equipment trends will allow the user more and easier access to the machine he uses. (Author)

  16. Convergence in International Output

    Microsoft Academic Search

    Andrew B. Bernard; Steven N. Durlauf

    1995-01-01

    This paper proposes and tests new definitions of convergence and common trends for per capita output. We define convergence for a group of countries to mean that each country has identical long-run trends, either stochastic, while common trends allow for proportionality of the stochastic elements. These definitions lead naturally to the use of cointegration techniques in testing. Using century-long time

  17. AN INTEGRATEDMICROELECTROMECHANICALRESONANT OUTPUT GYROSCOPE -

    E-print Network

    Tang, William C

    AN INTEGRATEDMICROELECTROMECHANICALRESONANT OUTPUT GYROSCOPE - Ashwin A. Seshia*,Roger T. Howe vibratory rate gyroscope based on resonant sensing of the Coriolis force. The new design has several advantages over rate gyroscopes that utilize open-loop displacement sensing for rotation rate measurement

  18. programming input/output

    E-print Network

    Liu, Yanhong Annie

    would ML fit in? COBOL and ML could safely be put down far apart. The in­ put/output facilities in COBOL to the verbose COBOL and ML is much better suited for structuring data and algorithms than COBOL is. ML is closer

  19. Reversing Heart Failure: Diastolic Recoil in a Proposed Cardiac Support Device

    E-print Network

    Snowden, Timothy D

    2012-07-11

    Congestive heart failure (CHF) holds millions in the grip of an endless cycle of decreased cardiac output and degenerative remodeling, often with little hope of recovery. Diastolic dysfunction, or failure of the heart to properly fill, is a...

  20. Reversing Heart Failure: Diastolic Recoil in a Proposed Cardiac Support Device 

    E-print Network

    Snowden, Timothy D

    2012-07-11

    Congestive heart failure (CHF) holds millions in the grip of an endless cycle of decreased cardiac output and degenerative remodeling, often with little hope of recovery. Diastolic dysfunction, or failure of the heart to properly fill, is a...

  1. Cardiac Oxidative Stress Is Elevated at the Onset of Dilated Cardiomyopathy in Streptozotocin-Diabetic Rats

    Microsoft Academic Search

    María J. Crespo; Joaquin Zalacaín; Donald C. Dunbar; Nildris Cruz; Lucy Arocho

    2008-01-01

    The association between nitric oxide synthase (eNOS and iNOS) status, oxidative stress, and cardiac function was evaluated in streptozotocin (STZ)-diabetic rats to understand the etiology of diabetic cardiomyopathy. Cardiac function was determined by echocardiography. eNOS and iNOS status and superoxide production were assessed by immunohistochemistry and chemiluminescence, respectively. In STZ-diabetic rats, stroke volume, cardiac output, and left ventricular ejection fraction

  2. Cardiac output and cardiac contractility by impedance cardiography during exercise of runners

    NASA Technical Reports Server (NTRS)

    Kubicek, W. G.; Tracy, R. A.

    1994-01-01

    Most of the solid state electronic engineering of the system now generally known as the Minnesota Impedance Cardiograph was performed with the support of a five-year contract, NAS9-4500, with the NASA Lyndon B. Johnson Space Center, Houston, Texas. This contract ran from 1965 to 1970. In addition to the engineering design and development of the hardware, the contract called for testing on both animals and human subjects. This project also provided funds to construct twenty impedance cardiographs and place them in selected research and clinical facilities for further evaluation. This, then, led to the First Symposium on Impedance Cardiography, held at the NASA Lyndon B. Johnson Space Center, Houston, Texas, 2-4 June 1969. Twenty-four excellent papers were presented.

  3. Thrombospondin-1 and CD47 regulate blood pressure and cardiac responses to vasoactive stress

    E-print Network

    Frazier, William A.

    Thrombospondin-1 and CD47 regulate blood pressure and cardiac responses to vasoactive stress Jeff S pressure Cardiac output Nitric oxide (NO) locally regulates vascular resistance and blood pressure-associated increases in heart rate, central diastolic and mean arterial blood pressure and a constant decrease in pulse

  4. Multi-Variate Visualization of Cardiac Virtual Tissue J W Handley

    E-print Network

    Brodlie, Ken

    Multi-Variate Visualization of Cardiac Virtual Tissue J W Handley K W Brodlie School of Computing United Kingdom r.clayton@dcs.shef.ac.uk Abstract In standard analysis of cardiac models, typically one visualizing the output of the model. In this paper, we present a novel approach to visualizing the entire

  5. Acute Hemodynamic Changes After Rapid Intravenous Bolus Dosing of Dexmedetomidine in Pediatric Heart Transplant Patients Undergoing Routine Cardiac Catheterization

    PubMed Central

    Jooste, EH; Muhly, WT; Ibinson, JW; Suresh, T; Damian, D; Phadke, A; Callahan, P; Miller, S; Feingold, B; Lichtenstein, SE; Cain, JG; Chrysostomou, C; Davis, PJ

    2011-01-01

    Introduction Dexmedetomidine is a highly selective ?2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central ?2A and imidazoline type 1 receptors while activation of peripheral ?2B–adrenoceptors result in an increase in arterial blood pressure and systemic vascular resistance (SVR). In this randomized, prospective, clinical study we attempted to quantify the short-term hemodynamic effects resulting from a rapid IV bolus administration of dexmedetomidine in pediatric cardiac transplant patients. Methods Twelve patients, aged ?10 years of age, weighing ?40kg, presenting for routine surveillance of right and left heart cardiac catheterization after cardiac transplantation were enrolled. After an inhaled or IV induction, the tracheas were intubated and anesthesia was maintained with 1 minimum alveolar concentration of isoflurane in room air, fentanyl (1mcg/kg) and rocuronium (1mg/kg). At the completion of the planned cardiac catheterization, 100% oxygen was administered. After recording a set of baseline values that included heart rate (HR), systolic blood pressure, diastolic blood pressure, central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and thermodilution-based cardiac output, a rapid IV dexmedetomidine bolus of either 0.25mcg/kg or 0.5mcg/kg was administered over 5 seconds. The hemodynamic measurements were repeated at 1 min and 5 mins. Results There were 6 patients in each group. Investigation suggested that systolic blood pressure, diastolic blood pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and systemic vascular resistance all increased at 1 minute after rapid IV bolus for both doses, and decreased significantly to near baseline for both doses by 5 minutes. The transient increase in pressures was more pronounced in the systemic system than in the pulmonary system. In the systemic system there was a larger percent increase in the diastolic pressures than the systolic pressures. Cardiac output, CVP and pulmonary vascular resistance did not change significantly. HR decreased at 1 min for both doses and was, within the 0.5 mcg/kg group, the only hemodynamic variable still changed from baseline at the 5 min time point Conclusion Rapid IV bolus administration of dexmedetomidine in this small sample of children having undergone heart transplants was clinically well tolerated, although it resulted in a transient but significant increase in systemic and pulmonary pressure and a decrease in HR. In the systemic system there is a larger percent increase in the diastolic pressures than the systolic pressures, and furthermore these transient increases in pressures were more pronounced in the systemic system than in the pulmonary system. PMID:21059743

  6. Salacia oblonga root improves cardiac lipid metabolism in Zucker diabetic fatty rats: Modulation of cardiac PPAR-?-mediated transcription of fatty acid metabolic genes

    Microsoft Academic Search

    Tom Hsun-Wei Huang; Qinglin Yang; Masaki Harada; Jasna Uberai; Jane Radford; George Q. Li; Johji Yamahara; Basil D. Roufogalis; Yuhao Li

    2006-01-01

    Excess cardiac triglyceride accumulation in diabetes and obesity induces lipotoxicity, which predisposes the myocytes to death. On the other hand, increased cardiac fatty acid (FA) oxidation plays a role in the development of myocardial dysfunction in diabetes. PPAR-? plays an important role in maintaining homeostasis of lipid metabolism. We have previously demonstrated that the extract from Salacia oblonga root (SOE),

  7. Hyperplastic cardiac sarcoma recurrence.

    PubMed

    Shariff, Masood A; Abreu, Juan A; Durrani, Farida; Daniele, Eddie; Bowman, Kimberly C; Sadel, Scott; Asgarian, Kourosh T; McGinn, Joseph T; Nabagiez, John P

    2015-01-01

    Primary cardiac sarcomas are rare tumors with a median survival of 6-12 months. Data suggest that an aggressive multidisciplinary approach may improve patient outcome. We present the case of a male who underwent resection of cardiac sarcoma three times from the age of 32 to 34. This report discusses the malignant nature of cardiac sarcoma and the importance of postoperative multidisciplinary care. PMID:25861508

  8. THE CARDIOVASCULAR RESPONSES OF THE RED-EARED SLIDER (TRACHEMYS SCRIPTA) ACCLIMATED TO EITHER 22 OR 5 °C I. EFFECTS OF ANOXIC EXPOSURE ON IN VIVO CARDIAC PERFORMANCE

    Microsoft Academic Search

    J. M. T. HICKS; A. P. FARRELL

    The extreme anoxia-tolerance of freshwater turtles under cold conditions is well documented, but little is known about their cardiac performance in such situations. Using chronic catheterization techniques, we measured systemic cardiac power output (POsys), systemic cardiac output (Q. sys), heart rate (fH), systemic stroke volume (Vs,sys), systemic resistance (Rsys) and mean arterial pressure (Psys) in red-eared sliders (Trachemys scripta). The

  9. Cardiac effects of 3-iodothyronamine: a new aminergic system modulating cardiac function

    Microsoft Academic Search

    Grazia Chiellini; Sabina Frascarelli; Sandra Ghelardoni; Vittoria Carnicelli; Sandra C. Tobias; Andrea DeBarber; Simona Brogioni; Simonetta Ronca-Testoni; Elisabetta Cerbai; David K. Grandy; Thomas S. Scanlan; Riccardo Zucchi

    2007-01-01

    iodothyronamine T1AM is a novel en- dogenous thyroid hormone derivative that activates the G protein-coupled receptor known as trace anime- associated receptor 1 (TAAR1). In the isolated working rat heart and in rat cardiomyocytes, T1AM produced a reversible, dose-dependent negative inotropic effect (e.g. ,2 75, 513, and 652% decrease in cardiac output at 19, 25, and 38 M concentration, respec-

  10. Cardiac risk telemonitoring

    Microsoft Academic Search

    H. Hutten; M. Hribernigg; G. Rauchegger

    2001-01-01

    Utilization of advanced information, telecommunication and implant technology for cardiac risk stratification and management is one of the greatest challenges for modern health care provision. Sudden cardiac death is the major contributor to overall cardiovascular mortality with approximately 60% of all coronary heart disease fatalities occurring annually. Although some high-risk patient groups have been identified with reasonable sensitivity and specificity

  11. Garfinkel Cardiac Data

    NSDL National Science Digital Library

    Alan Garfinkel (University of California Los Angeles; Physiological Sci/Med-Cardio)

    2009-01-10

    Cardiac data on multiple variables for a selected population of 220 men and 338 women participating in a drug treatment study of dobutamine for heart attack prevention. Garfinkel, Alan, et. al. "Prognostic Value of Dobutamine Stress Echocardiography in Predicting Cardiac Events in Patients With Known or Suspected Coronary Artery Disease." Journal of the American College of Cardiology 33.3 (1999) 708-16.

  12. Living cardiac tissue slices: an organotypic pseudo two-dimensional model for cardiac biophysics research.

    PubMed

    Wang, Ken; Terrar, Derek; Gavaghan, David J; Mu-U-Min, Razik; Kohl, Peter; Bollensdorff, Christian

    2014-08-01

    Living cardiac tissue slices, a pseudo two-dimensional (2D) preparation, have received less attention than isolated single cells, cell cultures, or Langendorff-perfused hearts in cardiac biophysics research. This is, in part, due to difficulties associated with sectioning cardiac tissue to obtain live slices. With moderate complexity, native cell-types, and well-preserved cell-cell electrical and mechanical interconnections, cardiac tissue slices have several advantages for studying cardiac electrophysiology. The trans-membrane potential (Vm) has, thus far, mainly been explored using multi-electrode arrays. Here, we combine tissue slices with optical mapping to monitor Vm and intracellular Ca(2+) concentration ([Ca(2+)]i). This combination opens up the possibility of studying the effects of experimental interventions upon action potential (AP) and calcium transient (CaT) dynamics in 2D, and with relatively high spatio-temporal resolution. As an intervention, we conducted proof-of-principle application of stretch. Mechanical stimulation of cardiac preparations is well-established for membrane patches, single cells and whole heart preparations. For cardiac tissue slices, it is possible to apply stretch perpendicular or parallel to the dominant orientation of cells, while keeping the preparation in a constant focal plane for fluorescent imaging of in-slice functional dynamics. Slice-to-slice comparison furthermore allows one to assess transmural differences in ventricular tissue responses to mechanical challenges. We developed and tested application of axial stretch to cardiac tissue slices, using a manually-controlled stretching device, and recorded Vm and [Ca(2+)]i by optical mapping before, during, and after application of stretch. Living cardiac tissue slices, exposed to axial stretch, show an initial shortening in both AP and CaT duration upon stretch application, followed in most cases by a gradual prolongation of AP and CaT duration during stretch maintained for up to 50 min. After release of sustained stretch, AP duration (APD) and CaT duration reverted to shorter values. Living cardiac tissue slices are a promising experimental model for the study of cardiac mechano-electric interactions. The methodology described here can be refined to achieve more accurate control over stretch amplitude and timing (e.g. using a computer-controlled motorised stage, or by synchronising electrical and mechanical events) and through monitoring of regional tissue deformation (e.g. by adding motion tracking). PMID:25124067

  13. Cardiac fiber unfolding by semidefinite programming.

    PubMed

    Li, Hongying; Robini, Marc C; Yang, Feng; Magnin, Isabelle; Zhu, Yuemin

    2015-02-01

    Diffusion-tensor imaging allows noninvasive assessment of the myocardial fiber architecture, which is fundamental in understanding the mechanics of the heart. In this context, tractography techniques are often used for representing and visualizing cardiac fibers, but their output is only qualitative. We introduce here a new framework toward a more quantitative description of the cardiac fiber architecture from tractography results. The proposed approach consists in taking three-dimensional (3-D) fiber tracts as inputs, and then unfolding these fibers in the Euclidean plane under local isometry constraints using semidefinite programming. The solution of the unfolding problem takes the form of a Gram matrix which defines the two-dimensional (2-D) embedding of the fibers and whose spectrum provides quantitative information on their organization. Experiments on synthetic and real data show that unfolding makes it easier to observe and to study the cardiac fiber architecture. Our conclusion is that 2-D embedding of cardiac fibers is a promising approach to supplement 3-D rendering for understanding the functioning of the heart. PMID:25291787

  14. Matrix metalloproteinase expression in cardiac myocytes following myocardial infarction in the rabbit

    Microsoft Academic Search

    Anne M. Romanic; Cynthia L. Burns-Kurtis; Bernard Gout; Isabelle Berrebi-Bertrand; Eliot H. Ohlstein

    2001-01-01

    Myocardial infarction (MI), leads to cardiac remodeling, thinning of the ventricle wall, ventricular dilation, and heart failure, and is a leading cause of death. Interactions between the contractile elements of the cardiac myocytes and the extracellular matrix (ECM) help maintain myocyte alignment required for the structural and functional integrity of the heart. Following MI, reorganization of the ECM and the

  15. Reuse of permanent cardiac pacemakers.

    PubMed Central

    Rosengarten, M D; Portnoy, D; Chiu, R C; Paterson, A K

    1985-01-01

    Cardiac pacemakers are part of a growing group of expensive implantable electronic devices; hospitals in which 100 pacemakers are implanted per year must budget over $300 000 for these devices. This cost represents a considerable burden to health care resources. Since the "life-span" of modern pacemakers often exceeds that of the patients who receive them, the recovery and reuse of these devices seems logical. Pacemakers can be resterilized and tested with current hospital procedures. Reuse should be acceptable under Canadian law, but the manner in which the pacemakers are recovered and the patients selected should follow careful guidelines. Every patient should provide written informed consent before receiving a recovered pacemaker. Properly executed, reuse of pacemakers should provide a high level of health care while maintaining or reducing the cost of these devices. PMID:4016637

  16. Neurons within the same network independently achieve conserved output by differentially balancing variable conductance magnitudes.

    PubMed

    Ransdell, Joseph L; Nair, Satish S; Schulz, David J

    2013-06-12

    Biological and theoretical evidence suggest that individual neurons may achieve similar outputs by differentially balancing variable underlying ionic conductances. Despite the substantial amount of data consistent with this idea, a direct biological demonstration that cells with conserved output, particularly within the same network, achieve these outputs via different solutions has been difficult to achieve. Here we demonstrate definitively that neurons from native neural networks with highly similar output achieve this conserved output by differentially tuning underlying conductance magnitudes. Multiple motor neurons of the crab (Cancer borealis) cardiac ganglion have highly conserved output within a preparation, despite showing a 2-4-fold range of conductance magnitudes. By blocking subsets of these currents, we demonstrate that the remaining conductances become unbalanced, causing disparate output as a result. Therefore, as strategies to understand neuronal excitability become increasingly sophisticated, it is important that such variability in excitability of neurons, even among those within the same individual, is taken into account. PMID:23761890

  17. Image quality based x-ray dose control in cardiac imaging

    NASA Astrophysics Data System (ADS)

    Davies, Andrew G.; Kengyelics, Stephen M.; Gislason-Lee, Amber J.

    2015-03-01

    An automated closed-loop dose control system balances the radiation dose delivered to patients and the quality of images produced in cardiac x-ray imaging systems. Using computer simulations, this study compared two designs of automatic x-ray dose control in terms of the radiation dose and quality of images produced. The first design, commonly in x-ray systems today, maintained a constant dose rate at the image receptor. The second design maintained a constant image quality in the output images. A computer model represented patients as a polymethylmetacrylate phantom (which has similar x-ray attenuation to soft tissue), containing a detail representative of an artery filled with contrast medium. The model predicted the entrance surface dose to the phantom and contrast to noise ratio of the detail as an index of image quality. Results showed that for the constant dose control system, phantom dose increased substantially with phantom size (x5 increase between 20 cm and 30 cm thick phantom), yet the image quality decreased by 43% for the same thicknesses. For the constant quality control, phantom dose increased at a greater rate with phantom thickness (>x10 increase between 20 cm and 30 cm phantom). Image quality based dose control could tailor the x-ray output to just achieve the quality required, which would reduce dose to patients where the current dose control produces images of too high quality. However, maintaining higher levels of image quality for large patients would result in a significant dose increase over current practice.

  18. Early goal-directed therapy in moderate to high-risk cardiac surgery patients.

    PubMed

    Kapoor, Poonam Malhotra; Kakani, Madhava; Chowdhury, Ujjwal; Choudhury, Minati; Lakshmy; Kiran, Usha

    2008-01-01

    Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE >or=3 undergoing coronary artery bypass surgery under cardiopulmonary bypass. The patients were randomly divided into two groups, namely, control and early goal-directed therapy (EGDT) groups. All the subjects received standardized care; arterial pressure was monitored through radial artery, central venous pressure through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour and frequent arterial blood gas analysis. In addition, cardiac index monitoring using FloTrac and continuous central venous oxygen saturation using PreSep was used in patients in the EGTD group. Our aim was to maintain the cardiac index at 2.5-4.2 l/min/m2 , stroke volume index 30-65 ml/beat/m2 , systemic vascular resistance index 1500-2500 dynes/s/cm5/m2 , oxygen delivery index 450-600 ml/min/m2 , continuous central venous oximetry more than 70%, stroke volume variation less than 10%; in addition to the control group parameters such as central venous pressure 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal arterial blood gas analysis values, pulse oximetry, hematocrit value above 30% and urine output more than 1 ml/kg/h. The aims were achieved by altering the administration of intravenous fluids and doses of inotropic or vasodilator agents. Three patients were excluded from the study and the data of 27 patients analyzed. The extra volume used (330+/-160 v/s 80+/-80 ml, P=0.043) number of adjustments of inotropic agents (3.4+/-1.5 v/s 0.4+/-0.7, P=0.026) in the EGDT group were significant. The average duration of ventilation (13.8+/-3.2 v/s 20.7+/-7.1 h), days of use of inotropic agents (1.6+/-0.9 v/s 3.8+/-1.6 d), ICU stay (2.6+/-0.9 v/s 4.9+/-1.8 d) and hospital stay (5.6+/-1.2 v/s 8.9+/-2.1 d) were less in the EGDT group, compared to those in the control group. This study is inconclusive with regard to the beneficial aspects of the early goal-directed therapy in cardiac surgery patients, although a few benefits were observed. PMID:18182756

  19. Peru struggles to maintain crude production

    SciTech Connect

    Not Available

    1991-01-14

    Revival of Peru's moribund oil and gas industry in the 1990s hinges on whether the new administration of President Alberto Fujimori is successful in attracting foreign investment in Peru. Fujimori's success would mean Peru pushing ahead into stepped up exploration and major development projects, such as the huge Camisea gas/condensate field discovered 2 years ago. His failure could mean Peru continuing to fall further behind in its already lagging low oil production. Huge sums of money will be needed. Peru also needs to succeed in its efforts to become creditworthy again for international agencies, foreign governments, and commercial banks. Meanwhile, Petroleos del Peru SA (Petroperu), the state oil company, will have to transfer an increasing share of its operations to private investors. But the company is likely to try to hold onto producing fields, even though it is unable to maintain full output.

  20. Modeling inherited cardiac disorders.

    PubMed

    Sallam, Karim; Kodo, Kazuki; Wu, Joseph C

    2014-01-01

    Advances in the understanding and treatment of cardiac disorders have been thwarted by the inability to study beating human cardiac cells in vitro. Induced pluripotent stem cells (iPSCs) bypass this hurdle by enabling the creation of patient-specific iPSC-derived cardiomyocytes (iPSC-CMs). These cells provide a unique platform to study cardiac diseases in vitro, especially hereditary cardiac conditions. To date, iPSC-CMs have been used to successfully model arrhythmic disorders, showing excellent recapitulation of cardiac channel function and electrophysiologic features of long QT syndrome types 1, 2, 3, and 8, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Similarly, iPSC-CM models of dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) have shown robust correlation of predicted morphologic, contractile, and electrical phenotypes. In addition, iPSC-CMs have shown some features of the respective phenotypes for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), LEOPARD syndrome, Pompe's disease, and Friedriech's ataxia. In this review, we examine the progress of utilizing iPSC-CMs as a model for cardiac conditions and analyze the potential for the platform in furthering the biology and treatment of cardiac disorders.?? PMID:24632794

  1. [Cardiac manifestations of mitochondrial diseases].

    PubMed

    Ritzenthaler, Thomas; Luis, David; Hullin, Thomas; Fayssoil, Abdallah

    2015-05-01

    Mitochondrial diseases are multi-system disorders in relation with mitochondrial DNA and/or nuclear DNA abnormalities. Clinical pictures are heterogeneous, involving endocrine, cardiac, neurologic or sensory systems. Cardiac involvements are morphological and electrical disturbances. Prognosis is worsened in case of cardiac impairment. Treatments are related to the type of cardiac dysfunction including medication or pacemaker implantation. PMID:25890847

  2. Thyroid hormone regulates cardiac performance during cold acclimation in zebrafish (Danio rerio).

    PubMed

    Little, Alexander G; Seebacher, Frank

    2014-03-01

    Limitations to oxygen transport reduce aerobic scope and thereby activity at thermal extremes. Oxygen transport in fish is facilitated to a large extent by cardiac function so that climate variability may reduce fitness by constraining the performance of the heart. In zebrafish (Danio rerio), thyroid hormone (TH) regulates skeletal muscle function and metabolism in response to thermal acclimation. Here, we aimed to determine whether TH also regulates cardiac function during acclimation. We used propylthiouracil and iopanoic acid to induce hypothyroidism in zebrafish over a 3 week acclimation period to either 18 or 28°C. We found that cold-acclimated fish had higher maximum heart rates and sarco-endoplasmic reticulum Ca(2+)-ATPase (SERCA) activity than warm-acclimated fish. Hypothyroid treatment significantly decreased these responses in the cold-acclimated fish, but it did not affect the warm-acclimated fish. TH did not influence SERCA gene transcription, nor did it increase metabolic rate, of isolated whole hearts. To verify that physiological changes following hypothyroid treatment were in fact due to the action of TH, we supplemented hypothyroid fish with 3,5-diiodothryronine (T2) or 3,5,3'-triiodothyronine (T3). Supplementation of hypothyroid fish with T2 or T3 restored heart rate and SERCA activity to control levels. We also show that, in zebrafish, changes in cardiac output in response to warming are primarily mediated by heart rate, rather than by stroke volume. Thus, changes in heart rate are important for the overall aerobic capacity of the fish. In addition to its local effects on heart phenotype, we show that TH increases sympathetic tone on the heart at rest and during maximum exercise. Our findings reveal a new pathway through which fish can mitigate the limiting effects of temperature variability on oxygen transport to maintain aerobic scope and promote thermal tolerance. PMID:24265422

  3. Cardiac function of the naked mole-rat: ecophysiological responses to working underground.

    PubMed

    Grimes, Kelly M; Voorhees, Andrew; Chiao, Ying Ann; Han, Hai-Chao; Lindsey, Merry L; Buffenstein, Rochelle

    2014-03-01

    The naked mole-rat (NMR) is a strictly subterranean rodent with a low resting metabolic rate. Nevertheless, it can greatly increase its metabolic activity to meet the high energetic demands associated with digging through compacted soils in its xeric natural habitat where food is patchily distributed. We hypothesized that the NMR heart would naturally have low basal function and exhibit a large cardiac reserve, thereby mirroring the species' low basal metabolism and large metabolic scope. Echocardiography showed that young (2-4 yr old) healthy NMRs have low fractional shortening (28 ± 2%), ejection fraction (43 ± 2%), and cardiac output (6.5 ± 0.4 ml/min), indicating low basal cardiac function. Histology revealed large NMR cardiomyocyte cross-sectional area (216 ± 10 ?m(2)) and cardiac collagen deposition of 2.2 ± 0.4%. Neither of these histomorphometric traits was considered pathological, since biaxial tensile testing showed no increase in passive ventricular stiffness. NMR cardiomyocyte fibers showed a low degree of rotation, contributing to the observed low NMR cardiac contractility. Interestingly, when the exercise mimetic dobutamine (3 ?g/g ip) was administered, NMRs showed pronounced increases in fractional shortening, ejection fraction, cardiac output, and stroke volume, indicating an increased cardiac reserve. The relatively low basal cardiac function and enhanced cardiac reserve of NMRs are likely to be ecophysiological adaptations to life in an energetically taxing environment. PMID:24363308

  4. Molecular Basis of Cardiac Myxomas

    PubMed Central

    Singhal, Pooja; Luk, Adriana; Rao, Vivek; Butany, Jagdish

    2014-01-01

    Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis. PMID:24447924

  5. Maintaining optimum fluorescent lamp performance under elevated temperature conditions

    SciTech Connect

    Siminovitch, M.J.; Rubinstein, F.M.; Clark, T.A.; Verderber, R.R.

    1986-04-01

    This paper describes a new technique for optimizing fluorescent lamp performance under elevated temperature conditions. This approach uses a thermo-electric Peltier device to produce a localized cold spot temperature of approximately 40/sup 0/C, allowing the lamps to maintain maximum light output and efficacy independent of prevailing ambient temperatures inside a luminaire. Experimental data show that a 20% increase in light output and a 10% increase in efficacy over typical lamp performance in a warm fixture environment can be obtained using this device. Only 0.25 watts must be supplied to the Peltier device to produce these results.

  6. Cardiac muscle cells

    NSDL National Science Digital Library

    Nathanael Reveal (None; )

    2007-07-02

    Cardiac muscles are found only in the heart. They work together to bring deoxygenated blood in and push oxygenated blood out into the body. Essentially, they keep your heart pumping and your body alive.

  7. What Is Cardiac Rehabilitation?

    MedlinePLUS

    ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ... rate, blood pressure and EKG monitored. A cardiac rehabilitation (rehab) program takes place in a hospital or ...

  8. Cardiac Rehabilitation After Acute Myocardial Infarction Resuscitated From Cardiac Arrest

    PubMed Central

    Kim, Chul; Choi, Hee Eun; Kang, Seong Hoon

    2014-01-01

    Objective To examine the safety and effectiveness of cardiac rehabilitation on patients resuscitated from cardiac arrest due to acute myocardial infarction. Methods The study included 23 subjects, including 8 with history of cardiac arrest and 15 without history of cardiac arrest. Both groups underwent initial graded exercise test (GXT) and subsequent cardiac rehabilitation for 6 weeks. After 6 weeks, both groups received follow-up GXT. Results Statistically significant (p<0.05) increase of VO2peak and maximal MVO2 but significant (p<0.05) decrease of submaximal MVO2 and resting heart rate were observed in both groups after 6 weeks of cardiac rehabilitation. An increasing trend of maximal heart rates was observed in both groups. However, the increase was not statistically significant (p>0.05). There was no statistically significant change of resting heart rate, maximal heart rate, maximal MVO2, or submaximal MVO2 in both groups after cardiac rehabilitation. Fatal cardiac complications, such as abnormal ECG, cardiac arrest, death or myocardial infarction, were not observed. All subjects finished the cardiac rehabilitation program. Conclusion Improvement was observed in the exercise capacity of patients after aerobic exercise throughout the cardiac rehabilitation program. Therefore, cardiac rehabilitation can be safely administered for high-risk patients with history of cardiac arrest. Similar improvement in exercise capacity can be expected in patients without cardiac arrest experience. PMID:25566479

  9. Impairment of cardiac function and energetics in experimental renal failure.

    PubMed Central

    Raine, A E; Seymour, A M; Roberts, A F; Radda, G K; Ledingham, J G

    1993-01-01

    Cardiac function and energetics in experimental renal failure in the rat (5/6 nephrectomy) have been investigated by means of an isolated perfused working heart preparation and an isometric Langendorff preparation using 31P nuclear magnetic resonance (31P NMR). 4 wk after nephrectomy cardiac output of isolated hearts perfused with Krebs-Henseleit buffer was significantly lower (P < 0.0001) at all levels of preload and afterload in the renal failure groups than in the pair-fed sham operated control group. In control hearts, cardiac output increased with increases in perfusate calcium from 0.73 to 5.61 mmol/liter whereas uremic hearts failed in high calcium perfusate. Collection of 31P NMR spectra from hearts of renal failure and control animals during 30 min normoxic Langendorff perfusion showed that basal phosphocreatine was reduced by 32% to 4.7 mumol/g wet wt (P < 0.01) and the phosphocreatine to ATP ratio was reduced by 32% (P < 0.01) in uremic hearts. During low flow ischemia, there was a substantial decrease in phosphocreatine in the uremic hearts and an accompanying marked increase in release of inosine into the coronary effluent (14.9 vs 6.1 microM, P < 0.01). We conclude that cardiac function is impaired in experimental renal failure, in association with abnormal cardiac energetics and increased susceptibility to ischemic damage. Disordered myocardial calcium utilization may contribute to these derangements. PMID:8254048

  10. Predictive value of the stomach wall pH for complications after cardiac operations: comparison with other monitoring

    Microsoft Academic Search

    Richard G. Fiddian-Green; Stephen P. Baker

    1987-01-01

    The ability to predict impending complications after elective cardiac operations from measurements of BP, cardiac index, arterial pH, and urine output on the day of operation was compared with that of indirect measurement of stomach wall pH in 85 patients. We found that acidosis in the stomach wall was the most sensitive predictor for complications. The specificity of this predictive

  11. Effectiveness of mechanical versus manual chest compressions in out-of-hospital cardiac arrest resuscitation: a pilot study.

    PubMed

    Dickinson, E T; Verdile, V P; Schneider, R M; Salluzzo, R F

    1998-05-01

    A prospective, randomized effectiveness trial was undertaken to compare mechanical versus manual chest compressions as measured by end-tidal CO2 (ETCO2) in out-of-hospital cardiac arrest patients receiving advanced cardiac life support (ACLS) resuscitation from a municipal third-service, emergency medical services (EMS) agency. The EMS agency responds to approximately 6,700 emergencies annually, 79 of which were cardiac arrests in 1994, the study year. Following endotracheal intubation, all cardiac arrest patients were placed on 100% oxygen via the ventilator circuit of the mechanical cardiopulmonary resuscitation (CPR) device. Patients were randomized to receive mechanical CPR (TCPR) or human/manual CPR (HCPR) based on an odd/even day basis, with TCPR being performed on odd days. ETCO2 readings were obtained 5 minutes after the initiation of either TCPR or HCPR and again at the initiation of patient transport to the hospital. All patients received standard ACLS pharmacotherapy during the monitoring interval with the exception of sodium bicarbonate. CPR was continued until the patient was delivered to the hospital emergency department. Age, call response interval, initial electrocardiogram (ECG) rhythm, scene time, ETCO2 measurements, and arrest outcome were identified for all patients. Twenty patients were entered into the study, with 10 in each treatment group. Three patients in the TCPR group were excluded. Measurements in the HCPR group revealed a decreasing ETCO2 during the resuscitation in 8 of 10 patients (80%) and an increasing ETCO2 in the remaining 2 patients. No decrease in ETCO2 was noted in the TCPR group, with 4 of 7 patients (57%) actually showing an increased reading and 3 of 7 patients (43%) showing a constant ETCO2 reading. The differences in the ETCO2 measurements between TCPR and HCPR groups were statistically significant. Both groups were similar with regards to call response intervals, patient ages, scene times, and initial ECG rhythms. One patient in the TCPR group was admitted to the hospital but later died, leaving no survivors in the study. TCPR appears to be superior to standard HCPR as measured by ETCO2 in maintaining cardiac output during ACLS resuscitation of out-of-hospital cardiac arrest patients. PMID:9596436

  12. Cardiac oxygenation by extracorporeal membrane oxygenation in exteriorized fetal lambs

    Microsoft Academic Search

    Yuji Murata; Keiya Fujimori; Edward J. Quilligan; Naoki Nagata; Satoshi Ibara; Takahiro Hirano; Toshiya Kamimura

    1996-01-01

    OBJECTIVE: The purpose of this study was to determine the degree of cardiac oxygenation produced by different routes of extracorporeal membrane oxygenation in fetal lambs submerged in warm saline solution. STUDY DESIGN: Seven fetal lambs ranging in age from 113 to 133 days of gestation were delivered by cesarean section and oxygenated with extracorporeal membrane oxygenation. To maintain the patency

  13. A comparison between cardiac index and circulatory index in the dog during exercise and during infusion of isoproterenol

    E-print Network

    Smith, Thomas Lowell

    1975-01-01

    , exercise is now commonly imposed in a controlled, graded manner through the use of variable speed, variable pitch treadmills. William Cabitt, a British civil engineer, devised a elongated "stepping wheel" in 1818 which was used as a method of exercise... output. Proposed alternatives to the cardiac index include maximal oxygen uptake (42, 47, 54), a contractility index (46), a system for calculation of linear representations of cardiac output (1, 6), as well as the circulatory index as proposed...

  14. Echo-driven V-V optimization determines clinical improvement in non responders to cardiac resynchronization treatment.

    PubMed

    Naqvi, Tasneem Z; Rafique, Asim M; Peter, C Thomas

    2006-01-01

    Echocardiography plays an integral role in the detection of mechanical dyssynchrony in patients with congestive heart failure and in predicting beneficial response to cardiac resynchronization treatment. In patients who derive sup-optimal benefit from biventricular pacing, optimization of atrioventricular delay post cardiac resynchronization treatment has been shown to improve cardiac output. Some recent reports suggest that sequential ventricular pacing may further improve cardiac output. The mechanism whereby sequential ventricular pacing improves cardiac output is likely improved inter and possibly intraventricular synchrony, however these speculations have not been confirmed. In this report we describe the beneficial effect of sequential V-V pacing on inter and intraventricular synchrony, cardiac output and mitral regurgitation severity as the mechanisms whereby sequential biventricular pacing improves cardiac output and functional class in 8 patients who had derived no benefit or had deteriorated after CRT. Online tissue Doppler imaging including tissue velocity imaging, tissue synchronization imaging and strain and strain rate imaging were used in addition to conventional pulsed wave and color Doppler during sequential biventricular pacemaker programming. PMID:17049099

  15. Reduced neuronal nitric oxide synthase expression contributes to cardiac oxidative stress and nitroso-redox imbalance in ob\\/ob mice

    Microsoft Academic Search

    Roberto M. Saraiva; Khalid M. Minhas; Meizi Zheng; Eleanor Pitz; Adriana Treuer; Daniel Gonzalez; Karl H. Schuleri; Koenraad M. Vandegaer; Lili A. Barouch; Joshua M. Hare

    2007-01-01

    Disruption of leptin signaling in the heart may contribute to obesity-related cardiac disease, as leptin deficient (ob\\/ob) mice display cardiac hypertrophy, increased cardiac apoptosis and reduced survival. Since leptin maintains a tonic level of neuronal nitric oxide synthase (NOS1) expression in the brain, we hypothesized that leptin deficiency would decrease NOS1 cardiac expression, in turn activating xanthine oxidoreductase (XOR) and

  16. Direct Cardiac Reprogramming: Advances in Cardiac Regeneration

    PubMed Central

    Chen, Olivia; Qian, Li

    2015-01-01

    Heart disease is one of the lead causes of death worldwide. Many forms of heart disease, including myocardial infarction and pressure-loading cardiomyopathies, result in irreversible cardiomyocyte death. Activated fibroblasts respond to cardiac injury by forming scar tissue, but ultimately this response fails to restore cardiac function. Unfortunately, the human heart has little regenerative ability and long-term outcomes following acute coronary events often include chronic and end-stage heart failure. Building upon years of research aimed at restoring functional cardiomyocytes, recent advances have been made in the direct reprogramming of fibroblasts toward a cardiomyocyte cell fate both in vitro and in vivo. Several experiments show functional improvements in mouse models of myocardial infarction following in situ generation of cardiomyocyte-like cells from endogenous fibroblasts. Though many of these studies are in an early stage, this nascent technology holds promise for future applications in regenerative medicine. In this review, we discuss the history, progress, methods, challenges, and future directions of direct cardiac reprogramming.

  17. Lightweight multiple output converter development

    NASA Technical Reports Server (NTRS)

    Kisch, J. J.; Martinelli, R. M.

    1978-01-01

    A high frequency, multiple output power conditioner was developed and breadboarded using an eight-stage capacitor diode voltage multiplier to provide +1200 Vdc, and a three-stage for -350 Vdc. In addition, two rectifier bridges were capacitively coupled to the eight-stage multiplier to obtain 0.5 and 0.65 a dc constant current outputs referenced to +1200 Vdc. Total power was 120 watts, with an overall efficiency of 85 percent at the 80 kHz operating frequency. All outputs were regulated to three percent or better, with complete short circuit protection. The power conditioner component weight and efficiency were compared to the equivalent four outputs of the 10 kHz conditioner for the 8 cm ion engine. Weight reduction for the four outputs was 557 grams; extrapolated in the same ratio to all nine outputs, it would be 1100 to 1400 grams.

  18. Relationship between peak cardiac pumping capability and indices of cardio-respiratory fitness in healthy individuals.

    PubMed

    Jakovljevic, Djordje G; Popadic-Gacesa, Jelena Z; Barak, Otto F; Nunan, David; Donovan, Gay; Trenell, Michael I; Grujic, Nikola G; Brodie, David A

    2012-09-01

    Cardiac power output (CPO) is a unique and direct measure of overall cardiac function (i.e. cardiac pumping capability) that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the relationship between peak exercise CPO and selected indices of cardio-respiratory fitness. Thirty-seven healthy adults (23 men and 14 women) performed an incremental exercise test to volitional fatigue using the Bruce protocol with gas exchange and ventilatory measurements. Following a 40-min recovery, the subjects performed a constant maximum workload exercise test at or above 95% of maximal oxygen consumption. Cardiac output was measured using the exponential CO(2) rebreathing method. The CPO, expressed in W, was calculated as the product of the mean arterial blood pressure and cardiac output. At peak exercise, CPO was well correlated with cardiac output (r = 0·92, P<0·01), stroke volume (r = 0·90, P<0·01) and peak oxygen consumption (r = 0·77, P<0·01). The coefficient of correlation was moderate between CPO and anaerobic threshold (r = 0·47, P<0·01), oxygen pulse (r = 0·57, P<0·01), minute ventilation (r = 0·53, P<0·01) and carbon dioxide production (r = 0·56, P<0·01). Small but significant relationship was found between peak CPO and peak heart rate (r = 0·23, P<0·05). These findings suggest that only peak cardiac output and stroke volume truly reflect CPO. Other indices of cardio-respiratory fitness such as oxygen consumption, anaerobic threshold, oxygen pulse, minute ventilation, carbon dioxide production and heart rate should not be used as surrogates for overall cardiac function and pumping capability of the heart. PMID:22856346

  19. Cardiac Physiology of Aging: Extracellular Considerations.

    PubMed

    Horn, Margaux A

    2015-07-01

    Aging is a major risk factor for the development of cardiovascular disease, with the majority of affected patients being elderly. Progressive changes to myocardial structure and function occur with aging, often in concert with underlying pathologies. However, whether chronological aging results in a remodeled "aged substrate" has yet to be established. In addition to myocyte contractility, myocardial performance relies heavily on the cardiac extracellular matrix (ECM), the roles of which are as dynamic as they are significant; including providing structural integrity, assisting in force transmission throughout the cardiac cycle and acting as a signaling medium for communication between cells and the extracellular environment. In the healthy heart, ECM homeostasis must be maintained, and matrix deposition is in balance with degradation. Consequently, alterations to, or misregulation of the cardiac ECM has been shown to occur in both aging and in pathological remodeling with disease. Mounting evidence suggests that age-induced matrix remodeling may occur at the level of ECM control; including collagen synthesis, deposition, maturation, and degradation. Furthermore, experimental studies using aged animal models not only suggest that the aged heart may respond differently to insult than the young, but the identification of key players specific to remodeling with age may hold future therapeutic potential for the treatment of cardiac dysfunction in the elderly. This review will focus on the role of the cardiac interstitium in the physiology of the aging myocardium, with particular emphasis on the implications to age-related remodeling in disease. © 2015 American Physiological Society. Compr Physiol 5:1069-1121, 2015. PMID:26140710

  20. Isolated left ventricular assist as bridge to cardiac transplantation.

    PubMed

    Starnes, V A; Oyer, P E; Portner, P M; Ramasamy, N; Miller, P J; Stinson, E B; Baldwin, J C; Ream, A K; Wyner, J; Shumway, N E

    1988-07-01

    The electrically driven Novacor implantable left ventricular assist device has been implanted in six patients (four men and two women) since Sept. 7, 1984. In four of the six patients (67%) the device was a successful bridge to cardiac transplantation. One patient died of multiple organ failure and Candida sepsis after 16 days of support with the device. One patient died in the operating room of uncontrollable hemorrhage and biventricular failure caused by severe cardiac rejection. Three patients are alive with cardiac transplants 38, 17, and 10 months after transplantation. One patient died after cardiac transplantation of presumed sepsis. The Novacor left ventricular assist device performed in all cases without mechanical or electrical failure. Excluding the intraoperative death, assist duration ranged from 2 to 16 days. The cardiac index (synonymous with device output) ranged from 2.4 to 3.4 L/min/m2. No embolic events (cerebrovascular or systemic) occurred during assistance with the device. Minimal red cell hemolysis was documented during the period of support. The Novacor left ventricular assist device is a safe and effective bridge to cardiac transplantation in patients with refractory cardiogenic shock. PMID:3290589

  1. Researching grant?maintained schools

    Microsoft Academic Search

    David Halpin; John Fitz

    1990-01-01

    The 1988 Education Reform Act allows schools to ‘opt out’ of LEA control and become ‘grant?maintained’ by central government. This measure has provoked considerable controversy. Its supporters claim that it will increase parental choice and improve standards; its critics say that it will further fragment the education service and reintroduce selection. This paper examines the background to the measure and

  2. [Obesity and cardiac failure].

    PubMed

    Galinier, M; Pathak, A; Roncalli, J; Massabuau, P

    2005-01-01

    Obesity alone is the cause of 11% of cases of cardiac failure in men and 14% of cases in women in the United States. The frequency of obesity continues to rise in our country, 41% of our compatriots being obese or overweight. It is expected that obesity will become an important cause of cardiac failure in the coming years. The Framingham study showed that, after correction for other risk factors, for every point increase in body mass index, the increase in risk of developing cardiac failure was 5% in men and 7% in women. There are three physiopathological mechanisms to explain the adverse effects of obesity on left ventricular function: an increase in ventricular preload secondary to increased plasma volume induced by the high fatty mass; an increase in left ventricular afterload due to the common association of hypertension generated by activation of the sympathetic nervous system by hyperinsulinism; and systolic and diastolic dysfunction due to changes in the myocardial genome and coronary artery disease induced by risk factors of atherosclerosis aggravated by obesity. The adipocyte also secretes a number of hormones which act directly or indirectly on the myocardium: angiotensin II, leptin, resistin, adrenomedulin, cytokines. These haemodynamic and hormonal changes profoundly modify the genetic expression of the myocardium in obesity, favourising hypertrophy of the myocyte and the development of interstitial fibrosis. Whether it be eccentric in the absence of hypertension or concentric when hypertension is associated with obesity, left ventricular hypertrophy, although normalising left ventricular wall stress, has adverse consequences causing abnormal relaxation and decreased left ventricular compliance. Therefore, in obese patients, two forms of cardiac failure may be observed. The more common is due to diastolic dysfunction, obesity being one of the principal causes of cardiac failure with preserved systolic function. Cardiac failure due to systolic dysfunction is less common and may be observed in cases with inappropriate left ventricular hypertrophy which does not normalise abnormal left ventricular wall stress leading to cardiomyopathy, and in cases with associated coronary artery disease. Whatever the underlying mechanism, the diagnosis of cardiac failure is made more difficult by obesity. From the prognostic point of view, in the global population of patients with cardiac failure, obesity improves survival because it counteracts the adverse effect of cachexia; however, obesity increases the risk of sudden death. In fact, obesity is associated with dynamic change in QT interval. In cases of cardiac failure secondary to obesity-related cardiomyopathy, loss of weight leads to an improved functional status and a reduction of left ventricular remodelling and an increase of the ejection fraction. PMID:15724418

  3. Output coupler for laser resonator

    SciTech Connect

    Lundstrom, E.A.

    1984-07-17

    A laser output coupler utilizes a birefrigent lens which has one side thereof curved so as to present a non uniform polarization distribution across the face of the lens. A polarized beam splitter is employed to separate the output beam from the feedback beam; the feedback beam having a non uniform distribution across the laser aperture enhances mode discrimination of a pulsed resonator.

  4. Output coupler for laser resonator

    SciTech Connect

    Lundstrom, E.A.

    1981-09-15

    A laser output coupler utilizes a birefringent lens which has one side thereof curved so as to present a non-uniform polarization distribution across the face of the lens. A polarized beam splitter is employed to separate the output beam from the feedback beam; the feedback beam having a non uniform distribution across the laser aperture enhances mode discrimination of a pulsed resonator.

  5. PLA optimization using output encoding

    Microsoft Academic Search

    A. Saldanha; R. H. Katz

    1988-01-01

    An automatic tool that heuristically determines a good partitioning of a single large programmable logic array (PLA) into a PLA with a smaller number of encoded outputs (and usually fewer product terms), followed by a set of decoders to regenerate the original outputs, has been developed. Initial results using logic descriptions of processor chips and a benchmark set of industrial

  6. Influence of gravity on cardiac performance.

    PubMed

    Pantalos, G M; Sharp, M K; Woodruff, S J; O'Leary, D S; Lorange, R; Everett, S D; Bennett, T E; Shurfranz, T

    1998-01-01

    Results obtained by the investigators in ground-based experiments and in two parabolic flight series of tests aboard the NASA KC-135 aircraft with a hydraulic simulator of the human systemic circulation have confirmed that a simple lack of hydrostatic pressure within an artificial ventricle causes a decrease in stroke volume of 20%-50%. A corresponding drop in stroke volume (SV) and cardiac output (CO) was observed over a range of atrial pressures (AP), representing a rightward shift of the classic CO versus AP cardiac function curve. These results are in agreement with echocardiographic experiments performed on space shuttle flights, where an average decrease in SV of 15% was measured following a three-day period of adaptation to weightlessness. The similarity of behavior of the hydraulic model to the human system suggests that the simple physical effects of the lack of hydrostatic pressure may be an important mechanism for the observed changes in cardiac performance in astronauts during the weightlessness of space flight. PMID:9846932

  7. Drug Treatment of Cardiac Failure

    PubMed Central

    Achong, M. R.; Kumana, C. R.

    1982-01-01

    Treatment of cardiac failure should first be aimed at reversing or ameliorating the underlying pathological processes. This review highlights the common problems and pitfalls in the use of digoxin, diuretics and vasodilators in patients with cardiac failure. PMID:21289849

  8. Drug treatment of cardiac failure.

    PubMed

    Achong, M R; Kumana, C R

    1982-01-01

    Treatment of cardiac failure should first be aimed at reversing or ameliorating the underlying pathological processes. This review highlights the common problems and pitfalls in the use of digoxin, diuretics and vasodilators in patients with cardiac failure. PMID:21289849

  9. Sudden cardiac death.

    PubMed

    Kuriachan, Vikas P; Sumner, Glen L; Mitchell, L Brent

    2015-04-01

    Sudden death accounts for 300,000-400,000 deaths annually in the United States. Most sudden deaths are cardiac, and most sudden cardiac deaths are related to arrhythmias secondary to structural heart disease or primary electrical abnormalities of the heart. The most common structural disease leading to sudden death is ischemic heart disease. Nonischemic cardiomyopathy and other structural abnormalities such as arrhythmogenic ventricular dysplasia and hypertrophic cardiomyopathy may also be causative. Patients without structural disease have a primary electrical abnormality, such as long-QT syndrome or Brugada syndrome. Severe left ventricular systolic dysfunction is the main marker for sudden death in patients with ischemic or nonischemic cardiomyopathy. In other conditions, other markers for structural heart disease and electrical abnormalities need to be considered. It is seen that ?-blocker therapy is associated with a reduction in sudden cardiac death across a broad range of disorders. Nevertheless, the implantable cardioverter defibrillator remains the most effective treatment strategy in selected patients. PMID:25813838

  10. Primary cardiac tumors.

    PubMed Central

    Silverman, N A

    1980-01-01

    Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases. Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities. Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabodomyoma comprising 20% of lesions. Various histologic types of sarcoma are the predominant malignant cardiac neoplasms. With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality. Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences. Images Figs. 2A and B. Fig. 3. Fig. 4. Figs. 5A and B Fig. 6. PMID:7362282

  11. NITROGEN OUTPUTS OF SMALL MAMMALS FROM FECAL AND URINE DEPOSITION: IMPLICATIONS FOR NITROGEN CYCLING

    EPA Science Inventory

    The contribution of small mammals in nitrogen cycling is poorly understood and could have reverberations back to the producer community by maintaining or even magnifying increased nitrogen availability. Our objective was to model nitrogen outputs (deposition of feces and urine) ...

  12. Estrogen receptor alpha supports cardiomyocytes indirectly through post-infarct cardiac c-kit+ cells.

    PubMed

    Brinckmann, Marie; Kaschina, Elena; Altarche-Xifró, Wassim; Curato, Caterina; Timm, Melanie; Grzesiak, Aleksandra; Dong, Jun; Kappert, Kai; Kintscher, Ulrich; Unger, Thomas; Li, Jun

    2009-07-01

    Despite previous studies demonstrating a cardioprotective role of estradiol via its estrogen receptor (ER)alpha, the underlying mechanisms remain unclear. Here we aimed to define ERalpha-involved mechanisms against cardiac injury. Seven days after myocardial infarction in male rats, cardiac ERalpha was upregulated in post-infarct cardiac c-kit+ cells accumulating in periinfarct myocardium as shown by Western blotting and immunofluorescence staining. Further, we isolated post-infarct cardiac c-kit+ cell population by modified magnetic activated cell sorting (MACS) and fluorescence activated cell sorting (FACS), and confirmed predominant ERalpha expression in this post-infarct cardiac c-kit+ cell population by real-time PCR. These post-infarct cardiac c-kit+ cells, characterized by upregulated transcription factors implicated in cardiogenic differentiation (GATA-4, Notch-2) and genes required for self-renewal (Tbx3, Akt), maintained a stable phenotype in vitro for more than 3 months. ERalpha stimulation supported proliferation but prevented differentiation of undifferentiated myoblast cells. When adult myocytes isolated from infarcted rat hearts were co-cultured with post-infarct cardiac c-kit+ cells, ERalpha stimulation inhibited apoptosis and enhanced survival of these myocytes. These findings suggest that cardiac ERalpha supports survival of cardiomyocytes through post-infarct cardiac c-kit+ cells, which may contribute to cardioprotection against cardiac injury. PMID:19341743

  13. Graded-index-rod external coupled-cavity laser with backface output-monitor-stabilized single-frequency operation

    Microsoft Academic Search

    Kang-Yih Liou; CHARLES A. BURRUS; Fridolin Bosch

    1985-01-01

    We have demonstrated a graded-index-rod external coupled-cavity (GRECC) laser with backface output through a partially transmitting external cavity mirror. Laser output is monitored from the backface in a transmitter module with double-loop feedback control which stabilizes output power and maintains single-frequency operation under CW and pseudorandom pulse modulation.

  14. Cardiac Bioelectricity and Arrhythmias

    NSDL National Science Digital Library

    Flavio Fenton (Cornell University; )

    2006-09-22

    Deep inside a human heart, its pacemaker sends out bursts of electrical signals that keep the heart pumping rhythmically, supplying life-giving oxygen to the body. When these electrical waves become disorganized, the heart starts beating irregularly or arrhythmically. Flavio Fenton and Elizabeth Cherry of Cornell University made this interactive program to provide education on arrhythmias. It presents detailed information on cardiac anatomy, normal cardiac electrophysiology, and different kinds of arrhythmias using a combination of words, pictures, and interactive, computer simulations and animations.

  15. Cardiac Response and Personality Organization

    ERIC Educational Resources Information Center

    Blatt, Sidney J.; Feirstein, Alan

    1977-01-01

    This study examines the level and variability of cardiac response during complex problem-solving and interposed rest periods and their differing relationships to estimates of personality integration on the Rorschach. Findings suggest cardiac variability may be a more differentiated measure than level of cardiac response. (Author)

  16. Cardiac Xenotransplantation: Future and Limitations

    Microsoft Academic Search

    Kiyoshi Ogata; Jeffrey L. Platt

    2004-01-01

    Despite improvements in pharmacological therapies, the outlook for patients with severe cardiac disease remains poor. At present, only transplantation can ‘cure’ end-stage cardiac failure. However, fewer than 5% of those who need a cardiac transplant receive one in the United States each year. To address this problem, some propose using animals as a source of organs for transplantation, that is,

  17. Polarization-maintaining optical microfiber.

    PubMed

    Jung, Yongmin; Brambilla, Gilberto; Richardson, David J

    2010-06-15

    We have successfully demonstrated a polarization-maintaining (PM) fused silica microfiber by adiabatically tapering a conventional PM fiber. Compared to standard single-mode microfibers, the proposed PM microfibers exhibit robust polarization, preserving characteristics under the presence of external perturbations, such as bending. A polarization-extinction ratio of 16 dB is typically obtained through the device with a corresponding excess loss of 0.2 dB. PMID:20548377

  18. In vivo assessment of cardiac metabolism and function in the abdominal aortic banding model of compensated cardiac hypertrophy

    PubMed Central

    Ball, Vicky; Miller, Jack J.; Clarke, Kieran; Carr, Carolyn A.; Tyler, Damian J.

    2015-01-01

    Aims Left ventricular hypertrophy is an adaptive response of the heart to chronic mechanical overload and can lead to functional deterioration and heart failure. Changes in cardiac energy metabolism are considered as key to the hypertrophic remodelling process. The concurrence of obesity and hypertrophy has been associated with contractile dysfunction, and this work therefore aimed to investigate the in vivo structural, functional, and metabolic remodelling that occurs in the hypertrophied heart in the setting of a high-fat, high-sucrose, Western diet (WD). Methods and results Following induction of cardiac hypertrophy through abdominal aortic banding, male Sprague Dawley rats were exposed to either a standard diet or a WD (containing 45% fat and 16% sucrose) for up to 14 weeks. Cardiac structural and functional characteristics were determined by CINE MRI, and in vivo metabolism was investigated using hyperpolarized 13C-labelled pyruvate. Cardiac hypertrophy was observed at all time points, irrespective of dietary manipulation, with no evidence of cardiac dysfunction. Pyruvate dehydrogenase flux was unchanged in the hypertrophied animals at any time point, but increased incorporation of the 13C label into lactate was observed by 9 weeks and maintained at 14 weeks, indicative of enhanced glycolysis. Conclusion Hypertrophied hearts revealed little evidence of a switch towards increased glucose oxidation but rather an uncoupling of glycolytic metabolism from glucose oxidation. This was maintained under conditions of dietary stress provided by a WD but, at this compensated phase of hypertrophy, did not result in any contractile dysfunction. PMID:25750189

  19. Keeping the engine primed: HIF factors as key regulators of cardiac metabolism and angiogenesis during ischemia.

    PubMed

    Shohet, Ralph V; Garcia, Joseph A

    2007-12-01

    Myocardial ischemia, the most common cause of cardiac hypoxia in clinical medicine, occurs when oxygen delivery cannot meet myocardial metabolic requirements in the heart. This deficiency can result from either a reduced supply of oxygen (decreased coronary bloodflow) or an increased myocardial demand for oxygen (increased wall stress or afterload). Patients with stable coronary artery disease as well as patients experiencing acute myocardial infarction can experience episodes of severe ischemia. Although hypoxia is an obligatory component, it is not the sole environmental stress experienced by the ischemic heart. Reperfusion after ischemia is associated with increased oxidative stress as the heart reverts to aerobic respiration and thereby generates toxic levels of reactive oxygen species (ROS). During mild ischemia, mitochondrial function is partially compromised and substrate preferences adapt to sustain adequate ATP generation. With severe ischemia, mitochondrial function is markedly compromised and anaerobic metabolism must provide energy no matter what the cost in generation of toxic ROS adducts. Ischemia produces a variety of environmental stresses that impair cardiovascular function. As a result, multiple signaling pathways are activated in mammalian cells during ischemia/reperfusion injury in an attempt to minimize cellular injury and maintain cardiac output. Amongst the transcriptional regulators activated are members of the hypoxia inducible factor (HIF) transcription factor family. HIF factors regulate a variety of genes that affect a myriad of cellular processes including metabolism, angiogenesis, cell survival, and oxygen delivery, all of which are important in the heart. In this review, we will focus on the metabolic and angiogenic aspects of HIF biology as they relate to the heart during ischemia. We will review the metabolic requirements of the heart under normal as well as hypoxic conditions, the effects of preconditioning and its regulation as it pertains to HIF biology, the apparent roles of HIF-1 and HIF-2 in intermediary metabolism, and translational applications of HIF-1 and HIF-2 biology to cardiac angiogenesis. Increased understanding of the role of HIFs in cardiac ischemia will ultimately influence clinical cardiovascular practice. PMID:18026917

  20. Moore's law, Dabbawalas, and pediatric cardiac care in Sri Lanka

    PubMed Central

    Samarasinghe, Duminda

    2015-01-01

    Sri Lanka is an island nation in Indian Ocean that provides free healthcare to all citizens through government healthcare system. It has commendable health indices in the region. Pediatric cardiac services have rapidly progressed over past few years helping to further bring down infant and under-five mortality rates. Lady Ridgeway Hospital for Children (LRH) is the only tertiary care referral center for children with heart disease in the country. Currently it performs approximately 1,000 cardiac catheterizations and 1,000 cardiac surgeries every year. Target is to double the surgical output to treat all children with heart diseases in a timely and appropriate manner. Being a middle-income country, this is not an easy task. Technology used in diagnosis and treatment of congenital heart diseases is rapidly advancing with its price tag. In such a setting, it is challenging to proceed to achieve this target in a resource-limited environment.

  1. Elevated miR499 Levels Blunt the Cardiac Stress Response

    Microsoft Academic Search

    Joseph T. C. Shieh; Yu Huang; Jacqueline Gilmore; Deepak Srivastava; Masa Tsuchiya

    2011-01-01

    BackgroundThe heart responds to myriad stresses by well-described transcriptional responses that involve long-term changes in gene expression as well as more immediate, transient adaptations. MicroRNAs quantitatively regulate mRNAs and thus may affect the cardiac transcriptional output and cardiac function. Here we investigate miR-499, a microRNA embedded within a ventricular-specific myosin heavy chain gene, which is expressed in heart and skeletal

  2. 10 CFR 26.71 - Maintaining authorization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 false Maintaining authorization. 26.71 Section 26.71 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Granting and Maintaining Authorization § 26.71 Maintaining authorization. (a)...

  3. 10 CFR 26.71 - Maintaining authorization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 false Maintaining authorization. 26.71 Section 26.71 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Granting and Maintaining Authorization § 26.71 Maintaining authorization. (a)...

  4. The cardiac muscle cell

    Microsoft Academic Search

    Nicholas J. Severs

    2000-01-01

    Summary The cardiac myocyte is the most physically energetic cell in the body, contracting constantly, without tiring, 3 billion times or more in an average human lifespan. By coordinating its beating activity with that of its 3 billion neighbours in the main pump of the human heart, over 7,000 litres of blood are pumped per day, without con- scious effort,

  5. Cardiac and Pulmonary Injury

    Microsoft Academic Search

    George C. Velmahos; Muhammad U. Butt

    2008-01-01

    Cardiac and pulmonary injuries present major chal- lenges in diagnosis and treatment. Distinct differences between penetrating and blunt trauma of these or- gans exist. Outcomes for severe injuries are still grave. Organized trauma systems can provide optimal care by minimizing prehospital time, allowing easy access to imaging modalities, and offering state-of-the-art treatment strategies. A multidisciplinary approach, including surgeons, intensivists, and

  6. Cardiac Physiology of Pregnancy.

    PubMed

    May, Linda

    2015-07-01

    Although the physiology of the heart and vascular system has not changed, there are many things we have learned and are still learning today. Research related to heart adaptations during pregnancy has been performed since the 1930s. Since the mid-1950s, researchers began to look at changes in the maternal cardiovascular system during exercise while pregnant. Research related to exercise during pregnancy and offspring heart development began and has continued since the 1970s. We will review the normal female cardiovascular system adaptations to pregnancy in general. Additionally, topics related to maternal cardiac adaptations to pregnancy during acute exercise, as well as the chronic conditioning response from exercise training will be explored. Since physical activity during pregnancy influences fetal development, the fetal cardiac development will be discussed in regards to acute and chronic maternal exercise. Similarly, the influence of various types of maternal exercise on acute and chronic fetal heart responses will be described. Briefly, the topics related to how and if there is maternal-fetal synchrony will be explained. Lastly, the developmental changes of the fetal cardiovascular system that persist after birth will be explored. Overall, the article will discuss maternal cardiac physiology related to changes with normal pregnancy, and exercise during pregnancy, as well as fetal cardiac physiology related to changes with normal development, and exercise during pregnancy as well as developmental changes in offspring after birth. © 2015 American Physiological Society. Compr Physiol 5:1325-1344, 2015. PMID:26140720

  7. Hepato-cardiac disorders

    PubMed Central

    Fouad, Yasser Mahrous; Yehia, Reem

    2014-01-01

    Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases PMID:24653793

  8. Advanced Cardiac Life Support.

    ERIC Educational Resources Information Center

    Kirkwood Community Coll., Cedar Rapids, IA.

    This document contains materials for an advanced college course in cardiac life support developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, six references, evaluation criteria, course objectives by units, course…

  9. Output optics for laser velocimeters

    NASA Technical Reports Server (NTRS)

    Lynch, Dana H. (inventor); Gunter, William D. (inventor); Mcalister, Kenneth W. (inventor)

    1993-01-01

    Space savings are effected in the optical output system of a laser velocimeter. The output system is comprised of pairs of optical fibers having output ends from which a beam of laser light emerges, a transfer lens for each light beam, and at least one final (LV) lens for receiving the light passing through the transfer lenses and for focussing that light at a common crossing point or area. In order to closely couple the transfer lenses to the final lens, each transfer lens is positioned relative to the final lens receiving light therefrom such that the output waist of the corresponding beam received by the final lens from the transfer lens is a virtual waist located before the transfer lens.

  10. Sensitive electrometer features digital output

    NASA Technical Reports Server (NTRS)

    Doong, H.

    1965-01-01

    Four-stage transistorized electrometer eliminates the need for a logarithmic compression network. It measures very low currents and produces a digital output directly indicative of the input current magnitude.

  11. The Pathogenesis of Cardiac Fibrosis

    PubMed Central

    Kong, Ping; Christia, Panagiota; Frangogiannis, Nikolaos G

    2013-01-01

    Cardiac fibrosis is characterized by net accumulation of extracellular matrix proteins in the cardiac interstitium and contributes to both systolic and diastolic dysfunction in many cardiac pathophysiologic conditions. This review manuscript discusses the cellular effectors and molecular pathways implicated in the pathogenesis of cardiac fibrosis. Although activated myofibroblasts are the main effector cells in the fibrotic heart, monocytes/macrophages, lymphocytes, mast cells, vascular cells and cardiomyocytes may also contribute to the fibrotic response by secreting key fibrogenic mediators. Inflammatory cytokines and chemokines, reactive oxygen species, mast cell-derived proteases, endothelin-1, the renin/angiotensin/aldosterone system, matricellular proteins and growth factors (such as TGF-? and PDGF) are some of the best-studied mediators implicated in cardiac fibrosis. Both experimental and clinical evidence suggests that cardiac fibrotic alterations may be reversible. Understanding the mechanisms responsible for initiation, progression and resolution of cardiac fibrosis is crucial to design anti-fibrotic treatment strategies for patients with heart disease. PMID:23649149

  12. Genetics of sudden cardiac death.

    PubMed

    Bezzina, Connie R; Lahrouchi, Najim; Priori, Silvia G

    2015-06-01

    Sudden cardiac death occurs in a broad spectrum of cardiac pathologies and is an important cause of mortality in the general population. Genetic studies conducted during the past 20 years have markedly illuminated the genetic basis of the inherited cardiac disorders associated with sudden cardiac death. Here, we review the genetic basis of sudden cardiac death with a focus on the current knowledge on the genetics of the primary electric disorders caused primarily by mutations in genes encoding ion channels, and the cardiomyopathies, which have been attributed to mutations in genes encoding a broader category of proteins, including those of the sarcomere, the cytoskeleton, and desmosomes. We discuss the challenges currently faced in unraveling genetic factors that predispose to sudden cardiac death in the setting of sequela of coronary artery disease and present the genome-wide association studies conducted in recent years on electrocardiographic parameters, highlighting their potential in uncovering new biological insights into cardiac electric function. PMID:26044248

  13. Reaction to heat stress in the albino rat maintained on a vitamin B complex deficient diet 

    E-print Network

    Baban, Riadh M. Ali

    1965-01-01

    the adrenergic system to be the mediator for these re- sponses. Hardy (56) has extensively reviewed the physiological re- sponses to heat. Hyperthermia has been widely investigated. Marshall, et. al. (79) reported an increase in ventilation, cardiac output..., 52)hyperthermia (40, 79) and heat induced tetany (60, 61). The respiratory involvement is evident in the changes in ventila- tion rate (or panting)', 1, 31, 40, 56: 60). The endocrine glands in- volved are the adrenal cortex (90, 94) where...

  14. [The evaluation of prognostic value of biomarkers in patients with chronic cardiac insufficiency].

    PubMed

    Ro?tman, A P; Lysikov, O Iu; Bugrov, A V; Maksimova, I A; Dolgov, V V

    2014-07-01

    Nowadays, the laboratory markers of myocardial dysfunction (cerebral natriuretic peptide - NT-proBNP); instability of atherosclerotic plaque (highly sensitive C-reactive protein - hsCRP); damages of cardiac muscle (highly sensitive cardiac tropine I - hs-cTnl) play a key role in diagnostic, course prognostics and verification of risk of unfavorable outcomes in patients with chronic cardiac insufficiency. The article presents the results of study of dynamics of levels of NT-proBNP, hsCRP, hs-cTnl in 71 patients with chronic cardiac insufficiency of II and III functional class (according classification of New-York association of cardiologists - NYHA). The comparison was made concerning analyzed laboratory markers with fraction of output of left ventricle of heart and index of body mass relatively to their prognostic role inpatients with chronic cardiac insufficiency with different clinical conditions and various outcomes of disease. It is demonstrated that level of hs-cTnl is the most valuable in respect to unfavorable prognosis of course of chronic cardiac insufficiency and risk of lethal outcome. The level of NT-proBNP has invert correlation relationship with fraction of output of left ventricle of heart and can be considered as a laboratory indicator of functional condition of myocardium in patients with chronic cardiac insufficiency. PMID:25346981

  15. Network Reconstruction and Systems Analysis of Cardiac Myocyte Hypertrophy Signaling*

    PubMed Central

    Ryall, Karen A.; Holland, David O.; Delaney, Kyle A.; Kraeutler, Matthew J.; Parker, Audrey J.; Saucerman, Jeffrey J.

    2012-01-01

    Cardiac hypertrophy is managed by a dense web of signaling pathways with many pathways influencing myocyte growth. A quantitative understanding of the contributions of individual pathways and their interactions is needed to better understand hypertrophy signaling and to develop more effective therapies for heart failure. We developed a computational model of the cardiac myocyte hypertrophy signaling network to determine how the components and network topology lead to differential regulation of transcription factors, gene expression, and myocyte size. Our computational model of the hypertrophy signaling network contains 106 species and 193 reactions, integrating 14 established pathways regulating cardiac myocyte growth. 109 of 114 model predictions were validated using published experimental data testing the effects of receptor activation on transcription factors and myocyte phenotypic outputs. Network motif analysis revealed an enrichment of bifan and biparallel cross-talk motifs. Sensitivity analysis was used to inform clustering of the network into modules and to identify species with the greatest effects on cell growth. Many species influenced hypertrophy, but only a few nodes had large positive or negative influences. Ras, a network hub, had the greatest effect on cell area and influenced more species than any other protein in the network. We validated this model prediction in cultured cardiac myocytes. With this integrative computational model, we identified the most influential species in the cardiac hypertrophy signaling network and demonstrate how different levels of network organization affect myocyte size, transcription factors, and gene expression. PMID:23091058

  16. Cardiac adaptations of bullfrog tadpoles in response to chytrid infection.

    PubMed

    Salla, Raquel Fernanda; Gamero, Fernando Urban; Ribeiro, Larissa Rodrigues; Rizzi, Gisele Miglioranza; Medico, Samuel Espinosa Dal; Rissoli, Rafael Zanelli; Vieira, Conrado Augusto; Silva-Zacarin, Elaine Cristina Mathias; Leite, Domingos Silva; Abdalla, Fábio Camargo; Toledo, Luis Felipe; Costa, Monica Jones

    2015-08-01

    The chytrid fungus Batrachochytrium dendrobatidis (Bd) can result in heart failure in Bd-susceptible species. Since Bd infection generally does not cause mortality in North American bullfrogs, the aim of this work was to verify whether this species presents any cardiac adaptation that could improve the tolerance to the fungus. Thus, we analyzed tadpoles' activity level, relative ventricular mass, ventricle morphology, in loco heart frequency, and in vitro cardiac function. The results indicate that infected animals present an increase in both ventricular relative mass and in myofibrils' incidence, which accompanied the increase in myocytes' diameter. Such morphological alterations enabled an increase in the in vitro twitch force that, in vivo, would result in elevation of the cardiac stroke volume. This response requires much less energy expenditure than an elevation in heart frequency, but still enables the heart to pump a higher volume of blood per minute (i.e., an increase in cardiac output). As a consequence, the energy saved in the regulation of the cardiac function of Bd-infected tadpoles can be employed in other homeostatic adjustments to avoid the lethal effect of the fungus. Whether other species present this ability, and to what extent, remains uncertain, but such possible interspecific variability might explain different mortality rates among different species of Bd-infected amphibians. J. Exp. Zool. 323A: 487-496, 2015. © 2015 Wiley Periodicals, Inc. PMID:26055358

  17. Program Overview The Cardiac Sonography program prepares individuals to perform cardiac

    E-print Network

    Cheng, Mei-Fang

    and Physiology, Pathophysiology, Ultrasound Physics, Instrumentation and Applied Cardiac Sonography. ClinicalProgram Overview The Cardiac Sonography program prepares individuals to perform cardiac sonography hours. Program Description The Cardiac Sonography Program is located on the Scotch Plains campus

  18. Salacia oblonga root improves cardiac lipid metabolism in Zucker diabetic fatty rats: modulation of cardiac PPAR-alpha-mediated transcription of fatty acid metabolic genes.

    PubMed

    Huang, Tom Hsun-Wei; Yang, Qinglin; Harada, Masaki; Uberai, Jasna; Radford, Jane; Li, George Q; Yamahara, Johji; Roufogalis, Basil D; Li, Yuhao

    2006-01-01

    Excess cardiac triglyceride accumulation in diabetes and obesity induces lipotoxicity, which predisposes the myocytes to death. On the other hand, increased cardiac fatty acid (FA) oxidation plays a role in the development of myocardial dysfunction in diabetes. PPAR-alpha plays an important role in maintaining homeostasis of lipid metabolism. We have previously demonstrated that the extract from Salacia oblonga root (SOE), an Ayurvedic anti-diabetic and anti-obesity medicine, improves hyperlipidemia in Zucker diabetic fatty (ZDF) rats (a genetic model of type 2 diabetes and obesity) and possesses PPAR-alpha activating properties. Here we demonstrate that chronic oral administration of SOE reduces cardiac triglyceride and FA contents and decreases the Oil red O-stained area in the myocardium of ZDF rats, which parallels the effects on plasma triglyceride and FA levels. Furthermore, the treatment suppressed cardiac overexpression of both FA transporter protein-1 mRNA and protein in ZDF rats, suggesting inhibition of increased cardiac FA uptake as the basis for decreased cardiac FA levels. Additionally, the treatment also inhibited overexpression in ZDF rat heart of PPAR-alpha mRNA and protein and carnitine palmitoyltransferase-1, acyl-CoA oxidase and 5'-AMP-activated protein kinase mRNAs and restored the downregulated acetyl-CoA carboxylase mRNA. These results suggest that SOE inhibits cardiac FA oxidation in ZDF rats. Thus, our findings suggest that improvement by SOE of excess cardiac lipid accumulation and increased cardiac FA oxidation in diabetes and obesity occurs by reduction of cardiac FA uptake, thereby modulating cardiac PPAR-alpha-mediated FA metabolic gene transcription. PMID:16129467

  19. Cardiac arrest in children

    PubMed Central

    Tress, Erika E; Kochanek, Patrick M; Saladino, Richard A; Manole, Mioara D

    2010-01-01

    Major advances in the field of pediatric cardiac arrest (CA) were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term “post-cardiac arrest syndrome” has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners. PMID:20930971

  20. Cardiac Resynchronization Therapy

    PubMed Central

    Owen, Joseph S.; Khatib, Sammy; Morin, Daniel P.

    2009-01-01

    Systolic heart failure is a major problem for Americans today, with 550,000 new cases diagnosed per year, and ultimately contributes to 287,000 deaths annually. While pharmacologic therapy has drastically improved outcomes in patients with systolic heart failure, hospitalizations from systolic heart failure continue to increase and remain a major cost burden. In response to this unmet need, recent years have seen dramatic improvements in device-based therapy targeting one cause of systolic dysfunction: dyssynchronous ventricular contraction. Cardiac resynchronization therapy aims to restore mechanical synchrony by electrically activating the heart in a synchronized manner. This review summarizes the rationale for cardiac resynchronization therapy, evidence for its use, current guidelines, and ongoing and future directions for research. PMID:21603451

  1. Cardiac muscle tissue engineering

    Microsoft Academic Search

    Maria Papadaki

    2003-01-01

    Cell-based therapy has emerged as a novel approach for replacing heart muscle, which is known not to regenerate after injury such as that caused by infarction or reconstructive surgery. Two types of cell-based therapies have been employed: injection of isolated cells or the implantation of in-vitro-grown cardiac muscle tissue equivalents In the first case, several cell types - including skeletal

  2. Cardiac Arrest in Pregnancy

    Microsoft Academic Search

    Alison A. Rodriguez; Gary A. Dildy

    Cardiac arrest (CA) in pregnancy is an uncommon occurrence with an incidence of about 1 in every 30,000 deliveries (1). The causes are quite numerous, but the management is essentially the same with the exception of a few modifications regarding\\u000a the fetus. In this chapter, causes of maternal mortality are reviewed along with potential interventions to decrease its incidence.\\u000a A

  3. Delirium After Cardiac Surgery

    Microsoft Academic Search

    James L. Rudolph

    \\u000a Delirium is an acute change in cognitive functioning, characterized by inattention and associated with disorganized thinking\\u000a or altered level of consciousness, which preferentially affects the older patients (Diagnostic and statistical manual of mental\\u000a disorders, fourth edition, text revision. Washington: American Psychiatric Association; 2000). After cardiac surgery, the\\u000a incidence of delirium has been reported between 2 and 73%, depending on the

  4. Inflammation and Cardiac Outcome

    PubMed Central

    Hohensinner, P.J.; Niessner, A.; Huber, K.; Weyand, C.M.; Wojta, J

    2015-01-01

    Purpose of Review Inflammation is a key component in cardiovascular disease. Controlling inflammatory events and their subsequent processes hold the potential for novel therapeutic options. Cytokines are the propagators of inflammation. In this review we will discuss important cytokines, including IL-6, TNF-alpha, MCP-1, M-CSF and GDF-15 and their effect on cardiac outcome. Recent findings IL-6 is a useful biomarker in patients with coronary artery disease. Summary PMID:21378564

  5. Hypothermic Cardiac Arrest

    Microsoft Academic Search

    Daniel F. Danzl

    The contemporary allure of hypothermia is regularly sparked by the apparent “reanimations” of profoundly cold patients in\\u000a prolonged cardiac arrest (CA). Recently, a physician who was resuscitated from 13.7°C presented her own case report at an\\u000a international conference (1). There are also promising ongoing investigations of mild therapeutic hypothermia for traumatic intracranial hypertension\\u000a and stroke (2–4). Nevertheless, hypothermia remains more

  6. Cardiac regenerative medicine.

    PubMed

    Yuasa, Shinsuke; Fukuda, Keiichi

    2008-01-01

    Severe heart failure is associated with damage to the myocardium that is irreversible with current medical therapies. Recent experimental and clinical studies, however, have opened the possibility of solving many of the associated problems, making this an exciting and tangible goal. There are many potential cell sources for regenerative cardiac medicine, including bone marrow stem cells, endothelial progenitor cells, skeletal myocytes, adult cardiac stem cells, and embryonic stem (ES) cells. Although ES cells are highly proliferative and suitable for mass production, they are not autologous, and an efficient protocol is yet to be established to ensure selective cardiomyocyte induction. Recent studies have successfully established inducible pluripotent stem (iPS) cells from mouse and human fibroblasts by the gene transfer of 4 transcription factors that are strongly expressed in ES cells: Oct3/4, Sox2, Klf4 and c-Myc. iPS cells can differentiate into all 3 germ layer-derived cells and are syngeneic, indicating that they can become an ideal cell source for regenerative medicine. Despite these successes, the accumulating evidence from fields as diverse as developmental biology, stem cell biology and tissue engineering must be integrated to achieve the full potential of cardiac regenerative medicine. PMID:18772528

  7. Sudden cardiac death and obesity.

    PubMed

    Plourde, Benoit; Sarrazin, Jean-François; Nault, Isabelle; Poirier, Paul

    2014-09-01

    For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population. PMID:25160995

  8. Cardiac sarcoidosis: a comprehensive review

    PubMed Central

    Sekhri, Vishal; Sanal, Shireen; DeLorenzo, Lawrence J.; Aronow, Wilbert S.; Maguire, George P.

    2011-01-01

    Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by noncaseating granulomas in involved organs. Organs involved with sarcoidosis include lymph nodes, skin, lung, central nervous system, and eye. Only 40-50% of patients with cardiac sarcoidosis diagnosed at autopsy have the diagnosis made during their lifetime. Cardiac sarcoidosis can manifest itself as complete heart block, ventricular arrhythmias, congestive heart failure, pericardial effusion, pulmonary hypertension, and ventricular aneurysms. Diagnostic tests such as the electrocardiogram, two-dimensional echocardiography, cardiac magnetic resonance imaging, positron emission tomography scan, radionuclide scan, and endomyocardial biopsy can be helpful in the early detection of cardiac sarcoidosis. Considering the increased risk of sudden death, cardiac sarcoidosis is an indication for early treatment with corticosteroids or other immunosuppressive agents. Other treatments include placement of a pacemaker or implantable defibrillator to prevent sudden death. In refractory cases, cardiac transplantation should be considered. PMID:22291785

  9. Cardiac Emergencies in Neurosurgical Patients

    PubMed Central

    Petropolis, Andrea; Cappellani, Ronald B.

    2015-01-01

    Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events. PMID:25692145

  10. Sarcolipin and phospholamban as regulators of cardiac sarcoplasmic reticulum Ca 2+ ATPase

    Microsoft Academic Search

    Poornima Bhupathy; Gopal J. Babu; Muthu Periasamy

    2007-01-01

    The cardiac sarcoplasmic reticulum calcium ATPase (SERCA2a) plays a critical role in maintaining the intracellular calcium homeostasis during cardiac contraction and relaxation. It has been well documented over the years that altered expression and activity of SERCA2a can lead to systolic and diastolic dysfunction. The activity of SERCA2a is regulated by two structurally similar proteins, phospholamban (PLB) and sarcolipin (SLN).

  11. Automatic contour propagation in cine cardiac magnetic resonance images.

    PubMed

    Hautvast, Gilion; Lobregt, Steven; Breeuwer, Marcel; Gerritsen, Frans

    2006-11-01

    We have developed a method for automatic contour propagation in cine cardiac magnetic resonance images. The method consists of a new active contour model that tries to maintain a constant contour environment by matching gray values in profiles perpendicular to the contour. Consequently, the contours should maintain a constant position with respect to neighboring anatomical structures, such that the resulting contours reflect the preferences of the user. This is particularly important in cine cardiac magnetic resonance images because local image features do not describe the desired contours near the papillary muscle. The accuracy of the propagation result is influenced by several parameters. Because the optimal setting of these parameters is application dependent, we describe how to use full factorial experiments to optimize the parameter setting. We have applied our method to cine cardiac magnetic resonance image sequences from the long axis two-chamber view, the long axis four-chamber view, and the short axis view. We performed our optimization procedure for each contour in each view. Next, we performed an extensive clinical validation of our method on 69 short axis data sets and 38 long axis data sets. In the optimal parameter setting, our propagation method proved to be fast, robust, and accurate. The resulting cardiac contours are positioned within the interobserver ranges of manual segmentation. Consequently, the resulting contours can be used to accurately determine physiological parameters such as stroke volume and ejection fraction. PMID:17117776

  12. Clinical course and medical management of neonates with severe cardiac failure related to vein of Galen malformation

    PubMed Central

    Frawley, G; Dargaville, P; Mitchell, P; Tress, B; Loughnan, P

    2002-01-01

    Background: Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) with intractable cardiac failure is considered a poor prognostic sign. Interventional neuroradiology with embolisation has been shown to control cardiac failure, but there is a perception that neurological outcome in survivors is poor. Objective: To determine if aggressive intensive care and anaesthetic management of cardiac failure before urgent embolisation can influence morbidity and mortality. Patients: Nine newborns (four boys, five girls) were diagnosed with symptomatic vein of Galen malformations in the neonatal period during the period 1996–2001. Eight developed intractable high output cardiac failure requiring initial endovascular treatment in the first week of life. Results: The immediate outcome after a series of endovascular procedures was control of cardiac failure and normal neurological function in six (66%) patients, one death from intractable cardiac failure in the neonatal period, and two late deaths with severe hypoxic-ischaemic neurological injury (33% mortality). Clinical review at 6 months to 4 years of age showed five infants with no evidence of neurological abnormality or cardiac failure and one child with mild developmental delay (11%). Conclusions: Aggressive medical treatment of cardiac failure and early neurointervention combined with modern neuroanaesthetic care results in good survival rates with low morbidity even in cases of high risk VGAM presenting in the immediate perinatal period with cardiac failure. Systemic arterial vasodilators improve outcome in neonates with cardiac failure secondary to VGAM. Excessive ß adrenergic stimulation induced by conventional inotropic agents may exacerbate systemic hypoperfusion. PMID:12193525

  13. Are older patients’ cardiac rehabilitation needs being met?

    PubMed Central

    Tolmie, Elizabeth P; Lindsay, Grace M; Kelly, Tim; Tolson, Debbie; Baxter, Susan; Belcher, Philip R

    2009-01-01

    Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Design. Mixed methods. Methods. A purposive sample of 31 older men and women (?65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview. Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’. Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies. PMID:19638048

  14. Sudden cardiac death – Historical perspectives

    PubMed Central

    Abhilash, S.P.; Namboodiri, Narayanan

    2014-01-01

    Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time. PMID:24568828

  15. Cardiac risk stratification and protection.

    PubMed

    Halub, Meghan E; Sidwell, Richard A

    2015-04-01

    The goal of preoperative cardiac evaluation is to screen for undiagnosed cardiac disease or to find evidence of known conditions that are poorly controlled to allow management that reduces the risk of perioperative cardiac complications. A careful history and physical examination combined with the procedure-specific risk is the cornerstone of this assessment. This article reviews a brief history of prior cardiac risk stratification indexes, explores current practice guidelines by the American College of Cardiology and the American Heart Association Task Force, reviews current methods for preoperative evaluation, discusses revascularization options, and evaluates perioperative medication recommendations. PMID:25814103

  16. Registry of Unexplained Cardiac Arrest

    ClinicalTrials.gov

    2015-04-13

    Cardiac Arrest; Long QT Syndrome; Brugada Syndrome; Catecholaminergi Polymorphic Ventricular Tachycardia; Idiopathic VentricularFibrillation; Early Repolarization Syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy

  17. Remotely maintained waste transfer pump

    SciTech Connect

    Eargle, J.C.

    1990-12-31

    Westinghouse Savannah River Company (WSRC) operates the Savannah River Site (SRS) for the Department of Energy (DOE). Waste from the processing of irradiated material is stored in large shielded tanks. Treated liquid wastes are to be transferred from these tanks to the Defense Waste Processing Facility (DWPF) for incorporation in glass suitable for storage in a federal repository. Characteristics of the wastes range from water-like liquid to highly viscous wastes containing suspended solids. Pumping head requirements for various conditions ranged from 10 meters (35 feet) to 168 meters (550 feet). A specially designed, cantilever type, remotely operated and maintained pump was designed and built to transfer the wastes. To demonstrate the design, a prototype pump was built and testing thoroughly with simulated waste. Severe vibration problems were overcome by proper drive shaft selection and careful control of the space between the pump shaft and fixed running clearances (sometimes called seals). Eleven pumps are now installed and six pumps have been successfully run in water service.

  18. Remotely maintained waste transfer pump

    SciTech Connect

    Eargle, J.C.

    1990-01-01

    Westinghouse Savannah River Company (WSRC) operates the Savannah River Site (SRS) for the Department of Energy (DOE). Waste from the processing of irradiated material is stored in large shielded tanks. Treated liquid wastes are to be transferred from these tanks to the Defense Waste Processing Facility (DWPF) for incorporation in glass suitable for storage in a federal repository. Characteristics of the wastes range from water-like liquid to highly viscous wastes containing suspended solids. Pumping head requirements for various conditions ranged from 10 meters (35 feet) to 168 meters (550 feet). A specially designed, cantilever type, remotely operated and maintained pump was designed and built to transfer the wastes. To demonstrate the design, a prototype pump was built and testing thoroughly with simulated waste. Severe vibration problems were overcome by proper drive shaft selection and careful control of the space between the pump shaft and fixed running clearances (sometimes called seals). Eleven pumps are now installed and six pumps have been successfully run in water service.

  19. What to Expect during Cardiac Rehabilitation

    MedlinePLUS

    ... NHLBI on Twitter. What To Expect During Cardiac Rehabilitation During cardiac rehabilitation (rehab), you'll learn how to: Increase your ... Rate This Content: NEXT >> December 24, 2013 Cardiac Rehabilitation Clinical Trials Clinical trials are research studies that ...

  20. Output Interference in Recognition Memory

    ERIC Educational Resources Information Center

    Criss, Amy H.; Malmberg, Kenneth J.; Shiffrin, Richard M.

    2011-01-01

    Dennis and Humphreys (2001) proposed that interference in recognition memory arises solely from the prior contexts of the test word: Interference does not arise from memory traces of other words (from events prior to the study list or on the study list, and regardless of similarity to the test item). We evaluate this model using output

  1. Output regulation of nonlinear systems

    Microsoft Academic Search

    A. Isidori; C. I. Byrnes

    1990-01-01

    The problem of controlling a fixed nonlinear plant in order to have its output track (or reject) a family of reference (or disturbance) signal produced by some external generator is discussed. It is shown that, under standard assumptions, this problem is solvable if and only if a certain nonlinear partial differential equation is solvable. Once a solution of this equation

  2. x1 OUTPUT OUTPUT ROUTINES * 1. Output routines. This is the file that contains all the output routines fo*

    E-print Network

    van Leeuwen, Marc

    specific standard header files and `* *X Windows' programs are no exception. #include #include #include #include 3. There is one general header file pictures routines. This is the file that contains all the output routines fo* *r the pictures `X' envirom- ment

  3. Cardiovascular anatomy and cardiac function in the air-breathing swamp eel (Monopterus albus).

    PubMed

    Iversen, Nina K; Lauridsen, Henrik; Do, Thi Thanh Huong; Nguyen, Van Cong; Gesser, Hans; Buchanan, Rasmus; Bayley, Mark; Pedersen, Michael; Wang, Tobias

    2013-01-01

    Monopterus albus, a swamp eel inhabiting the freshwaters of South East Asia, relies on an extensive vascularisation of the buccal cavity, pharynx and anterior oesophagus for gas exchange, while the gills are much reduced. In the present study we describe the macro-circulation in the cephalic region and the vascularisation of the buccal cavity of M. albus using vascular fillings and micro-computed tomography (?CT). We also show that M. albus has the capacity to use the buccal cavity for aquatic gas exchange, being able to maintain normal arterial blood gas composition, blood pressure, heart rate and cardiac output throughout 10h of forced submergence. M. albus therefore can be characterised as a facultative air-breather. Because M. albus aestivates for many months in moist mud during the dry season we characterised in vivo cardiovascular function during exposure to anoxia as well as the effects of anoxia on in vitro contractility of strip preparations from atria and ventricle. Both studies revealed a low anoxia tolerance, rendering it unlikely that M. albus can survive prolonged exposure to anoxia. PMID:22944727

  4. Topical minoxidil: cardiac effects in bald man.

    PubMed Central

    Leenen, F H; Smith, D L; Unger, W P

    1988-01-01

    Systemic cardiovascular effects during chronic treatment with topical minoxidil vs placebo were evaluated using a double-blind, randomized design for two parallel groups (n = 20 for minoxidil, n = 15 for placebo). During 6 months of follow-up, blood pressure did not change, whereas minoxidil increased heart rate by 3-5 beats min-1. Compared with placebo, topical minoxidil caused significant increases in LV end-diastolic volume, in cardiac output (by 0.751 min-1) and in LV mass (by 5 g m-2). We conclude that in healthy subjects short-term use of topical minoxidil is likely not to be detrimental. However, safety needs to be established regarding ischaemic symptoms in patients with coronary artery disease as well as for the possible development of LV hypertrophy in healthy subjects during years of therapy. PMID:3191000

  5. Antifibrinolytics in cardiac surgery.

    PubMed

    Dhir, Achal

    2013-01-01

    Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA) or epsilon amino caproic acid (EACA). While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances. PMID:23545866

  6. Cardiac tamponade in Taiwan.

    PubMed

    Wang, M L; Liao, W B; Bullard, M J; Lin, F C; Lin, P J; Chiang, C W; Liaw, S J; Chiang, C H

    1997-09-01

    We retrospectively reviewed all of the patients who were treated for cardiac tamponade at Linkou Chang Gung Memorial Hospital between January 1991 and December 1995. There were a total of 112 patients (57 males, 55 females) with a mean age of 51 +/- 14 years (53 +/- 15, 49 +/- 13, respectively). Dyspnea was the most common complaint (85%). The mean blood pressure was 129 +/- 24/78 +/- 17 mmHg, and only 8% had a systolic blood pressure of less than 90 mmHg. Sinus tachycardia was the most frequent electrocardiographic finding (72%, 62/86). Diffuse low voltage was noted in 35% (30/86) of the patients and electrical alternans was seen in 17% (15/86). The mean volume of pericardial effusion was 610 +/- 263 ml. Sixty-five percent of the pericardial effusions were bloody, 31% were serosanguineous, 2% were purulent and 2% were chylous. Overall, 54.5% of the patients had malignant diseases. Of the 61 patients who died, 79% had malignancies. Thirty-five (57%) of these 48 patients had lung cancer. The mean survival time from emergent pericardiocentesis was 3.4 months. In conclusion, non-traumatic cardiac tamponade had a poor prognosis because most patients had malignant etiologies. There is still no definitive treatment for recurrent malignant pericardial effusion-induced cardiac tamponade. Percutaneous pericardiocentesis as clinically required may be the most appropriate treatment, since it is questionable whether such subjects should be subjected to the unnecessary pain and suffering associated with an operative procedure, considering their short mean survival time. PMID:9293407

  7. Adaptive Neural Output Feedback Control of Output-Constrained Nonlinear Systems With Unknown Output Nonlinearity.

    PubMed

    Liu, Zhi; Lai, Guanyu; Zhang, Yun; Chen, Chun Lung Philip

    2015-08-01

    This paper addresses the problem of adaptive neural output-feedback control for a class of special nonlinear systems with the hysteretic output mechanism and the unmeasured states. A modified Bouc-Wen model is first employed to capture the output hysteresis phenomenon in the design procedure. For its fusion with the neural networks and the Nussbaum-type function, two key lemmas are established using some extended properties of this model. To avoid the bad system performance caused by the output nonlinearity, a barrier Lyapunov function technique is introduced to guarantee the prescribed constraint of the tracking error. In addition, a robust filtering method is designed to cancel the restriction that all the system states require to be measured. Based on the Lyapunov synthesis, a new neural adaptive controller is constructed to guarantee the prescribed convergence of the tracking error and the semiglobal uniform ultimate boundedness of all the signals in the closed-loop system. Simulations are implemented to evaluate the performance of the proposed neural control algorithm in this paper. PMID:25915964

  8. Dilated cardiomyopathy and impaired cardiac hypertrophic response to angiotensin II in mice lacking FGF-2

    PubMed Central

    Pellieux, Corinne; Foletti, Alessandro; Peduto, Giovanni; Aubert, Jean-François; Nussberger, Jürg; Beermann, Friedrich; Brunner, Hans-R.; Pedrazzini, Thierry

    2001-01-01

    FGF-2 has been implicated in the cardiac response to hypertrophic stimuli. Angiotensin II (Ang II) contributes to maintain elevated blood pressure in hypertensive individuals and exerts direct trophic effects on cardiac cells. However, the role of FGF-2 in Ang II–induced cardiac hypertrophy has not been established. Therefore, mice deficient in FGF-2 expression were studied using a model of Ang II–dependent hypertension and cardiac hypertrophy. Echocardiographic measurements show the presence of dilated cardiomyopathy in normotensive mice lacking FGF-2. Moreover, hypertensive mice without FGF-2 developed no compensatory cardiac hypertrophy. In wild-type mice, hypertrophy was associated with a stimulation of the c-Jun N-terminal kinase, the extracellular signal regulated kinase, and the p38 kinase pathways. In contrast, mitogen-activated protein kinase (MAPK) activation was markedly attenuated in FGF-2–deficient mice. In vitro, FGF-2 of fibroblast origin was demonstrated to be essential in the paracrine stimulation of MAPK activation in cardiomyocytes. Indeed, fibroblasts lacking FGF-2 expression have a defective capacity for releasing growth factors to induce hypertrophic responses in cardiomyocytes. Therefore, these results identify the cardiac fibroblast population as a primary integrator of hypertrophic stimuli in the heart, and suggest that FGF-2 is a crucial mediator of cardiac hypertrophy via autocrine/paracrine actions on cardiac cells. PMID:11748268

  9. Genetic determinants of cardiac hypertrophy

    PubMed Central

    Marian, Ali J.

    2009-01-01

    Purpose of review Cardiac hypertrophy is a common phenotypic response of the heart to stimulants. It is associated with increased morbidity and mortality in various cardiovascular disorders. Genetic factors are important determinants of phenotypic expression of cardiac hypertrophy, whether in single-gene disorders or in complex traits. We focus on the molecular genetics of cardiac hypertrophy in various conditions with an emphasis on hypertrophic cardiomyopathy, a genetic paradigm of cardiac hypertrophic response. Recent findings The molecular genetic basis of cardiac hypertrophy in single-gene disorders has been partially elucidated. Likewise, the impact of genetics on the expression of cardiac hypertrophy in the general population has been demonstrated. Identification of mutations in the Z disk proteins has expanded the spectrum of causal mutations beyond the thin and thick filaments of the sarcomeres. In addition, modifier loci have been mapped and shown to impart considerable effects on the expression of cardiac hypertrophy in hypertrophic cardiomyopathy. Elucidation of the molecular genetics of sarcomeric hypertrophic cardiomyopathy and many of the phenocopies has highlighted the limitations of clinical diagnosis as a determinant of management and prognostic advice. The findings have raised the importance of diagnosis and treatment algorithms, which are based on both genotype and phenotype information. Summary Cardiac hypertrophy, regardless of the cause, is the phenotypic consequence of complex interactions between genetic and nongenetic factors. PMID:18382207

  10. Optogenetic Control of Cardiac Function

    Microsoft Academic Search

    Aristides B. Arrenberg; Didier Y. R. Stainier; Herwig Baier; Jan Huisken

    2010-01-01

    The cardiac pacemaker controls the rhythmicity of heart contractions and can be substituted by a battery-operated device as a last resort. We created a genetically encoded, optically controlled pacemaker by expressing halorhodopsin and channelrhodopsin in zebrafish cardiomyocytes. Using patterned illumination in a selective plane illumination microscope, we located the pacemaker and simulated tachycardia, bradycardia, atrioventricular blocks, and cardiac arrest. The

  11. Health Instruction Packages: Cardiac Anatomy.

    ERIC Educational Resources Information Center

    Phillips, Gwen; And Others

    Text, illustrations, and exercises are utilized in these five learning modules to instruct nurses, students, and other health care professionals in cardiac anatomy and functions and in fundamental electrocardiographic techniques. The first module, "Cardiac Anatomy and Physiology: A Review" by Gwen Phillips, teaches the learner to draw and label…

  12. Dexmedetomidine decreases inhibitory but not excitatory neurotransmission to cardiac vagal neurons in the nucleus ambiguus.

    PubMed

    Sharp, Douglas B; Wang, Xin; Mendelowitz, David

    2014-07-29

    Dexmedetomidine, an ?2 adrenergic agonist, is a useful sedative but can also cause significant bradycardia. This decrease in heart rate may be due to decreased central sympathetic output as well as increased parasympathetic output from brainstem cardiac vagal neurons. In this study, using whole cell voltage clamp methodology, the actions of dexmedetomidine on excitatory glutamatergic and inhibitory GABAergic and glycinergic neurotransmission to parasympathetic cardiac vagal neurons in the rat nucleus ambiguus was determined. The results indicate that dexmedetomidine decreases both GABAergic and glycinergic inhibitory input to cardiac vagal neurons, with no significant effect on excitatory input. These results provide a mechanism for dexmedetomidine induced bradycardia and has implications for the management of this potentially harmful side effect. PMID:24933328

  13. Microgyroscope with closed loop output

    NASA Technical Reports Server (NTRS)

    Challoner, A. Dorian (Inventor); Gutierrez, Roman C. (Inventor); Tang, Tony K. (Inventor); Cargille, Donald R. (Inventor)

    2002-01-01

    A micro-gyroscope (10) having closed loop operation by a control voltage (V.sub.TY), that is demodulated by an output signal of the sense electrodes (S1, S2), providing Coriolis torque rebalance to prevent displacement of the micro-gyroscope (10) on the output axis (y-axis). The present invention provides wide-band, closed-loop operation for a micro-gyroscope (10) and allows the drive frequency to be closely tuned to a high Q sense axis resonance. A differential sense signal (S1-S2) is compensated and fed back by differentially changing the voltage on the drive electrodes to rebalance Coriolis torque. The feedback signal is demodulated in phase with the drive axis signal (K.sub..omega..crclbar..sub.x) to produce a measure of the Coriolis force.

  14. The Chemotherapy of Cardiac Arrest

    PubMed Central

    Minuck, Max

    1965-01-01

    Direct-air ventilation, external cardiac compression, and external defibrillation are established techniques for patients who unexpectedly develop cardiac arrest. The proper use of drugs can increase the incidence of successful resuscitation. Intracardiac adrenaline (epinephrine) acts as a powerful stimulant during cardiac standstill and, in addition, converts fine ventricular fibrillation to a coarser type, more responsive to electrical defibrillation. Routine use of intravenous sodium bicarbonate is recommended to combat the severe metabolic acidosis accompanying cardiac arrest. Lidocaine is particularly useful when ventricular fibrillation or ventricular tachycardia tends to recur. Analeptics are contraindicated, since they invariably increase oxygen requirements of already hypoxic cerebral tissues. The following acrostic is a useful mnemonic for recalling the details of the management of cardiac arrest in their proper order: A (Airway), B (Breathing), C (Circulation), D (Diagnosis of underlying cause), E (Epinephrine), F (Fibrillation), G (Glucose intravenously), pH (Sodium bicarbonate), I (Intensive care). ImagesFig. 1Fig. 3Fig. 4 PMID:14216141

  15. Cardiac Remodeling in Obesity

    PubMed Central

    ABEL, E. DALE; LITWIN, SHELDON E.; SWEENEY, GARY

    2010-01-01

    The dramatic increase in the prevalence of obesity and its strong association with cardiovascular disease have resulted in unprecedented interest in understanding the effects of obesity on the cardiovascular system. A consistent, but puzzling clinical observation is that obesity confers an increased susceptibility to the development of cardiac disease, while at the same time affording protection against subsequent mortality (termed the obesity paradox). In this review we focus on evidence available from human and animal model studies and summarize the ways in which obesity can influence structure and function of the heart. We also review current hypotheses regarding mechanisms linking obesity and various aspects of cardiac remodeling. There is currently great interest in the role of adipokines, factors secreted from adipose tissue, and their role in the numerous cardiovascular complications of obesity. Here we focus on the role of leptin and the emerging promise of adiponectin as a cardioprotective agent. The challenge of understanding the association between obesity and heart failure is complicated by the multifaceted interplay between various hemodynamic, metabolic, and other physiological factors that ultimately impact the myocardium. Furthermore, the end result of obesity-associated changes in the myocardial structure and function may vary at distinct stages in the progression of remodeling, may depend on the individual pathophysiology of heart failure, and may even remain undetected for decades before clinical manifestation. Here we summarize our current knowledge of this complex yet intriguing topic. PMID:18391168

  16. A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol

    Microsoft Academic Search

    Janice Sangster; Susan Furber; Margaret Allman-Farinelli; Marion Haas; Philayrath Phongsavan; Andy Mark; Adrian Bauman

    2010-01-01

    BACKGROUND: Maintaining a healthy weight and undertaking regular physical activity are important for the secondary prevention of cardiovascular disease (CVD). However, many people with CVD are overweight and insufficiently active. In addition, in Australia only 20-30% of people requiring cardiac rehabilitation (CR) for CVD actually attend. To improve outcomes of and access to CR the efficacy, effectiveness and cost-effectiveness of

  17. EGF is required for cardiac differentiation of P19CL6 cells through interaction with GATA-4 in a time- and dose-dependent manner.

    PubMed

    Ma, Cai-Xia; Song, Yang-Liu; Xiao, Liyun; Xue, Li-Xiang; Li, Wen-Juan; Laforest, Brigitte; Komati, Hiba; Wang, Wei-Ping; Jia, Zhu-Qing; Zhou, Chun-Yan; Zou, Yunzeng; Nemer, Mona; Zhang, Shan-Feng; Bai, Xiaowen; Wu, Huijian; Zang, Ming-Xi

    2015-05-01

    The regulation of cardiac differentiation is critical for maintaining normal cardiac development and function. The precise mechanisms whereby cardiac differentiation is regulated remain uncertain. Here, we have identified a GATA-4 target, EGF, which is essential for cardiogenesis and regulates cardiac differentiation in a dose- and time-dependent manner. Moreover, EGF demonstrates functional interaction with GATA-4 in inducing the cardiac differentiation of P19CL6 cells in a time- and dose-dependent manner. Biochemically, GATA-4 forms a complex with STAT3 to bind to the EGF promoter in response to EGF stimulation and cooperatively activate the EGF promoter. Functionally, the cooperation during EGF activation results in the subsequent activation of cyclin D1 expression, which partly accounts for the lack of additional induction of cardiac differentiation by the GATA-4/STAT3 complex. Thus, we propose a model in which the regulatory cascade of cardiac differentiation involves GATA-4, EGF, and cyclin D1. PMID:25504289

  18. Stemming heart failure with cardiac- or reprogrammed-stem cells.

    PubMed

    Tateishi, Kento; Takehara, Naofumi; Matsubara, Hiroaki; Oh, Hidemasa

    2008-12-01

    Despite extensive efforts to control myocyte growth by genetic targeting of the cell cycle machinery and small molecules for cardiac repair, adult myocytes themselves appeared to divide a limited number of times in response to a variety of cardiac muscle stresses. Rare tissue-resident stem cells are thought to exist in many adult organs that are capable of self-renewal and differentiation and possess a range of actions that are potentially therapeutic. Recent studies suggest that a population of cardiac stem cells (CSCs) is maintained after cardiac development in the adult heart in mammals including human beings; however, homeostatic cardiomyocyte replacement might be stem cell-dependent, and functional myocardial regeneration after cardiac muscle damage is not yet considered as sufficient to fully maintain or reconstitute the cardiovascular system and function. Although it is clear that adult CSCs have limitations in their capabilities to proliferate extensively and differentiate in response to injury in vivo for replenishing mature car-diomyocytes and potentially function as resident stem cells. Transplantation of CSCs expanded ex vivo seems to require an integrated strategy of cell growth-enhancing factor(s) and tissue engineering technologies to support the donor cell survival and subsequent proliferation and differentiation in the host microenvironment. There has been substantial interest regarding the evidence that mammalian fibroblasts can be genetically reprogrammed to induced pluripotent stem (iPS) cells, which closely resemble embryonic stem (ES) cell properties capable of differentiating into functional cardiomyocytes, and these cells may provide an alternative cell source for generating patient-specific CSCs for therapeutic applications. PMID:18754813

  19. Right atrial tamponade complicating cardiac operation: clinical, hemodynamic, and scintigraphic correlates

    SciTech Connect

    Bateman, T.; Gray, R.; Chaux, A.; Lee, M.; De Robertis, M.; Berman, D.; Matloff, J.

    1982-09-01

    Persistent bleeding into the pericardial space in the early hours after cardiac operation not uncommonly results in cardiac tamponade. Single chamber tamponade also might be expected, since in this setting the pericardium frequently contains firm blood clots localized to the area of active bleeding. However, this complication has received very little attention in the surgical literature. We are therefore providing documentation that isolated right atrial tamponade can occur as a complication of cardiac operation and that there exists a potential for misdiagnosis and hence incorrect treatment of this condition. Right atrial tamponade may be recognized by a combination of low cardiac output, low blood pressure, prominent neck veins, right atrial pressure in excess of pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, and a poor response to plasma volume expansion. Findings on chest roentgenogram and gated wall motion scintigraphy may be highly suggestive. This review should serve to increase awareness of this complication and to provide some helpful diagnostic clues.

  20. Registration-based segmentation of murine 4D cardiac micro-CT data using symmetric normalization

    PubMed Central

    Clark, Darin; Badea, Alexandra; Liu, Yilin; Johnson, G. Allan; Badea, Cristian T.

    2013-01-01

    Micro-CT can play an important role in preclinical studies of cardiovascular disease because of its high spatial and temporal resolution. Quantitative analysis of 4D cardiac images requires segmentation of the cardiac chambers at each time point, an extremely time consuming process if done manually. To improve throughput this study proposes a pipeline for registration-based segmentation and functional analysis of 4D cardiac micro-CT data in the mouse. Following optimization and validation using simulations, the pipeline was applied to in vivo cardiac micro-CT data corresponding to 10 cardiac phases acquired in C57BL/6 mice (n = 5). After edge-preserving smoothing with a novel adaptation of 4D bilateral filtration, one phase within each cardiac sequence was manually segmented. Deformable registration was used to propagate these labels to all other cardiac phases for segmentation. The volumes of each cardiac chamber were calculated and used to derive stroke volume, ejection fraction, cardiac output, and cardiac index. Dice coefficients and volume accuracies were used to compare manual segmentations of two additional phases with their corresponding propagated labels. Both measures were, on average, >0.90 for the left ventricle and >0.80 for the myocardium, the right ventricle, and the right atrium, consistent with trends in inter- and intra-segmenter variability. Segmentation of the left atrium was less reliable. On average, the functional metrics of interest were underestimated by 6.76% or more due to systematic label propagation errors around atrioventricular valves; however, execution of the pipeline was 80% faster than performing analogous manual segmentation of each phase. PMID:22971564

  1. Microdomain Effects on Transverse Cardiac Propagation

    PubMed Central

    Lin, Joyce; Keener, James P.

    2014-01-01

    The effect of gap junctional coupling, sodium ion channel distribution, and extracellular conductivity on transverse conduction in cardiac tissue is explored using a microdomain model that incorporates aspects of the inhomogeneous cellular structure. The propagation velocities found in our model are compared to those in the classic bidomain model and indicate a strong ephaptic microdomain contribution to conduction depending on the parameter regime. We show that ephaptic effects can be quite significant in the junctional spaces between cells, and that the cell activation sequence is modified substantially by these effects. Further, we find that transverse propagation can be maintained by ephaptic effects, even in the absence of gap junctional coupling. The mechanism by which this occurs is found to be cablelike in that the junctional regions act like inverted cables. Our results provide insight into several recent experimental studies that indirectly indicate a mode of action potential propagation that does not rely exclusively on gap junctions. PMID:24559995

  2. Cardiac Nonmyocytes in the Hub of Cardiac Hypertrophy.

    PubMed

    Kamo, Takehiro; Akazawa, Hiroshi; Komuro, Issei

    2015-06-19

    Cardiac hypertrophy is characterized by complex multicellular alterations, such as cardiomyocyte growth, angiogenesis, fibrosis, and inflammation. The heart consists of myocytes and nonmyocytes, such as fibroblasts, vascular cells, and blood cells, and these cells communicate with each other directly or indirectly via a variety of autocrine or paracrine mediators. Accumulating evidence has suggested that nonmyocytes actively participate in the development of cardiac hypertrophy. In this review, recent progress in our understanding of the importance of nonmyocytes as a hub for induction of cardiac hypertrophy is summarized with an emphasis of the contribution of noncontact communication mediated by diffusible factors between cardiomyocytes and nonmyocytes in the heart. PMID:26089366

  3. Constitutive phosphorylation of cardiac Myosin regulatory light chain in vivo.

    PubMed

    Chang, Audrey N; Battiprolu, Pavan K; Cowley, Patrick M; Chen, Guohua; Gerard, Robert D; Pinto, Jose R; Hill, Joseph A; Baker, Anthony J; Kamm, Kristine E; Stull, James T

    2015-04-24

    In beating hearts, phosphorylation of myosin regulatory light chain (RLC) at a single site to 0.45 mol of phosphate/mol by cardiac myosin light chain kinase (cMLCK) increases Ca(2+) sensitivity of myofilament contraction necessary for normal cardiac performance. Reduction of RLC phosphorylation in conditional cMLCK knock-out mice caused cardiac dilation and loss of cardiac performance by 1 week, as shown by increased left ventricular internal diameter at end-diastole and decreased fractional shortening. Decreased RLC phosphorylation by conventional or conditional cMLCK gene ablation did not affect troponin-I or myosin-binding protein-C phosphorylation in vivo. The extent of RLC phosphorylation was not changed by prolonged infusion of dobutamine or treatment with a ?-adrenergic antagonist, suggesting that RLC is constitutively phosphorylated to maintain cardiac performance. Biochemical studies with myofilaments showed that RLC phosphorylation up to 90% was a random process. RLC is slowly dephosphorylated in both noncontracting hearts and isolated cardiac myocytes from adult mice. Electrically paced ventricular trabeculae restored RLC phosphorylation, which was increased to 0.91 mol of phosphate/mol of RLC with inhibition of myosin light chain phosphatase (MLCP). The two RLCs in each myosin appear to be readily available for phosphorylation by a soluble cMLCK, but MLCP activity limits the amount of constitutive RLC phosphorylation. MLCP with its regulatory subunit MYPT2 bound tightly to myofilaments was constitutively phosphorylated in beating hearts at a site that inhibits MLCP activity. Thus, the constitutive RLC phosphorylation is limited physiologically by low cMLCK activity in balance with low MLCP activity. PMID:25733667

  4. Multithreaded cardiac CT

    SciTech Connect

    Kachelriess, Marc; Knaup, Michael; Kalender, Willi A. [Institute of Medical Physics, University of Erlangen, Nuernberg (Germany)

    2006-07-15

    Phase-correlated CT, as it is used for cardiac imaging, is the most popular and the most important but also the most demanding special CT application in the clinical routine, today. Basically, it fulfills the four-dimensional imaging task of depicting a quasiperiodically moving object at any desired motion phase with significantly reduced motion artifacts. Although image quality with phase-correlated reconstruction is far better than with standard reconstruction, there are motion artifacts remaining and improvements of temporal resolution are required. As a well-known alternative to simply decreasing rotation time, we consider a spiral cone-beam CT scanner that has G x-ray guns and detectors mounted. We call this a multisource or a multithreaded CT scanner. Aiming for improved temporal resolution the relative temporal resolution {tau}, which measures the fraction of a motion period that enters the image, is studied as a function of the motion rate (heart rate) and the degree of scan overlap (pitch value) for various configurations. The parameters to optimize are the number of threads G and the interthread parameters {delta}{alpha} and {delta}z, which are the angular and the longitudinal separation between adjacent threads, respectively. To demonstrate the improvements approximate image reconstruction of multithreaded raw data is performed by using a generalization of the extended parallel back projection cone-beam reconstruction algorithm [Med. Phys. 31(6), 1623-1641 (2004)] to the case of multithreaded CT. Reconstructions of a simulated cardiac motion phantom and of simulated semi-antropomorphic phantoms are presented for two and three threads and compared to the single-threaded case to demonstrate the potential of multithreaded cardiac CT. Patient data were acquired using a clinical double-threaded CT scanner to validate the theoretical results. The optimum angle {delta}{alpha} between the tubes is 90 deg.for a double-threaded system, and for triple-threaded scanners it is 60 deg.or 120 deg.. In all cases, {delta}z=0 results as an optimum, which means that the threads should be mounted in the same transversal plane. However, the dependency of the temporal resolution on {delta}z is very weak and a longitudinal separation {delta}z{ne}0 would not deteriorate image quality. The mean temporal resolution achievable with an optimized multithreaded CT scanner is a factor of G better than the mean temporal resolution obtained with a single-threaded scanner. The standard reconstructions showed decreased cone-beam artifacts with multithreaded CT compared to the single-threaded case. Our phase-correlated reconstructions demonstrate that temporal resolution is significantly improved with multithreaded CT. The clinical patient data confirm our results.

  5. Trends in Cardiac Pacemaker Batteries

    PubMed Central

    Mallela, Venkateswara Sarma; Ilankumaran, V; Rao, N.Srinivasa

    2004-01-01

    Batteries used in Implantable cardiac pacemakers-present unique challenges to their developers and manufacturers in terms of high levels of safety and reliability. In addition, the batteries must have longevity to avoid frequent replacements. Technological advances in leads/electrodes have reduced energy requirements by two orders of magnitude. Micro-electronics advances sharply reduce internal current drain concurrently decreasing size and increasing functionality, reliability, and longevity. It is reported that about 600,000 pacemakers are implanted each year worldwide and the total number of people with various types of implanted pacemaker has already crossed 3 million. A cardiac pacemaker uses half of its battery power for cardiac stimulation and the other half for housekeeping tasks such as monitoring and data logging. The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. This paper briefly reviews various developments of battery technologies since the inception of cardiac pacemaker and presents the alternative to lithium iodine battery for the near future. PMID:16943934

  6. Automatic UAV Landing with Ground Target Maintained in the Field of View

    E-print Network

    Automatic UAV Landing with Ground Target Maintained in the Field of View Laurent Burlion and Henry de Plinval Abstract In this paper, a key feature for UAV visual servoing in automatic land- ing. First, a control law for UAV automatic landing is proposed. Then, the output con- straint method

  7. Maintaining and Enhancing a College or University Image. AIR Forum 1982 Paper.

    ERIC Educational Resources Information Center

    Fram, Eugene H.

    The use of marketing concepts to maintain and enhance the image of a university is considered. Over all, what is needed is a system for image assessment to provide a basis for image development. Without this system and its information outputs, misconceptions can enter the policy-making process at critical junctures, and the life of the institution…

  8. Cardiac neurones of autonomic ganglia.

    PubMed

    Wallis, D; Watson, A H; Mo, N

    1996-09-01

    The properties of the postganglionic sympathetic neurones supplying the heart and arising in the stellate and adjacent paravertebral ganglia of various species are discussed with respect to their location, morphology, synaptic input and membrane characteristics. Results from our laboratory on the morphology of rat stellate neurones projecting to the heart were obtained either by intracellular injection of hexammine cobaltic (III) chloride or by retrograde labelling of cells using cobalt-lysine complex. Intracellular recordings were made from cells using electrodes filled either with potassium chloride plus hexammine cobaltic chloride or potassium acetate. Neurones which projected axons into cardiac nerve branches arising from the stellate ganglion were termed putative cardiac neurones, because of the possibility that some supply pulmonary targets. Putative cardiac neurones had unbranched axons and were ovoid or polygonal in shape, but showed considerable variation in soma size and in the complexity of dendritic trees. The mean two-dimensional surface area was 463 microns2 and the mean number of primary dendrites was seven. Other studies have found that the morphology of rat stellate ganglion neurones is similar to that of superior cervical ganglion cells. However, in strains of rat displaying spontaneous hypertension, dendritic length may be increased. Histochemical studies do not, as yet, seem to have demonstrated a distinctive neurochemical profile for stellate cardiac neurones, but various types of peptide-containing intraganglionic nerve fibres have been identified in the guinea pig. In our electrophysiological studies, putative cardiac neurones were found to receive a complex presynaptic input arising from the caudal sympathetic trunk and from T1 and T2 thoracic rami. In addition, 16% of cardiac neurones received a synaptic input from the cardiac nerve. The properties of postganglionic parasympathetic neurones distributed in the cardiac plexus and termed intrinsic cardiac neurones are discussed, including the results of studies on cultures of these neurones. PMID:8873060

  9. Cardiac cone-beam CT

    SciTech Connect

    Manzke, Robert [University of London (King's College) (United Kingdom)]. E-mail: robert.manzke@philips.com

    2005-10-15

    This doctoral thesis addresses imaging of the heart with retrospectively gated helical cone-beam computed tomography (CT). A thorough review of the CT reconstruction literature is presented in combination with a historic overview of cardiac CT imaging and a brief introduction to other cardiac imaging modalities. The thesis includes a comprehensive chapter about the theory of CT reconstruction, familiarizing the reader with the problem of cone-beam reconstruction. The anatomic and dynamic properties of the heart are outlined and techniques to derive the gating information are reviewed. With the extended cardiac reconstruction (ECR) framework, a new approach is presented for the heart-rate-adaptive gated helical cardiac cone-beam CT reconstruction. Reconstruction assessment criteria such as the temporal resolution, the homogeneity in terms of the cardiac phase, and the smoothness at cycle-to-cycle transitions are developed. Several reconstruction optimization approaches are described: An approach for the heart-rate-adaptive optimization of the temporal resolution is presented. Streak artifacts at cycle-to-cycle transitions can be minimized by using an improved cardiac weighting scheme. The optimal quiescent cardiac phase for the reconstruction can be determined automatically with the motion map technique. Results for all optimization procedures applied to ECR are presented and discussed based on patient and phantom data. The ECR algorithm is analyzed for larger detector arrays of future cone-beam systems throughout an extensive simulation study based on a four-dimensional cardiac CT phantom. The results of the scientific work are summarized and an outlook proposing future directions is given. The presented thesis is available for public download at www.cardiac-ct.net.

  10. [Tolerance of +Gz accelerations in chronic compensated cardiac muscle disease].

    PubMed

    Suvorov, P M; Bykova, Iu I

    1975-01-01

    The functional potentialities of the cardiovascular system were investigated during an exposure of people with compensated chronic diseases of the cardiac muscle to acceleration (+Gz). The test subjects were exposed to acceleration of 3 and 5 g for 30 sec with an interval of 5 min. The parameters of hemodynamics, ECG and visual perception were recorded. The systolic blood volume, cardiac output and specific peripheral resistance were derived from the Bremser-Ranke formula. Seventy one subjects with heart diseases and 23 healthy subjects were examined. The subjects with myocardiodystrophy and myocarditic cardiosclerosis (12+/-16) showed a reduced tolerance to accelerations. During an exposure the subjects with atherosclerotic cardiosclerosis showed a higher pressure in vessels of ear conch than the healthy subjects. The myocardiodystrophic subjects frequently (20%) exhibited an inversion of electrocardiographic T2. The subjects with heart diseases (27-33%) showed extrasystolic disturbances. The results may be used in medical expertise of pilots. PMID:1214489

  11. Influence of Vascular Function and Pulsatile Hemodynamics on Cardiac Function.

    PubMed

    Bell, Vanessa; Mitchell, Gary F

    2015-09-01

    Interactions between cardiac and vascular structure and function normally are optimized to ensure delivery of cardiac output with modest pulsatile hemodynamic overhead. Aortic stiffening with age or disease impairs optimal ventricular-vascular coupling, increases pulsatile load, and contributes to left ventricular (LV) hypertrophy, reduced systolic function, and impaired diastolic relaxation. Aortic pulse pressure and timing of peak systolic pressure are well-known measures of hemodynamic ventricular-vascular interaction. Recent work has elucidated the importance of direct, mechanical coupling between the aorta and the heart. LV systolic contraction results in displacement of aortic and mitral annuli, thereby producing longitudinal stretch in the ascending aorta and left atrium, respectively. Force associated with longitudinal stretch increases systolic load on the LV. However, the resulting energy stored in the elastic elements of the proximal aorta during systole facilitates early diastolic LV recoil and rapid filling. This review discusses current views on hemodynamics and mechanics of ventricular-vascular coupling. PMID:26164466

  12. Videoscope-assisted cardiac surgery

    PubMed Central

    Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic. PMID:24455172

  13. Predicting cardiac complications in patients undergoing non-cardiac surgery

    Microsoft Academic Search

    Allan S. Detsky; Howard B. Abrams; John R. McLaughlin; Daniel J. Drucker; Zion Sasson; Nancy Johnston; J. Gerald Scott; Nicholas Forbath; Joseph R. Hilliard

    1986-01-01

    The authors prospectively studied 455 consecutive patients referred to the general medical consultation service for cardiac\\u000a risk assessment prior to non-cardiac surgery, in order to validate a previously derived multifactorial index in their clinical\\u000a setting. They also tested a version of the index that they had modified to reflect factors they believed to be important.\\u000a For patients undergoing major surgery,

  14. Fetal cardiac hypertrophy and cardiac function in diabetic pregnancies

    Microsoft Academic Search

    Jyotsna A. Gandhi; Xiao Yang Zhang; Jack E. Maidman

    1995-01-01

    OBJECTIVE: Our purpose was to evaluate the relationship between fetal cardiac wall hypertrophy and ventricular function in fetuses of metabolically controlled, insulin-requiring diabetics.STUDY DESIGN: M-mode directed fetal echocardiography included measurements of left and right ventricular free wall and interventricular septal thickness and ventricular diastolic and systolic dimensions. Fetal measurements included biparietal diameter, estimation of fetal weight, and cardiac area\\/thoracic area.

  15. Designing for Maintainability and System Availability

    NASA Technical Reports Server (NTRS)

    Lalli, Vincent R.; Packard, Michael H.

    1997-01-01

    The final goal for a delivered system (whether a car, aircraft, avionics box or computer) should be its availability to operate and perform its intended function over its expected design life. Hence, in designing a system, we cannot think in terms of delivering the system and just walking away. The system supplier needs to provide support throughout the operating life of the product. Here, supportability requires an effective combination of reliability, maintainability, logistics and operations engineering (as well as safety engineering) to have a system that is available for its intended use throughout its designated mission lifetime. Maintainability is a key driving element in the effective support and upkeep of the system as well as providing the ability to modify and upgrade the system throughout its lifetime. This paper then, will concentrate on maintainability and its integration into the system engineering and design process. The topics to be covered include elements of maintainability, the total cost of ownership, how system availability, maintenance and logistics costs and spare parts cost effect the overall program costs. System analysis and maintainability will show how maintainability fits into the overall systems approach to project development. Maintainability processes and documents will focus on how maintainability is to be performed and what documents are typically generated for a large scale program. Maintainability analysis shows how trade-offs can be performed for various alternative components. The conclusions summarize the paper and are followed by specific problems for hands-on training.

  16. Cardiac Metabolism in Heart Failure - Implications beyond ATP production

    PubMed Central

    Doenst, Torsten; Nguyen, T. Dung; Abel, E. Dale

    2013-01-01

    The heart has a high rate of ATP production and turnover which is required to maintain its continuous mechanical work. Perturbations in ATP generating processes may therefore affect contractile function directly. Characterizing cardiac metabolism in heart failure revealed several metabolic alterations termed metabolic remodeling, ranging from changes in substrate utilization to mitochondrial dysfunction, ultimately resulting in ATP deficiency and impaired contractility. However, ATP depletion is not the only relevant consequence of metabolic remodeling during heart failure. By providing cellular building blocks and signaling molecules, metabolic pathways control essential processes such as cell growth and regeneration. Thus, alterations in cardiac metabolism may also affect the progression to heart failure by mechanisms beyond ATP supply. Our aim is therefore to highlight that metabolic remodeling in heart failure not only results in impaired cardiac energetics, but also induces other processes implicated in the development of heart failure such as structural remodeling and oxidative stress. Accordingly, modulating cardiac metabolism in heart failure may have significant therapeutic relevance that goes beyond the energetic aspect. PMID:23989714

  17. Cardiac Rehabilitation: Then and Now.

    ERIC Educational Resources Information Center

    Wilson, Philip K.

    1988-01-01

    As more and more patients survive a coronary event, the need for cardiac rehabilitation will increase. The author reviews the history and current status of this field and predicts what lies ahead. (JD)

  18. Cardiac performance correlates of relative heart ventricle mass in amphibians.

    PubMed

    Kluthe, Gregory J; Hillman, Stanley S

    2013-08-01

    This study used an in situ heart preparation to analyze the power output and stroke work of spontaneously beating hearts of four anurans (Rhinella marina, Lithobates catesbeianus, Xenopus laevis, Pyxicephalus edulis) and three urodeles (Necturus maculosus, Ambystoma tigrinum, Amphiuma tridactylum) that span a representative range of relative ventricle mass (RVM) found in amphibians. Previous research has documented that RVM correlates with dehydration tolerance and maximal aerobic capacity in amphibians. The power output (mW g(-1) ventricle mass) and stroke work (mJ g(-1) ventricle muscle mass) were independent of RVM and were indistinguishable from previously published results for fish and reptiles. RVM was significantly correlated with maximum power output (P max, mW kg(-1) body mass), stroke volume, cardiac output, afterload pressure (P O) at P max, and preload pressure (P I) at P max. P I at P max and P O at P max also correlated very closely with each other. The increases in both P I and P O at maximal power outputs in large hearts suggest that concomitant increases in blood volume and/or increased modulation of vascular compliance either anatomically or via sympathetic tone on the venous vasculature would be necessary to achieve P max in vivo. Hypotheses for variation in RVM and its concomitant increased P max in amphibians are developed. PMID:23619575

  19. Basal ganglia outputs map instantaneous position coordinates during behavior.

    PubMed

    Barter, Joseph W; Li, Suellen; Sukharnikova, Tatyana; Rossi, Mark A; Bartholomew, Ryan A; Yin, Henry H

    2015-02-11

    The basal ganglia (BG) are implicated in many movement disorders, yet how they contribute to movement remains unclear. Using wireless in vivo recording, we measured BG output from the substantia nigra pars reticulata (SNr) in mice while monitoring their movements with video tracking. The firing rate of most nigral neurons reflected Cartesian coordinates (either x- or y-coordinates) of the animal's head position during movement. The firing rates of SNr neurons are either positively or negatively correlated with the coordinates. Using an egocentric reference frame, four types of neurons can be classified: each type increases firing during movement in a particular direction (left, right, up, down), and decreases firing during movement in the opposite direction. Given the high correlation between the firing rate and the x and y components of the position vector, the movement trajectory can be reconstructed from neural activity. Our results therefore demonstrate a quantitative and continuous relationship between BG output and behavior. Thus, a steady BG output signal from the SNr (i.e., constant firing rate) is associated with the lack of overt movement, when a stable posture is maintained by structures downstream of the BG. Any change in SNr firing rate is associated with a change in position (i.e., movement). We hypothesize that the SNr output quantitatively determines the direction, velocity, and amplitude of voluntary movements. By changing the reference signals to downstream position control systems, the BG can produce transitions in body configurations and initiate actions. PMID:25673860

  20. The Network Structure of Economic Output

    E-print Network

    Hidalgo, Cesar A.

    Much of the analysis of economic growth has focused on the study of aggregate output. Here, we deviate from this tradition and look instead at the structure of output embodied in the network connecting countries to the ...

  1. Estrogen-related receptor ? (ERR?) and ERR? are essential coordinators of cardiac metabolism and function.

    PubMed

    Wang, Ting; McDonald, Caitlin; Petrenko, Nataliya B; Leblanc, Mathias; Wang, Tao; Giguere, Vincent; Evans, Ronald M; Patel, Vickas V; Pei, Liming

    2015-04-01

    Almost all cellular functions are powered by a continuous energy supply derived from cellular metabolism. However, it is little understood how cellular energy production is coordinated with diverse energy-consuming cellular functions. Here, using the cardiac muscle system, we demonstrate that nuclear receptors estrogen-related receptor ? (ERR?) and ERR? are essential transcriptional coordinators of cardiac energy production and consumption. On the one hand, ERR? and ERR? together are vital for intact cardiomyocyte metabolism by directly controlling expression of genes important for mitochondrial functions and dynamics. On the other hand, ERR? and ERR? influence major cardiomyocyte energy consumption functions through direct transcriptional regulation of key contraction, calcium homeostasis, and conduction genes. Mice lacking both ERR? and cardiac ERR? develop severe bradycardia, lethal cardiomyopathy, and heart failure featuring metabolic, contractile, and conduction dysfunctions. These results illustrate that the ERR transcriptional pathway is essential to couple cellular energy metabolism with energy consumption processes in order to maintain normal cardiac function. PMID:25624346

  2. Results of a 4-week head-down tilt with and without LBNP countermeasure: II. Cardiac and peripheral hemodynamics--comparison with a 25-day spaceflight.

    PubMed

    Arbeille, P; Gauquelin, G; Pottier, J M; Pourcelot, L; Güell, A; Gharib, C

    1992-01-01

    Cardiovascular hemodynamics were assessed by ultrasound echography and Doppler during a 28-d head-down tilt "CNES HDT: 87-88," and during the 25-d French-Soviet spaceflight "Aragatz 88." For both studies we used the same ultrasound methodology. The main hemodynamic parameters of the left heart function and of the peripheral arterial system (cerebral, renal, femoral arteries) were measured four times during the HDT (day 7, 14, 21, 28) and twice post-HDT. The same measurements were performed six times during the flight (day 4, 5, 15, 18, 20, 24) and five times postflight. During the HDT, two groups were studied: six subjects no countermeasures and six subjects with repeated lower body negative pressure (LBNP). In the first group the cardiac volumes and the cardiac output were significantly decreased, whereas in the group with LBNP these parameters were superior to the basal value. In the group without LBNP the cerebral flow was maintained because of a decrease of the brain vascular resistance. In this group the renal vascular resistance was decreased as inflight. In the lower limbs we observed a loss of the vasomotor control. The vascular resistance was decreased after the end of the HDT and the subjects suffered orthostatic intolerance. In the population with LBNP, we did not observe the same decrease of vascular resistance during the HDT, and after the HDT no sign of orthostatic intolerance was observed. During the flight, the left ventricular volume was significantly decreased. The carotid flow was maintained owing to a decrease of the cerebral vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1550542

  3. Cardiac manifestations in systemic sclerosis

    PubMed Central

    Lambova, Sevdalina

    2014-01-01

    Primary cardiac involvement, which develops as a direct consequence of systemic sclerosis (SSc), may manifest as myocardial damage, fibrosis of the conduction system, pericardial and, less frequently, as valvular disease. In addition, cardiac complications in SSc may develop as a secondary phenomenon due to pulmonary arterial hypertension and kidney pathology. The prevalence of primary cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations, the presence of subclinical periods, the type of diagnostic tools applied, and the diversity of patient populations. When clinically manifested, cardiac involvement is thought to be an important prognostic factor. Profound microvascular disease is a pathognomonic feature of SSc, as both vasospasm and structural alterations are present. Such alterations are thought to predict macrovascular atherosclerosis over time. There are contradictory reports regarding the prevalence of atherosclerosis in SSc. According to some authors, the prevalence of atherosclerosis of the large epicardial coronary arteries is similar to that of the general population, in contrast with other rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the level of inflammation in SSc is inferior. Thus, the atherosclerotic process may not be as aggressive and not easily detectable in smaller studies. Echocardiography (especially tissue Doppler imaging), single-photon emission computed tomography, magnetic resonance imaging and cardiac computed tomography are sensitive techniques for earlier detection of both structural and functional scleroderma-related cardiac pathologies. Screening for subclinical cardiac involvement via modern, sensitive tools provides an opportunity for early diagnosis and treatment, which is of crucial importance for a positive outcome. PMID:25276300

  4. CT-guided cardiac electrophysiology

    Microsoft Academic Search

    Farhood Saremi; Trien Dang

    2009-01-01

    Recent advances in cardiac electrophysiology with revolutionary development of transcutaneous procedures have required electrophysiologists\\u000a to have precise knowledge of the spatial anatomy of the heart, and thus, led to the increasing use of cardiac imaging procedures\\u000a such as multidetector CT (MDCT). The introduction of 64-detector (and higher) scanners has made it possible to visualize the\\u000a anatomic landmarks that are essential

  5. NADPH oxidases and cardiac remodelling

    Microsoft Academic Search

    Adam Nabeebaccus; Min Zhang; Ajay M. Shah

    2011-01-01

    A heart under chronic stress undergoes cardiac remodelling, a process that comprises structural and functional changes including\\u000a cardiomyocyte hypertrophy, interstitial fibrosis, contractile dysfunction, cell death and ventricular dilatation. Reactive\\u000a oxygen species (ROS)-dependent modulation of intracellular signalling is implicated in the development of cardiac remodelling.\\u000a Among the different ROS sources that are present in the heart, NADPH oxidases (NOXs) are particularly

  6. Overview of cardiac computed tomography

    Microsoft Academic Search

    Matthew J. Budoff

    2008-01-01

    Cardiac CT (CCT) has evolved rapidly over the past 20 years. Initially designed as a test for myocardial perfusion, CCT has\\u000a developed into a potent screening test for atherosclerosis and a surrogate for invasive angiography (CT angiography). CT angiography,\\u000a with high correlation to invasive angiography, is now being increasingly used in clinical practice as an alternative to cardiac\\u000a catheterization or

  7. The Toronto Risk Score for adverse events following cardiac surgery

    PubMed Central

    Ivanov, Joan; Borger, Michael A; Rao, Vivek; David, Tirone E

    2006-01-01

    OBJECTIVE To develop and validate an objective and reliable measure of acuity that will identify high-risk patients and predict length of stay following all cardiac surgery procedures. METHODS Logistical regression analysis of 12,683 patients undergoing cardiac surgery between 1996 and 2000 was used to identify the independent predictors of postoperative adverse events (AEs, defined as death, myocardial infarction, low cardiac output syndrome, postoperative renal failure, stroke or deep sternal wound infection). The rounded ORs for each of the 18 predictors of AEs were summed to calculate the Toronto Risk Score (TRS) for each patient. Weighted linear regression was used to determine the relationship between TRS and length of stay in the 4378 patients who underwent cardiac surgery between 2001 and 2002. RESULTS TRS was significantly associated with cardiovascular intensive care unit length of stay (R2=0.85, slope=0.42, intercept=0.4; P<0.001). For each unit increase in TRS, cardiovascular intensive care unit length of stay increased by 0.4±0.05 days. TRS was also significantly associated with total postoperative length of stay (R2=0.88, slope=0.71, intercept=4.9; P<0.001). TRS captured a significant increase in acuity from 1996 and 2000 (5.12±3.5) to 2001 and 2002 (5.54±3.5; P<0.001). Despite increased acuity, AEs were reduced in 2001 and 2002 (8.1%) compared with 1996 to 2000 (9.8%; P=0.012). CONCLUSIONS The TRS is a valid measure of acuity that can identify patients who are at high risk of experiencing an AE and having prolonged length of stay after any cardiac surgery procedure, capture changes in acuity over time and allow for continuous quality performance evaluation. PMID:16520853

  8. Indeterminacy of spatiotemporal cardiac alternans

    NASA Astrophysics Data System (ADS)

    Zhao, Xiaopeng

    2008-07-01

    Cardiac alternans, a beat-to-beat alternation in action potential duration (at the cellular level) or in electrocardiogram morphology (at the whole heart level), is a marker of ventricular fibrillation, a fatal heart rhythm that kills hundreds of thousands of people in the United States each year. Investigating cardiac alternans may lead to a better understanding of the mechanisms of cardiac arrhythmias and eventually better algorithms for the prediction and prevention of such dreadful diseases. In paced cardiac tissue, alternans develops under increasingly shorter pacing period. Existing experimental and theoretical studies adopt the assumption that alternans in homogeneous cardiac tissue is exclusively determined by the pacing period. In contrast, we find that, when calcium-driven alternans develops in cardiac fibers, it may take different spatiotemporal patterns depending on the pacing history. Because there coexist multiple alternans solutions for a given pacing period, the alternans pattern on a fiber becomes unpredictable. Using numerical simulation and theoretical analysis, we show that the coexistence of multiple alternans patterns is induced by the interaction between electrotonic coupling and an instability in calcium cycling.

  9. Global availability of cardiac rehabilitation

    PubMed Central

    Turk-Adawi, Karam; Sarrafzadegan, Nizal; Grace, Sherry L.

    2015-01-01

    Cardiovascular disease (CVD) is the most-prevalent noncommunicable disease and leading cause of death globally. Over 80% of deaths from CVD occur in low-income and middle-income countries (LMICs). To limit the socioeconomic impact of CVD, a comprehensive approach to health care is needed. Cardiac rehabilitation delivers a cost-effective and structured exercise, education, and risk reduction programme, which can reduce mortality by up to 25% in addition to improving a patient’s functional capacity and lowering rehospitalization rates. Despite these benefits and recommendations in clinical practice guidelines, cardiac rehabilitation programmes are grossly under-used compared with revascularization or medical therapy for patients with CVD. Worldwide, only 38.8% of countries have cardiac rehabilitation programmes. Specifically, 68.0% of high-income and 23% of LMICs (8.3% for low-income and 28.2% for middle-income countries) offer cardiac rehabilitation programmes to patients with CVD. Cardiac rehabilitation density estimates range from one programme per 0.1 to 6.4 million inhabitants. Multilevel strategies to augment cardiac rehabilitation capacity and availability at national and international levels, such as supportive public health policies, systematic referral strategies, and alternative models of delivery are needed. PMID:25027487

  10. Intracellular signaling of cardiac fibroblasts.

    PubMed

    Roche, Patricia L; Filomeno, Krista L; Bagchi, Rushita A; Czubryt, Michael P

    2015-03-01

    Long regarded as a mere accessory cell for the cardiomyocyte, the cardiac fibroblast is now recognized as a critical determinant of cardiac function in health and disease. A recent renaissance in fibroblast-centered research has fostered a better understanding than ever before of the biology of fibroblasts and their contractile counterparts, myofibroblasts. While advanced methodological approaches, including transgenics, lineage fate mapping, and improved cell marker identification have helped to facilitate this new work, the primary driver is arguably the contribution of myofibroblasts to cardiac pathophysiology including fibrosis and arrhythmogenesis. Fibrosis is a natural sequel to numerous common cardiac pathologies including myocardial infarction and hypertension, and typically exacerbates cardiovascular disease and progression to heart failure, yet no therapies currently exist to specifically target fibrosis. The regulatory processes and intracellular signaling pathways governing fibroblast and myofibroblast behavior thus represent important points of inquiry for the development of antifibrotic treatments. While steady progress is being made in uncovering the signaling pathways specific for cardiac fibroblast function (including proliferation, phenotype conversion, and matrix synthesis), much of what is currently known of fibroblast signaling mechanisms is derived from noncardiac fibroblast populations. Given the heterogeneity of fibroblasts across tissues, this dearth of information further underscores the need for progress in cardiac fibroblast biological research. © 2015 American Physiological Society. Compr Physiol 5: 721-760, 2015. PMID:25880511

  11. Drosophila Models of Cardiac Disease

    PubMed Central

    Piazza, Nicole; Wessells, R.J.

    2013-01-01

    The fruit fly Drosophila melanogaster has emerged as a useful model for cardiac diseases, both developmental abnormalities and adult functional impairment. Using the tools of both classical and molecular genetics, the study of the developing fly heart has been instrumental in identifying the major signaling events of cardiac field formation, cardiomyocyte specification, and the formation of the functioning heart tube. The larval stage of fly cardiac development has become an important model system for testing isolated preparations of living hearts for the effects of biological and pharmacological compounds on cardiac activity. Meanwhile, the recent development of effective techniques to study adult cardiac performance in the fly has opened new uses for the Drosophila model system. The fly system is now being used to study long-term alterations in adult performance caused by factors such as diet, exercise, and normal aging. The fly is a unique and valuable system for the study of such complex, long-term interactions, as it is the only invertebrate genetic model system with a working heart developmentally homologous to the vertebrate heart. Thus, the fly model combines the advantages of invertebrate genetics (such as large populations, facile molecular genetic techniques, and short lifespan) with physiological measurement techniques that allow meaningful comparisons with data from vertebrate model systems. As such, the fly model is well situated to make important contributions to the understanding of complicated interactions between environmental factors and genetics in the long-term regulation of cardiac performance. PMID:21377627

  12. Cardiac effects of 3-iodothyronamine: a new aminergic system modulating cardiac function.

    PubMed

    Chiellini, Grazia; Frascarelli, Sabina; Ghelardoni, Sandra; Carnicelli, Vittoria; Tobias, Sandra C; DeBarber, Andrea; Brogioni, Simona; Ronca-Testoni, Simonetta; Cerbai, Elisabetta; Grandy, David K; Scanlan, Thomas S; Zucchi, Riccardo

    2007-05-01

    3-Iodothyronamine T1AM is a novel endogenous thyroid hormone derivative that activates the G protein-coupled receptor known as trace anime-associated receptor 1 (TAAR1). In the isolated working rat heart and in rat cardiomyocytes, T1AM produced a reversible, dose-dependent negative inotropic effect (e.g., 27+/-5, 51+/-3, and 65+/-2% decrease in cardiac output at 19, 25, and 38 microM concentration, respectively). An independent negative chronotropic effect was also observed. The hemodynamic effects of T1AM were remarkably increased in the presence of the tyrosine kinase inhibitor genistein, whereas they were attenuated in the presence of the tyrosine phosphatase inhibitor vanadate. No effect was produced by inhibitors of protein kinase A, protein kinase C, calcium-calmodulin kinase II, phosphatidylinositol-3-kinase, or MAP kinases. Tissue cAMP levels were unchanged. In rat ventricular tissue, Western blot experiments with antiphosphotyrosine antibodies showed reduced phosphorylation of microsomal and cytosolic proteins after perfusion with synthetic T1AM; reverse transcriptase-polymerase chain reaction experiments revealed the presence of transcripts for at least 5 TAAR subtypes; specific and saturable binding of [125I]T1AM was observed, with a dissociation constant in the low micromolar range (5 microM); and endogenous T1AM was detectable by tandem mass spectrometry. In conclusion, our findings provide evidence for the existence of a novel aminergic system modulating cardiac function. PMID:17284482

  13. Maintaining the Gains in Malaria Control

    E-print Network

    Klein, Ophir

    Maintaining the Gains in Malaria Control Ethiopia | Rwanda | Senegal | Tanzania (Mainland and Zanzibar) COUNTRY BRIEFS September 2011 #12;#12;SEpTEMbER 2011 MainTaining ThE gainS in MalaRia conTRol | ExEcuTivE SuMMaRy | 3 Key messages · aggressive campaigns to scale up malaria control have led

  14. Encapsulation method for maintaining biodecontamination activity

    DOEpatents

    Rogers, Robert D. (Idaho Falls, ID); Hamilton, Melinda A. (Idaho Falls, ID); Nelson, Lee O. (Idaho Falls, ID); Benson, Jennifer (Cockermouth, GB); Green, Martin J. (Wooton, GB); Milner, Timothy N. (Centerville, VA)

    2002-01-01

    A method for maintaining the viability and subsequent activity of microorganisms utilized in a variety of environments to promote biodecontamination of surfaces. One application involves the decontamination of concrete surfaces. Encapsulation of microbial influenced degradation (MID) microorganisms has shown that MID activity is effectively maintained under passive conditions, that is, without manual addition of moisture or nutrients, for an extended period of time.

  15. Encapsulation method for maintaining biodecontamination activity

    DOEpatents

    Rogers, Robert D.; Hamilton, Melinda A.; Nelson, Lee O.; Benson, Jennifer; Green, Martin J.; Milner, Timothy N.

    2006-04-11

    A method for maintaining the viability and subsequent activity of microorganisms utilized in a variety of environments to promote biodecontamination of surfaces. One application involves the decontamination of concrete surfaces. Encapsulation of microbial influenced degradation (MID) microorganisms has shown that MID activity is effectively maintained under passive conditions, that is, without manual addition of moisture or nutrients, for an extended period of time.

  16. PRODUCING SALMON TO MAINTAIN COMMERCIAL AND

    E-print Network

    THIS IS A SALMO HATCH PRODUCING SALMON TO MAINTAIN COMMERCIAL AND SPORT FISHERIES SHKT* illiiniltiiiii SALMON HATCHERY? To maintain the resource, enough of the mature salmon entering and destroyed young salmon. To counteract the effects of these, salmon hatcheries are necessary. Hatchery salmon

  17. Maintaining Stream Statistics over Sliding Windows

    Microsoft Academic Search

    Mayur Datar; Aristides Gionis; Piotr Indyk; Rajeev Motwani

    2002-01-01

    We consider the problem of maintaining aggregates and statistics over data streams, with respect to the last N data elements seen so far. We refer to this model as the sliding window model. We consider the following basic problem: Given a stream of bits, maintain a count of the number of 1's in the last N elements seen from the

  18. Agent Program Planning Information Maintain No Gain

    E-print Network

    Agent Program Planning Information Maintain No Gain Relevance In South Texas (Texas Department is a community and worksite wellness program created by the Cardiovascular Health and Wellness Program A model plan will be available for agents in the TExAS system. Agents wishing to implement the Maintain

  19. Digital plus analog output encoder

    NASA Technical Reports Server (NTRS)

    Hafle, R. S. (inventor)

    1976-01-01

    The disclosed encoder is adapted to produce both digital and analog output signals corresponding to the angular position of a rotary shaft, or the position of any other movable member. The digital signals comprise a series of binary signals constituting a multidigit code word which defines the angular position of the shaft with a degree of resolution which depends upon the number of digits in the code word. The basic binary signals are produced by photocells actuated by a series of binary tracks on a code disc or member. The analog signals are in the form of a series of ramp signals which are related in length to the least significant bit of the digital code word. The analog signals are derived from sine and cosine tracks on the code disc.

  20. Success of re-use of cardiac electrode catheters.

    PubMed

    Dunnigan, A; Roberts, C; McNamara, M; Benson, D W; Benditt, D G

    1987-10-01

    The feasibility of cardiac electrode catheter re-use was prospectively evaluated over a 5-year period (1981 to 1986), during which time 178 catheters were used 1,526 times for 847 electrophysiologic procedures. Detailed records of catheter testing and use were maintained. No complications were encountered during the study period. All re-used catheters functioned for cardiac pacing and electrographic recording. Surveillance cultures and biologic indicators revealed that adequate sterilization procedures were used. Thus, electrode catheters may be safely re-used provided a thorough cleaning, testing and record-keeping system is instituted. This may result in lower patient cost (approximately $30 per re-use vs [200 per single use) for electrophysiologic catheterization. PMID:3661394

  1. Thrombolysis and cardiac arrest.

    PubMed

    Maca, J; Kula, R; Jahoda, J; Chylek, V; Gumulec, J

    2010-01-01

    Cardiac arrest (CA) is a serious clinical condition that might be responsible in many cases for death, in other at least for development of irreversible multiple organ dysfunctions. During and after the CA a significant coagulopathy develops causing a decrease in proper tissue perfusion even if an early return of spontaneous circulation (ROSC) is achieved (no-reflow phenomenon). Administration of thrombolytics can solve the problem by destructing the blood clot in both macrocirculation and microcirculation. Results of some clinical trials proving an effectiveness of thrombolysis were published in the literature. Generally, it was done by describing its positive influence on some important clinical outcome measures (24hour survival, number of hospital admissions, better neurological status etc.) without significant increase in the number of bleeding complications. However, recent pivotal evidence based medicine (EBM) trial represented by TROICA study did not confirm the expected positive results. Because of that and also for other reasons (cost, fear of adverse effects, little practice etc.) thrombolysis, although theoretically promising therapeutical intervention, is not overly recommended and used in routine clinical practice in both out-of-hospital and in-hospital settings (Fig. 2, Tab. 4, Ref. 24). Full Text in free PDF www.bmj.sk. PMID:21384750

  2. Cardiac Imaging System

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Although not available to all patients with narrowed arteries, balloon angioplasty has expanded dramatically since its introduction with an estimated further growth to 562,000 procedures in the U.S. alone by 1992. Growth has fueled demand for higher quality imaging systems that allow the cardiologist to be more accurate and increase the chances of a successful procedure. A major advance is the Digital Cardiac Imaging (DCI) System designed by Philips Medical Systems International, Best, The Netherlands and marketed in the U.S. by Philips Medical Systems North America Company. The key benefit is significantly improved real-time imaging and the ability to employ image enhancement techniques to bring out added details. Using a cordless control unit, the cardiologist can manipulate images to make immediate assessment, compare live x-ray and roadmap images by placing them side-by-side on monitor screens, or compare pre-procedure and post procedure conditions. The Philips DCI improves the cardiologist's precision by expanding the information available to him.

  3. Post-hypothermic cardiac left ventricular systolic dysfunction after rewarming in an intact pig model

    PubMed Central

    2010-01-01

    Introduction We developed a minimally invasive, closed chest pig model with the main aim to describe hemodynamic function during surface cooling, steady state severe hypothermia (one hour at 25°C) and surface rewarming. Methods Twelve anesthetized juvenile pigs were acutely catheterized for measurement of left ventricular (LV) pressure-volume loops (conductance catheter), cardiac output (Swan-Ganz), and for vena cava inferior occlusion. Eight animals were surface cooled to 25°C, while four animals were kept as normothermic time-matched controls. Results During progressive cooling and steady state severe hypothermia (25°C) cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), maximal deceleration of pressure in the cardiac cycle (dP/dtmin), indexes of LV contractility (preload recruitable stroke work, PRSW, and maximal acceleration of pressure in the cardiac cycle, dP/dtmax) and LV end diastolic and systolic volumes (EDV and ESV) were significantly reduced. Systemic vascular resistance (SVR), isovolumetric relaxation time (Tau), and oxygen content in arterial and mixed venous blood increased significantly. LV end diastolic pressure (EDP) remained constant. After rewarming all the above mentioned hemodynamic variables that were depressed during 25°C remained reduced, except for CO that returned to pre-hypothermic values due to an increase in heart rate. Likewise, SVR and EDP were significantly reduced after rewarming, while Tau, EDV, ESV and blood oxygen content normalized. Serum levels of cardiac troponin T (TnT) and tumor necrosis factor-alpha (TNF-?) were significantly increased. Conclusions Progressive cooling to 25°C followed by rewarming resulted in a reduced systolic, but not diastolic left ventricular function. The post-hypothermic increase in heart rate and the reduced systemic vascular resistance are interpreted as adaptive measures by the organism to compensate for a hypothermia-induced mild left ventricular cardiac failure. A post-hypothermic increase in TnT indicates that hypothermia/rewarming may cause degradation of cardiac tissue. There were no signs of inadequate global oxygenation throughout the experiments. PMID:21092272

  4. Cardiac Workup of Ischemic Stroke

    PubMed Central

    Ustrell, Xavier; Pellisé, Anna

    2010-01-01

    Stroke is the leading cause of disability in developed countries and the third cause of mortality. Up to 15-30% of ischemic strokes are caused by cardiac sources of emboli being associated with poor prognosis and high index of fatal recurrence. In order to establish an adequate preventive strategy it is crucial to identify the cause of the embolism. After a complete diagnostic workup up to 30% of strokes remain with an undetermined cause, and most of them are attributed to an embolic mechanism suggesting a cardiac origin. There is no consensus in the extent and optimal approach of cardiac workup of ischemic stroke. Clinical features along with brain imaging and the study of the cerebral vessels with ultrasonography or MRI/CT based angiography can identify other causes or lead to think about a possible cardioembolic origin. Atrial fibrillation is the most common cause of cardioembolic stroke. Identification of occult atrial fibrillation is essential. Baseline ECG, serial ECG(’s), cardiac monitoring during the first 48 hours, and Holter monitoring have detection rates varying from 4 to 8% each separately. Extended cardiac monitoring with event loop recorders has shown higher rates of detection of paroxysmal atrial fibrillation. Cardiac imaging with echocardiography is necessary to identify structural sources of emboli. There is insufficient data to determine which is the optimal approach. Transthoracic echocardiography has an acceptable diagnostic yield in patients with heart disease but transesophageal echocardiography has a higher diagnostic yield and is necessary if no cardiac sources have been identified in patients with cryptogenic stroke with embolic mechanism. PMID:21804776

  5. Molecular candidates for cardiac stretch-activated ion channels

    PubMed Central

    Reed, Alistair; Kohl, Peter; Peyronnet, Rémi

    2014-01-01

    The heart is a mechanically-active organ that dynamically senses its own mechanical environment. This environment is constantly changing, on a beat-by-beat basis, with additional modulation by respiratory activity and changes in posture or physical activity, and further overlaid with more slowly occurring physiological (e.g. pregnancy, endurance training) or pathological challenges (e.g. pressure or volume overload). Far from being a simple pump, the heart detects changes in mechanical demand and adjusts its performance accordingly, both via heart rate and stroke volume alteration. Many of the underlying regulatory processes are encoded intracardially, and are thus maintained even in heart transplant recipients. Over the last three decades, molecular substrates of cardiac mechanosensitivity have gained increasing recognition in the scientific and clinical communities. Nonetheless, the processes underlying this phenomenon are still poorly understood. Stretch-activated ion channels (SAC) have been identified as one contributor to mechanosensitive autoregulation of the heartbeat. They also appear to play important roles in the development of cardiac pathologies – most notably stretch-induced arrhythmias. As recently discovered, some established cardiac drugs act, in part at least, via mechanotransduction pathways suggesting SAC as potential therapeutic targets. Clearly, identification of the molecular substrate of cardiac SAC is of clinical importance and a number of candidate proteins have been identified. At the same time, experimental studies have revealed variable–and at times contrasting–results regarding their function. Further complication arises from the fact that many ion channels that are not classically defined as SAC, including voltage and ligand-gated ion channels, can respond to mechanical stimulation. Here, we summarise what is known about the molecular substrate of the main candidates for cardiac SAC, before identifying potential further developments in this area of translational research. PMID:25405172

  6. Impact of Chronic Alcohol Ingestion on Cardiac Muscle Protein Expression

    PubMed Central

    Fogle, Rachel L.; Lynch, Christopher J.; Palopoli, Mary; Deiter, Gina; Stanley, Bruce A.; Vary, Thomas C.

    2014-01-01

    Background Chronic alcohol abuse contributes not only to an increased risk of health-related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved. Methods The purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol-containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair-fed to consume the same caloric intake. Heart homogenates from control- and ethanol-fed rats were labeled with the cleavable isotope coded affinity tags (ICAT™). Following the reaction with the ICAT™ reagent, we applied one-dimensional gel electrophoresis with in-gel trypsin digestion of proteins and subsequent MALDI-TOF-TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control- and ethanol-fed rats were determined by mass spectrometry approaches. Results Initial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial-, glycolytic-, myofibrillar-, membrane-associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system. Conclusions Based on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions. PMID:20477769

  7. Temporary cardiac pacing for fatal arrhythmia in living-donor liver transplantation: three case reports.

    PubMed

    Kobayashi, T; Sato, Y; Yamamoto, S; Oya, H; Takeishi, T; Kokai, H; Hatakeyama, K

    2008-10-01

    Cardiac pacing often turns out to be the only effective treatment of severe, life-threatening arrhythmias. We performed 77 living-donor liver transplantations (LDLT) from 1999 to 2007. In these cases, three recipients experienced fatal arrhythmia and required temporary cardiac pacing during the perioperative period. The first case was a 68-year-old woman diagnosed with liver cirrhosis and hepatocellular carcinoma (HCC). Her Model for End-Stage Liver Disease (MELD) score was 34. We performed LDLT using a right lobe graft. She showed complete atrioventricular block with cardiac arrest at postoperative day (POD) 42 after a bacterial infection. We performed a resuscitation and instituted temporary cardiac pacing. However, she was dead at POD 43. Pathologic findings at autopsy showed a diffuse myocardial abscess, which caused the fatal arrhythmia. The second case was a 58-year-old man diagnosed with HCC and liver cirrhosis; his MELD score was 9. We performed LDLT using a right lobe graft. He showed atrial fibrillation after septic shock. He also showed sinus bradycardia with a cardiac arrest at POD 10. We performed resuscitation and emergent temporary pacing. He recovered and was alive without recurrence of arrhythmia or infection. The third case was a 58-year-old woman diagnosed with multiple HCC. During preoperative regular check-up, she was diagnosed to have cardiac hypertrophy and was started on beta-blockers as treatment for cardiac hypertrophy. However, severe bradycardia necessitated temporary cardiac pacing. LDLT was performed safely after implantation of a pacemaker. Early use of temporary cardiac pacing for severe arrhythmias may be effective to maintain the hemodynamic state in LDLT. PMID:18929869

  8. Toll-Like Receptor 9 Promotes Cardiac Inflammation and Heart Failure during Polymicrobial Sepsis

    PubMed Central

    Lohner, Ralph; Schwederski, Markus; Narath, Carolin; Klein, Johanna; Duerr, Georg D.; Torno, Alexandra; Knuefermann, Pascal; Hoeft, Andreas; Baumgarten, Georg; Meyer, Rainer; Boehm, Olaf

    2013-01-01

    Background. Aim was to elucidate the role of toll-like receptor 9 (TLR9) in cardiac inflammation and septic heart failure in a murine model of polymicrobial sepsis. Methods. Sepsis was induced via colon ascendens stent peritonitis (CASP) in C57BL/6 wild-type (WT) and TLR9-deficient (TLR9-D) mice. Bacterial load in the peritoneal cavity and cardiac expression of inflammatory mediators were determined at 6, 12, 18, 24, and 36?h. Eighteen hours after CASP cardiac function was monitored in vivo. Sarcomere length of isolated cardiomyocytes was measured at 0.5 to 10?Hz after incubation with heat-inactivated bacteria. Results. CASP led to continuous release of bacteria into the peritoneal cavity, an increase of cytokines, and differential regulation of receptors of innate immunity in the heart. Eighteen hours after CASP WT mice developed septic heart failure characterised by reduction of end-systolic pressure, stroke volume, cardiac output, and parameters of contractility. This coincided with reduced cardiomyocyte sarcomere shortening. TLR9 deficiency resulted in significant reduction of cardiac inflammation and a sustained heart function. This was consistent with reduced mortality in TLR9-D compared to WT mice. Conclusions. In polymicrobial sepsis TLR9 signalling is pivotal to cardiac inflammation and septic heart failure. PMID:23935245

  9. Direct Cardiac Reprogramming: From Developmental Biology to Cardiac Regeneration

    PubMed Central

    Qian, Li; Srivastava, Deepak

    2013-01-01

    Heart disease affects millions worldwide and is a progressive condition involving loss of cardiomyocytes. The human heart has limited endogenous regenerative capacity and is thus an important target for novel regenerative medicine approaches. While cell-based regenerative therapies hold promise, cellular reprogramming of endogenous cardiac fibroblasts, which represent more than half of the cells in the mammalian heart, may be an attractive alternative strategy for regenerating cardiac muscle. Recent advances leveraging years of developmental biology point to the feasibility of generating de novo cardiomyocyte-like cells from terminally differentiated non-myocytes in the heart in situ after ischemic damage. Here, we review the progress in cardiac reprogramming methods and consider the opportunities and challenges that lie ahead in refining this technology for regenerative medicine. PMID:24030021

  10. Model output: fact or artefact?

    NASA Astrophysics Data System (ADS)

    Melsen, Lieke

    2015-04-01

    As a third-year PhD-student, I relatively recently entered the wonderful world of scientific Hydrology. A science that has many pillars that directly impact society, for example with the prediction of hydrological extremes (both floods and drought), climate change, applications in agriculture, nature conservation, drinking water supply, etcetera. Despite its demonstrable societal relevance, hydrology is often seen as a science between two stools. Like Klemeš (1986) stated: "By their academic background, hydrologists are foresters, geographers, electrical engineers, geologists, system analysts, physicists, mathematicians, botanists, and most often civil engineers." Sometimes it seems that the engineering genes are still present in current hydrological sciences, and this results in pragmatic rather than scientific approaches for some of the current problems and challenges we have in hydrology. Here, I refer to the uncertainty in hydrological modelling that is often neglected. For over thirty years, uncertainty in hydrological models has been extensively discussed and studied. But it is not difficult to find peer-reviewed articles in which it is implicitly assumed that model simulations represent the truth rather than a conceptualization of reality. For instance in trend studies, where data is extrapolated 100 years ahead. Of course one can use different forcing datasets to estimate the uncertainty of the input data, but how to prevent that the output is not a model artefact, caused by the model structure? Or how about impact studies, e.g. of a dam impacting river flow. Measurements are often available for the period after dam construction, so models are used to simulate river flow before dam construction. Both are compared in order to qualify the effect of the dam. But on what basis can we tell that the model tells us the truth? Model validation is common nowadays, but validation only (comparing observations with model output) is not sufficient to assume that a model reflects reality. E.g. due to nonuniqueness or so called equifinality; different model construction lead to same output (Oreskes et al., 1994, Beven, 2005). But also because validation only does not provide us information on whether we are 'right for the wrong reasons' (Kirchner, 2006; Oreskes et al., 1994). We can never know how right or wrong our models are, because we do not fully understand reality. But we can estimate the uncertainty from the model and the input data itself. Many techniques have been developed that help in estimating model uncertainty. E.g. model structural uncertainty, studied in the FUSE framework (Clark et al., 2008), parameter uncertainty with GLUE (Beven and Binley, 1992) and DREAM (Vrugt et al., 2008), input data uncertainty using BATEA (Kavetski et al., 2006). These are just some examples that pop-up in a first search. But somehow, these techniques are only used and applied in studies that focus on the model uncertainty itself, and hardly ever occur in studies that have a research question outside of the uncertainty-region. We know that models don't tell us the truth, but we have the tendency to claim they are, based on validation only. A model is always a simplification of reality, which by definition leads to uncertainty when model output and observations of reality are compared. The least we could do is estimate the uncertainty of the model and the data itself. My question therefore is: As a scientist, can we accept that we believe things of which we know they might not be true? And secondly: How to deal with this? How should model uncertainty change the way we communicate scientific results? References Beven, K., and A. Binley, The future of distributed models: Model calibration and uncertainty prediction, HP 6 (1992). Beven, K., A manifesto for the equifinality thesis, JoH 320 (2006). Clark, M.P., A.G. Slater, D.E. Rupp, R.A. Woods, J.A. Vrugt, H.V. Gupta, T. Wagener and L.E. Hay, Framework for Understanding Structural Errors (FUSE): A modular framework to diagnose differences between hydrological models, WRR 44 (20

  11. The cardiac output response and the oxygen cost of increased work of breathing 

    E-print Network

    Krause, Kevin Michael

    1989-01-01

    has been shown to closely reflect local absolute pleural pressures over the full vital capacity in most subjects (Mead, McIlroy, Selverstone, & Kriete, 1955; Petit & Milic-Emili, 1958; Mi lie-Emili, Mead, Turner, & Glauser, 1964). This technique... pressure can be measured. Using this technique, the work of breathing has been measured over a range of ventilatory volumes (Margaria, Mille-Emili, Petit, & Cavagna, 1960). It was observed that the work of breathing per liter of ventilation increases...

  12. Drug detection in breath: effects of pulmonary blood flow and cardiac output on propofol exhalation

    Microsoft Academic Search

    Svend Kamysek; Patricia Fuchs; Henny Schwoebel; Jan P. Roesner; Sabine Kischkel; Kathi Wolter; Christian Loeseken; Jochen K. Schubert; Wolfram Miekisch

    Breath analysis could offer a non-invasive means of intravenous drug monitoring if robust correlations between drug concentrations\\u000a in breath and blood can be established. In this study, propofol blood and breath concentrations were determined in an animal\\u000a model under varying physiological conditions. Propofol concentrations in breath were determined by means of two independently\\u000a calibrated analytical methods: continuous, real-time proton transfer

  13. The measurement of cardiac output and related cardiovascular parameters in the Javelina (Tayassu tajacu) 

    E-print Network

    Schilling, Paul Wesley

    1968-01-01

    the aorta were carefully dissected from a section about 4 cm. in length. Clamps were applied to occlude blood flow through this segment of the aorta and. a purse string suture placed in the wall of the vessel. A small puncture was made through the center... of this purse string suture, the catheter inserted and secured with the suture. Be- cause of the high pressure in the arterial system it was also necessary to further secure the catheter with stay sutures from the wall of the aorta to a specially prepared...

  14. Non-Invasive Cardiac Output Monitoring by Aortic Blood Flow Measurement With the Dynemo 3000

    Microsoft Academic Search

    Jean-Luc G. Boulnois; Thierry Pechoux

    2000-01-01

    The operating principles and methods for the continuous determination of aortic blood flow (ABF) with the Dynemo 3000 system\\u000a are described in detail. The system uses a novel transesophageal ultrasonic Echo-Doppler probe simultaneously to measure aortic\\u000a diameter and blood flow velocity at the same anatomic level, in real-time. Non-invasive ABF measurement is combined with vital\\u000a sign data from standard monitors

  15. Changes in cardiac output and tibial artery flow during and after progressive LBNP

    NASA Technical Reports Server (NTRS)

    1980-01-01

    A 3.0 MHz Pulsed Doppler velocity meter (PD) was used to determine blood velocities in the ascending aorta from the suprasternal notch before, during and after progressive 5 min stages of lower body negative pressure (LBNP) in 7 subjects. Changes in stroke volume were calculated from the systolic velocity integrals. A unique 20 MHz PD was used to estimate bloodflow in the posterior tibial artery. With -20 torr mean stroke volume fell 11% and then continued to decline by 48% before LBNP was terminated. Mean tibial flow fell progressively with LBNP stress, due to an increase in reverse flow component and a reduction in peak forward flow and diameter. Stroke volume increased and heart rate fell dramatically during the first 15 sec of recovery. The LBNP was terminated early in 2 subjects because of vasovagal symptons (V). During V the stroke volume rose 86% which more than compensated for the drop in heart rate. This implies that V is accompanied by a paradoxical increase in venous return and that the reduction in HR is the primary cardiovascular event. During the first 15 sec of recovery these 2 subjects had a distinctive marked rise to heart rate reminiscent of the Bainbridge reflex.

  16. The measurement of cardiac output and related cardiovascular parameters in the Javelina (Tayassu tajacu)

    E-print Network

    Schilling, Paul Wesley

    1968-01-01

    for the erosions encountered is that the brachiocephalic and left brachial arteries branch frozn the aorta at a much shorter distance from the heart in the javelina than in miniature swine. This resulted in the Doppler flowprobe being crowded very close...

  17. Control system maintains compartment at constant temperature

    NASA Technical Reports Server (NTRS)

    Lindberg, J. G.

    1966-01-01

    Gas-filled permeable insulating material maintains an enclosed compartment at a uniform temperature. The material is interposed between the two walls of a double-walled enclosure surrounding the compartment.

  18. Prediction of electron beam output factors.

    PubMed

    Mills, M D; Hogstrom, K R; Almond, P R

    1982-01-01

    A method to predict square and rectangular field output factors from the measurement of selected fields of electron beams on the Therac 20 Saturne has been developed. A two parameter fit of the square field output factor data, based on the functional dependence as predicted by a pencil beam calculational model, has proven clinically acceptable. The pencil beam distributions are given by the Fermi-Eyges theory of multiple Coulomb scattering. For a rectangular field, the output factor can be calculated from the square root of the product of the two square field output factors wtih sides equal to those of the rectangular field. If however, there is a significant asymmetry between the X and Y collimator systems, then rectangular field output factors should be predicted from the product of the X and Y one-dimensional output factors. One-dimensional output factors are defined as output factors of rectangular fields where one side remains constant and equal to the side of the square reference field. Measured data indicate either of the two methods of determining rectangular field output factors to be clinically acceptable for the Therac 20, the use of one-dimensional output factors demonstrating greater accuracy. Data show agreement to within approximately 1.5% at electron energies of 6, 9, 13, and 17 MeV. PMID:6804772

  19. Cardiac memory in humans: vectocardiographic quantification in cardiac resynchronization therapy

    Microsoft Academic Search

    Luigi PadelettiChiara; Chiara Fantappiè; Laura Perrotta; Giuseppe Ricciardi; Paolo Pieragnoli; Marco Chiostri; Sergio Valsecchi; Maria Cristina Porciani; Antonio Michelucci; Fabio Fantini

    2011-01-01

    Background  “Cardiac memory” (CM) refers to a change in repolarization induced by an altered pathway of activation. The effects of biventricular\\u000a pacing on CM induction have not been investigated.\\u000a \\u000a \\u000a \\u000a \\u000a Objective  To investigate the development of CM during cardiac resynchronization therapy (CRT) through vectorcardiography (VCG).\\u000a \\u000a \\u000a \\u000a Methods  Eleven patients undergoing CRT were enrolled. VCG was acquired during spontaneous ventricular activation at baseline and during\\u000a AAI

  20. Maintaining Financial Stability in a Global Economy

    NSDL National Science Digital Library

    1997-01-01

    The Federal Reserve Bank of Kansas City has made available the papers presented at the "Maintaining Financial Stability in a Global Economy" symposium. The aim of the symposium is to explore "options for public authorities in adapting policies to keep financial systems safe and efficient, and to discuss response mechanisms to financial crises." The papers presented here look at the causes of financial instability, why policymakers should be concerned about financial instability, lessons from recent financial crises, and policies for maintaining financial stability.

  1. An integrated platform for image-guided cardiac resynchronization therapy

    NASA Astrophysics Data System (ADS)

    Ma, Ying Liang; Shetty, Anoop K.; Duckett, Simon; Etyngier, Patrick; Gijsbers, Geert; Bullens, Roland; Schaeffter, Tobias; Razavi, Reza; Rinaldi, Christopher A.; Rhode, Kawal S.

    2012-05-01

    Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets by computing the registration error of the LV pacing lead electrodes which was found to be 2.2 ± 0.9 mm. Furthermore, the use of Unfold Navigation was demonstrated in real-time for four clinical cases.

  2. Cardiac alterations induced by a fish-catching diving competition.

    PubMed

    Gargne, O; Joulia, F; Golé, Y; Coulange, M; Bessereau, J; Fontanari, P; Desruelle, A-V; Gavarry, O; Boussuges, A

    2012-06-01

    Cardiac changes induced by repeated breath-hold diving were investigated after a fish-catching diving competition. Eleven healthy subjects carried out repeated breath-hold dives at a mean maximal depth of 20 ± 2.7 msw (66 ± 9 fsw) during 5 h. One hour after the competition, the body mass loss was -1.7 ± 0.5 kg. Most of the breath-hold divers suffered from cold and although the core temperature remained normal, a decrease in cutaneous temperature was recorded in the extremities. Systolic blood pressure was reduced in both upper and lower limbs. Heart rate was unchanged, but left ventricular (LV) stroke volume was reduced leading to a decrease in cardiac output (-20%). Left atrial and LV diameters were significantly decreased. LV filling was assessed on a trans-mitral profile. An increase in the contribution of the atrial contraction to LV filling was observed. Right cavity diameters were increased. The cardiac autonomic alterations were in favor of sympathetic hyperactivity. After a fish-catching diving competition in cold water, alterations suggesting dehydration, contraction in plasma volume and sympathetic hyperactivity were observed. Furthermore, enlargements of right cavities were in favor of right ventricular strains. Repeated apnea and swimming in cold water may account for these alterations. PMID:20738824

  3. Cardiac Complications in Acute Ischemic Stroke

    E-print Network

    2011-01-01

    of cardiac function and complications with AIS. EmergencyAIS patients. 50,51 Regarding structural systolic functionAIS (ie, the ischemic penumbra) intrinsic autoregulation of the vasculature is lost, rendering cerebral blood ?ow directly dependent on cardiac function.

  4. CARDIAC SURGERY MORTALITY RATES UK cardiac surgeons have shown the best way to

    E-print Network

    Aickelin, Uwe

    CARDIAC SURGERY MORTALITY RATES UK cardiac surgeons have shown the best way to ensure good clinical cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland offers, UCL. Publishing cardiac surgery mortality rates: lessons for other specialties. BMJ 2013;346:f1139

  5. Cardiac Metastasis from Invasive Thymoma Via the Superior Vena Cava: Cardiac MRI Findings

    SciTech Connect

    Dursun, Memduh, E-mail: memduhdursun@yahoo.com; Sarvar, Sadik; Cekrezi, Bledi [Istanbul University, Istanbul Faculty of Medicine, Department of Radiology (Turkey); Kaba, Erkan [Istanbul University, Istanbul Faculty of Medicine, Department of Thoracic Surgery (Turkey); Bakir, Baris [Istanbul University, Istanbul Faculty of Medicine, Department of Radiology (Turkey); Toker, Alper [Istanbul University, Istanbul Faculty of Medicine, Department of Thoracic Surgery (Turkey)

    2008-07-15

    Cardiac tumors are rare, and metastatic deposits are more common than primary cardiac tumors. We present cardiac magnetic resonance imaging (MRI) findings of a 50-year-old woman with invasive thymoma. Cardiac MRI revealed a heterogeneous, lobulated anterior mediastinal mass invading the superior vena cava and extending to the right atrium. In cine images there was no invasion to the right atrial wall.

  6. NITROGEN OUTPUTS FROM FECAL AND URINE DEPOSITION OF SMALL MAMMALS: IMPLICATIONS FOR NITROGEN CYCLING

    EPA Science Inventory

    The contribution of small mammals to nitrogen cycling is poorly understood, but it could have reverberations back to the producer community by maintaining or perhaps magnifying nitrogen availability. Our objective was to model nitrogen outputs (deposition of feces and urine) of ...

  7. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

    NASA Astrophysics Data System (ADS)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2014-03-01

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial blood flow estimation. In conclusion, quantitative model-based dynamic cardiac CT perfusion assessment is capable of accurately estimating MBF across a range of cardiac outputs and tissue perfusion states, outperforms comparable static perfusion estimates, and is relatively robust to noise and temporal subsampling.

  8. Simulation Evaluation of Quantitative Myocardial Perfusion Assessment from Cardiac CT.

    PubMed

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R; La Riviere, Patrick J; Alessio, Adam M

    2014-03-19

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ?0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ?1.2 and ?1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial blood flow estimation. In conclusion, quantitative model-based dynamic cardiac CT perfusion assessment is capable of accurately estimating MBF across a range of cardiac outputs and tissue perfusion states, outperforms comparable static perfusion estimates, and is relatively robust to noise and temporal subsampling. PMID:25395812

  9. Cardiac manifestations in Behcet's disease

    PubMed Central

    Demirelli, Selami; Degirmenci, Husnu; Inci, Sinan; Arisoy, Arif

    2015-01-01

    Summary Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD. PMID:25984424

  10. Cardiac manifestations in Behcet's disease.

    PubMed

    Demirelli, Selami; Degirmenci, Husnu; Inci, Sinan; Arisoy, Arif

    2015-05-01

    Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD. PMID:25984424

  11. Mechanical regulation of cardiac development

    PubMed Central

    Lindsey, Stephanie E.; Butcher, Jonathan T.; Yalcin, Huseyin C.

    2014-01-01

    Mechanical forces are essential contributors to and unavoidable components of cardiac formation, both inducing and orchestrating local and global molecular and cellular changes. Experimental animal studies have contributed substantially to understanding the mechanobiology of heart development. More recent integration of high-resolution imaging modalities with computational modeling has greatly improved our quantitative understanding of hemodynamic flow in heart development. Merging these latest experimental technologies with molecular and genetic signaling analysis will accelerate our understanding of the relationships integrating mechanical and biological signaling for proper cardiac formation. These advances will likely be essential for clinically translatable guidance for targeted interventions to rescue malforming hearts and/or reconfigure malformed circulations for optimal performance. This review summarizes our current understanding on the levels of mechanical signaling in the heart and their roles in orchestrating cardiac development. PMID:25191277

  12. Cardiac myofilaments: mechanics and regulation

    NASA Technical Reports Server (NTRS)

    de Tombe, Pieter P.; Bers, D. M. (Principal Investigator)

    2003-01-01

    The mechanical properties of the cardiac myofilament are an important determinant of pump function of the heart. This report is focused on the regulation of myofilament function in cardiac muscle. Calcium ions form the trigger that induces activation of the thin filament which, in turn, allows for cross-bridge formation, ATP hydrolysis, and force development. The structure and protein-protein interactions of the cardiac sarcomere that are responsible for these processes will be reviewed. The molecular mechanism that underlies myofilament activation is incompletely understood. Recent experimental approaches have been employed to unravel the mechanism and regulation of myofilament mechanics and energetics by activator calcium and sarcomere length, as well as contractile protein phosphorylation mediated by protein kinase A. Central to these studies is the question whether such factors impact on muscle function simply by altering thin filament activation state, or whether modulation of cross-bridge cycling also plays a part in the responses of muscle to these stimuli.

  13. Stochastic Aspects of Cardiac Arrhythmias

    NASA Astrophysics Data System (ADS)

    Lerma, Claudia; Krogh-Madsen, Trine; Guevara, Michael; Glass, Leon

    2007-07-01

    Abnormal cardiac rhythms (cardiac arrhythmias) often display complex changes over time that can have a random or haphazard appearance. Mathematically, these changes can on occasion be identified with bifurcations in difference or differential equation models of the arrhythmias. One source for the variability of these rhythms is the fluctuating environment. However, in the neighborhood of bifurcation points, the fluctuations induced by the stochastic opening and closing of individual ion channels in the cell membrane, which results in membrane noise, may lead to randomness in the observed dynamics. To illustrate this, we consider the effects of stochastic properties of ion channels on the resetting of pacemaker oscillations and on the generation of early afterdepolarizations. The comparison of the statistical properties of long records showing arrhythmias with the predictions from theoretical models should help in the identification of different mechanisms underlying cardiac arrhythmias.

  14. Bifid cardiac apex in a 25-year-old male with sudden cardiac death.

    PubMed

    Wu, Annie; Kay, Deborah; Fishbein, Michael C

    2014-01-01

    Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly. PMID:23928367

  15. Cardiac Crises and the Family Physician Robert

    PubMed Central

    Galliver, Robert H. L.

    1980-01-01

    Family physicians involved in pre-hospital emergency cardiac care need training in basic cardiac life support (BCLS) and advanced cardiac life support (ACLS). They should also become involved in mobilizing community resources to provide necessary equipment and training for the public in CPR. The article outlines the procedure to be followed in cardiac arrest, the contents of a critical care bag, and the administration of various drugs. PMID:21293702

  16. Bessel function output from an optical correlator.

    PubMed

    Davis, J A; Haavig, L L; Cottrell, D M

    1997-04-10

    We introduce a new filter for an optical correlator that produces a Bessel function correlation output. The advantage of this type of output is that the width of the central dark spot at the center of the correlator output is narrower than the width of the usual correlation spot. In addition, the dark spot is insensitive to changes in illumination intensity. We present experimental results with which we write the new filter onto a programmable magneto-optic spatial light modulator. PMID:18253215

  17. Cardiac and vascular adaptation to 0g with and without thigh cuffs (Antares 14 and Altair 21 day Mir spaceflights)

    Microsoft Academic Search

    Ph. Arbeille; G. Fomina; F. Achaibou; J. Pottier; A. Kotovskaya

    1995-01-01

    Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output,

  18. Neurological complications of cardiac surgery.

    PubMed

    McDonagh, David L; Berger, Miles; Mathew, Joseph P; Graffagnino, Carmelo; Milano, Carmelo A; Newman, Mark F

    2014-05-01

    As increasing numbers of elderly people undergo cardiac surgery, neurologists are frequently called upon to assess patients with neurological complications from the procedure. Some complications mandate acute intervention, whereas others need longer term observation and management. A large amount of published literature exists about these complications and guidance on best practice is constantly changing. Similarly, despite technological advances in surgical intervention and modifications in surgical technique to make cardiac procedures safer, these advances often create new avenues for neurological injury. Accordingly, rapid and precise neurological assessment and therapeutic intervention rests on a solid understanding of the evidence base and procedural variables. PMID:24703207

  19. Cardiac Syndrome X: update 2014.

    PubMed

    Agrawal, Shilpa; Mehta, Puja K; Bairey Merz, C Noel

    2014-08-01

    Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking. PMID:25091971

  20. Evaluation of quasi periodicity in cardiac rhythm

    Microsoft Academic Search

    Ravindra Sheth; Christopher Druzgalski

    2009-01-01

    Summary form only given. Variability of cardiac activity reflected in electrocardiograms has been of considerable interest and the subject of different studies. In particular, the presented project included development of a scheme for presentation of cardiac activity and a comparative evaluation of heart rate variability. The graphical representation of cardiac rhythm variability is demonstrated in a form of circular displays,

  1. Cardiac Anatomy and Physiology: A Review

    Microsoft Academic Search

    Mary Gavaghan

    1998-01-01

    This article reviews the normal anatomy and physiology of the heart. Understanding the normal anatomic and physiologic relationships described in this article will help perioperative nurses care for patients who are undergoing cardiac procedures. Such knowledge also assists nurses in educating patients about cardiac procedures and about activities that can prevent, reverse, or improve cardiac illness. AORN J 67 (April

  2. Segmentation and Visualization for Cardiac Ablation Procedures

    E-print Network

    Golland, Polina

    present novel medical image analysis methods to improve planning and outcome evaluation of cardiacSegmentation and Visualization for Cardiac Ablation Procedures by Michal Depa B.S., Mc and Visualization for Cardiac Ablation Procedures by Michal Depa Submitted to the Department of Electrical

  3. Advanced Imaging Applications to Cardiac Resynchronization Therapy

    E-print Network

    Zanibbi, Richard

    D ultrasound, and electron paramagnetic imaging. His research includes the development of novelAdvanced Imaging Applications to Cardiac Resynchronization Therapy Justin D. Pearlman Professor of the Center for Imaging Science For Cardiac Resynchronization Therapy the goal is to identify where cardiac

  4. The cardiac sodium pump: structure and function

    Microsoft Academic Search

    Alicia A. McDonough; Jeffrey B. Velotta; Robert H. G. Schwinger; Kenneth D. Philipson; Robert A. Farley

    2002-01-01

    Cardiac sodium pumps (Na,K-ATPase) influence cell calcium and contractility by generating the Na + gradient driving Ca ++ extrusion via the Na +\\/Ca ++ exchanger (NCX), and are the receptors for cardiac glycosides such as digitalis which increases cardiac contractility by decreasing the Na + gradient driving Ca ++ extrusion. There are multiple isoforms of the sodium pump expressed in

  5. Cardiac torsion and electromagnetic fields: the cardiac bioinformation hypothesis.

    PubMed

    Burleson, Katharine O; Schwartz, Gary E

    2005-01-01

    Although in physiology the heart is often referred to as a simple piston pump, there are in fact two additional features that are integral to cardiac physiology and function. First, the heart as it contracts in systole, also rotates and produces torsion due to the structure of the myocardium. Second, the heart produces a significant electromagnetic field with each contraction due to the coordinated depolarization of myocytes producing a current flow. Unlike the electrocardiogram, the magnetic field is not limited to volume conduction and extends outside the body. The therapeutic potential for interaction of this cardioelectromagnetic field both within and outside the body is largely unexplored. It is our hypothesis that the heart functions as a generator of bioinformation that is central to normative functioning of body. The source of this bioinformation is based on: (1) vortex blood flow in the left ventricle; (2) a cardiac electromagnetic field and both; (3) heart sounds; and (4) pulse pressure which produce frequency and amplitude information. Thus, there is a multidimensional role for the heart in physiology and biopsychosocial dynamics. Recognition of these cardiac properties may result in significant implications for new therapies for cardiovascular disease based on increasing cardiac energy efficiency (coherence) and bioinformation from the cardioelectromagnetic field. Research studies to test this hypothesis are suggested. PMID:15823696

  6. Cardiac myxoma with oncocytic change--cardiac oncocytoma?

    PubMed

    Puskarz-Thomas, Skye; Dettrick, Andrew; Pohlner, Peter G

    2012-01-01

    We report the case of an incidental cardiac myxoma that was remarkable for the presence of extensive oncocytic change, a feature that has not be reported previously. The oncocytes most likely represent part of a spectrum of degenerative changes present in the tumor, but the possibility that they are neoplastic is also discussed. PMID:22104003

  7. Health Literacy Predicts Cardiac Knowledge Gains in Cardiac Rehabilitation Participants

    ERIC Educational Resources Information Center

    Mattson, Colleen C.; Rawson, Katherine; Hughes, Joel W.; Waechter, Donna; Rosneck, James

    2015-01-01

    Objective: Health literacy is increasingly recognised as a potentially important patient characteristic related to patient education efforts. We evaluated whether health literacy would predict gains in knowledge after completion of patient education in cardiac rehabilitation. Method: This was a re-post observational analysis study design based on…

  8. Inhibition of endogenous thioredoxin in the heart increases oxidative stress and cardiac hypertrophy

    PubMed Central

    Yamamoto, Mitsutaka; Yang, Guiping; Hong, Chull; Liu, Jing; Holle, Eric; Yu, Xianzhong; Wagner, Thomas; Vatner, Stephen F.; Sadoshima, Junichi

    2003-01-01

    Thioredoxin 1 (Trx1) has redox-sensitive cysteine residues and acts as an antioxidant in cells. However, the extent of Trx1 contribution to overall antioxidant mechanisms is unknown in any organs. We generated transgenic mice with cardiac-specific overexpression of a dominant negative (DN) mutant (C32S/C35S) of Trx1 (Tg-DN-Trx1 mice), in which the activity of endogenous Trx was diminished. Markers of oxidative stress were significantly increased in hearts from Tg-DN-Trx1 mice compared with those from nontransgenic (NTg) mice. Tg-DN-Trx1 mice exhibited cardiac hypertrophy with maintained cardiac function at baseline. Intraperitoneal injection of N-2-mercaptopropionyl glycine, an antioxidant, normalized cardiac hypertrophy in Tg-DN-Trx1 mice. Thoracic aortic banding caused greater increases in myocardial oxidative stress and enhanced hypertrophy in Tg-DN-Trx1 compared with NTg mice. In contrast, transgenic mice with cardiac-specific overexpression of wild-type Trx1 did not show cardiac hypertrophy at baseline but exhibited reduced levels of hypertrophy and oxidative stress in response to pressure overload. These results demonstrate that endogenous Trx1 is an essential component of the cellular antioxidant mechanisms and plays a critical role in regulating oxidative stress in the heart in vivo. Furthermore, inhibition of endogenous Trx1 in the heart primarily stimulates hypertrophy, both under basal conditions and in response to pressure overload through redox-sensitive mechanisms. PMID:14597765

  9. Short-duration spaceflight impairs human carotid baroreceptor-cardiac reflex responses

    NASA Technical Reports Server (NTRS)

    Fritsch, Janice M.; Charles, John B.; Bennett, Barbara S.; Jones, Michele M.; Eckberg, Dwain L.

    1992-01-01

    The effect of a spaceflight on the vagally mediated baroreceptor-cardiac reflex responses of humans were investigated by measuring the responses (provoked by neck pressure changes) in supine position and the heart rate and blood pressure in the supine and standing positions in 16 astronauts before and after 4- to 5-day long Space Shuttle missions. The results showed that exposures to spaceflight resulted in reduced baseline levels of the vagal-cardiac outflow and the vagally mediated responses to changes of the arterial baroreceptor input and that these changes contribute to postflight reductions of astronauts' ability to maintain standing arterial pressures.

  10. Congenital cardiac disease in dogs.

    PubMed

    Aronson, E; McCaw, D

    1984-09-01

    Aortic stenosis is a heritable cardiac anomaly most common in German Shepherds, Boxers and Newfoundlands, and less common in Pugs, English Bulldogs, Boston Terriers, Fox Terriers, Schnauzers and Bassets. Clinical signs are associated with secondary left-sided heart failure and include coughing, moist rales, exercise intolerance, arrhythmias and a weak femoral pulse. It causes an ejection-type crescendo-decrescendo, systolic murmur best heard on the left side near the elbow. The ECG may be normal or may show signs of left ventricular hypertrophy, including an axis of less than 40 degrees, a QRS complex of greater than 60 seconds in duration, R waves greater than 3 mv in amplitude, ST segment slurring or depression, or T waves of an amplitude greater than 25% of that of R waves. A LAT radiograph usually reveals an enlarged cardiac silhouette, loss of the cranial cardiac waist, and normal pulmonary vasculature, while DV projections show an elongated cardiac silhouette, rounding of the left ventricular border, and a normal descending aorta. Nonselective angiocardiography reveals poststenotic dilatation of the aorta. Treatment of severely affected dogs involves surgical correction. PMID:6482869

  11. Reninoma presenting as cardiac syncope

    PubMed Central

    Tak, Shahid I; Wani, Mohd Lateef; Khan, Khursheed A; Alai, Mohd Sultan; Shera, Altaf Hussain; Ahangar, Abdul G; Khan, Yasir Bashir; Nayeem-ul-Hassan; Irshad, Ifat

    2011-01-01

    Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia. PMID:21677812

  12. Reninoma presenting as cardiac syncope.

    PubMed

    Tak, Shahid I; Wani, Mohd Lateef; Khan, Khursheed A; Alai, Mohd Sultan; Shera, Altaf Hussain; Ahangar, Abdul G; Khan, Yasir Bashir; Nayeem-Ul-Hassan; Irshad, Ifat

    2011-01-01

    Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia. PMID:21677812

  13. Cardiac surgery in the octogenarian

    Microsoft Academic Search

    K. S. Naunheim; P. A. Dean; A. C. Fiore; L. R. McBride; D. G. Pennington; G. C. Kaiser; V WILLMAN; H BARNER

    1990-01-01

    The increasing safety of cardiac surgery has led to the frequent referral of octogenarians for operation. Between 1980 and 1989, we reviewed our experience with 103 octogenarians (59 male, 44 female; mean age 82 years) to determine the surgical risk factors and outcome in the elderly population. There were 71 coronary bypass- es (CABG), 11 aortic valve replacements (AVR), 11

  14. Cardiac glycosides from erysimum cheiranthoides.

    PubMed

    Lei, Zhen Huan; Jin, Zhe Xion; Ma, Ying Li; Tai, Bao Shan; Kong, Qi; Yahara, Shoji; Nohara, Toshihiro

    1998-11-20

    Two new cardiac glycosides were isolated from the seeds of Erysimum cheiranthoides. Their structures were characterized as strophanthidin glycosides of 3-O-alpha-L-rhamnopyranosyl-(1-->4)-3-O-acetyl-beta-D-digitoxopyranosyl and 3-O-beta-D-glucpyranosyl-(1-->4)-alpha-L-rhamnopyranosyl-(1-->4)-3-O-acetyl-beta-D-digitoxopyranosyl. PMID:11711105

  15. Bifurcation theory and cardiac arrhythmias.

    PubMed

    Karagueuzian, Hrayr S; Stepanyan, Hayk; Mandel, William J

    2013-01-01

    In this paper we review two types of dynamic behaviors defined by the bifurcation theory that are found to be particularly useful in describing two forms of cardiac electrical instabilities that are of considerable importance in cardiac arrhythmogenesis. The first is action potential duration (APD) alternans with an underlying dynamics consistent with the period doubling bifurcation theory. This form of electrical instability could lead to spatially discordant APD alternans leading to wavebreak and reentrant form of tachyarrhythmias. Factors that modulate the APD alternans are discussed. The second form of bifurcation of importance to cardiac arrhythmogenesis is the Hopf-homoclinic bifurcation that adequately describes the dynamics of the onset of early afterdepolarization (EAD)-mediated triggered activity (Hopf) that may cause ventricular tachycardia and ventricular fibrillation (VT/VF respectively). The self-termination of the triggered activity is compatible with the homoclinic bifurcation. Ionic and intracellular calcium dynamics underlying these dynamics are discussed using available experimental and simulation data. The dynamic analysis provides novel insights into the mechanisms of VT/VF, a major cause of sudden cardiac death in the US. PMID:23459417

  16. Cardiac Physiology in Transgenic Mice

    Microsoft Academic Search

    Jeanne F. James; Timothy E. Hewett; Jeffrey Robbins

    2010-01-01

    By use of gene targeting and\\/or transgenesis, it is now possible to make defined changes in genes whose functions underlie mammalian cardiovascular function. Because of technical and economic considerations, these experiments are largely confined to the mouse. Genetic modification of the loci responsible for aspects of cardiac development, differentiation, and function via gene targeting, as well as modulation of the

  17. Device Assists Cardiac Chest Compression

    NASA Technical Reports Server (NTRS)

    Eichstadt, Frank T.

    1995-01-01

    Portable device facilitates effective and prolonged cardiac resuscitation by chest compression. Developed originally for use in absence of gravitation, also useful in terrestrial environments and situations (confined spaces, water rescue, medical transport) not conducive to standard manual cardiopulmonary resuscitation (CPR) techniques.

  18. Cardiac sarcoidosis: diagnosis and management.

    PubMed

    Dubrey, S W; Sharma, R; Underwood, R; Mittal, T

    2015-07-01

    Cardiac sarcoidosis is one of the most serious and unpredictable aspects of this disease state. Heart involvement frequently presents with arrhythmias or conduction disease, although myocardial infiltration resulting in congestive heart failure may also occur. The prognosis in cardiac sarcoidosis is highly variable, which relates to the heterogeneous nature of heart involvement and marked differences between racial groups. Electrocardiography and echocardiography often provide the first clue to the diagnosis, but advanced imaging studies using positron emission tomography and MRI, in combination with nuclear isotope perfusion scanning are now essential to the diagnosis and management of this condition. The identification of clinically occult cardiac sarcoidosis and the management of isolated and/or asymptomatic heart involvement remain both challenging and contentious. Corticosteroids remain the first treatment choice with the later substitution of immunosuppressive and steroid-sparing therapies. Heart transplantation is an unusual outcome, but when performed, the results are comparable or better than heart transplantation for other disease states. We review the epidemiology, developments in diagnostic techniques and the management of cardiac sarcoidosis. PMID:26130811

  19. Phenomics of Cardiac Chloride Channels

    PubMed Central

    Duan, Dayue Darrel

    2014-01-01

    Forward genetic studies have identified several chloride (Cl?) channel genes, including CFTR, ClC-2, ClC-3, CLCA, Bestrophin, and Ano1, in the heart. Recent reverse genetic studies using gene targeting and transgenic techniques to delineate the functional role of cardiac Cl? channels have shown that Cl? channels may contribute to cardiac arrhythmogenesis, myocardial hypertrophy and heart failure, and cardioprotection against ischemia reperfusion. The study of physiological or pathophysiological phenotypes of cardiac Cl? channels, however, is complicated by the compensatory changes in the animals in response to the targeted genetic manipulation. Alternatively, tissue-specific conditional or inducible knockout or knockin animal models may be more valuable in the phenotypic studies of specific Cl? channels by limiting the effect of compensation on the phenotype. The integrated function of Cl? channels may involve multiprotein complexes of the Cl? channel subproteome. Similar phenotypes can be attained from alternative protein pathways within cellular networks, which are influenced by genetic and environmental factors. The phenomics approach, which characterizes phenotypes as a whole phenome and systematically studies the molecular changes that give rise to particular phenotypes achieved by modifying the genotype under the scope of genome/proteome/phenome, may provide more complete understanding of the integrated function of each cardiac Cl? channel in the context of health and disease. PMID:23720326

  20. OCT imaging of cardiac architecture

    NASA Astrophysics Data System (ADS)

    Jenkins, Michael W.; Rothenberg, Florence; Wade, Ryan S.; Nikolski, Vladimir; Efimov, Igor R.; Rollins, Andrew M.; Pederson, C. J.

    2004-07-01

    Using Optical Coherence Tomography (OCT), an emerging imaging modality, we have produced both 3D and 4D images of cardiac architecture. We captured 3D images of rabbit Purkinje fiber networks and we also created a 4D representation of a beating stage 28 chicken embryo heart. For the 4D reconstruction, we generated a movie by employing a gated reconstruction technique.

  1. Thoracocentesis in cardiac surgery patients.

    PubMed

    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders

    2015-01-01

    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter. PMID:25901010

  2. Temperate Drosophila preserve cardiac function at low temperature.

    PubMed

    Andersen, Jonas Lembcke; MacMillan, Heath Andrew; Overgaard, Johannes

    2015-06-01

    Most insects are chill susceptible and will enter a coma if exposed to sufficiently low temperature. This chill coma has been associated with a failure of the neuromuscular system. Insect heart rate (HR) is determined by intrinsic regulation (muscle pacemaker) with extrinsic (nervous and humoral) input. By examining the continually active heart of five Drosophila species with markedly different cold tolerance, we investigated whether cardiac performance is related to the whole animal critical thermal minimum (CTmin). Further, to separate the effects of cold on extrinsic and intrinsic regulators of HR, we measured HR under similar conditions in decapitated flies as well as amputated abdomens of Drosophila montana. Cardiac performance was assessed from break points in HR-temperature relationship (Arrhenius break point, ABP) and from the HR cessation temperature. Among the five species, we found strong relationships for both the HR-ABP and HR cessation temperatures to whole animal CTmin, such that temperate Drosophila species maintained cardiac function at considerably lower temperatures than their tropical congeners. Hearts of amputated abdomens, with reduced extrinsic input, had a higher thermal sensitivity and a significantly lower break point temperature, suggesting that central neuronal input is important for stimulating HR at low temperatures. PMID:25871726

  3. Fibroblasts in post-infarction inflammation and cardiac repair

    PubMed Central

    Chen, Wei; Frangogiannis, Nikolaos G

    2012-01-01

    Fibroblasts are the predominant cell type in the cardiac interstitium. As the main matrix-producing cells in the adult mammalian heart, fibroblasts maintain the integrity of the extracellular matrix network, thus preserving geometry and function. Following myocardial infarction fibroblasts undergo dynamic phenotypic alterations and direct the reparative response. Due to their strategic location, cardiac fibroblasts serve as sentinel cells that sense injury and activate the inflammasome secreting cytokines and chemokines. During the proliferative phase of healing, infarct fibroblasts undergo myofibroblast transdifferentiation forming stress fibers and expressing contractile proteins (such as ?-smooth muscle actin). Mechanical stress, Transforming Growth Factor (TGF)-?/Smad3 signaling and alterations in the composition of the extracellular matrix induce acquisition of the myofibroblast phenotype. In the highly cellular and growth factor-rich environment of the infarct, activated myofibroblasts produce matrix proteins, proteases and their inhibitors regulating matrix metabolism. As the infarct matures, “stress-shielding” of myofibroblasts by the cross-linked matrix and growth factor withdrawal may induce quiescence and ultimately cause apoptotic death. Because of their critical role in post-infarction cardiac remodeling, fibroblasts are promising therapeutic targets following myocardial infarction. However, the complexity of fibroblast functions and the pathophysiologic heterogeneity of post-infarction remodeling in the clinical context discourage oversimplified approaches in clinical translation. PMID:22982064

  4. Arginylation regulates myofibrils to maintain heart function and prevent dilated cardiomyopathy

    PubMed Central

    Kurosaka, Satoshi; Leu, N. Adrian; Pavlov, Ivan; Han, Xuemei; Ribeiro, Paula Aver Bretanha; Xu, Tao; Bunte, Ralph; Saha, Sougata; Wang, Junling; Cornachione, Anabelle; Mai, Wilfried; Yates, John R; Rassier, Dilson E.; Kashina, Anna

    2012-01-01

    Protein arginylation mediated by arginyltransferase (ATE1) is essential for heart formation during embryogenesis, however its cell-autonomous role in cardiomyocytes and the differentiated heart muscle has never been investigated. To address this question, we generated cardiac muscle-specific Ate1 knockout mice, in which Ate1 deletion was driven by ?-myosin heavy chain promoter (?MHC-Ate1 mouse). These mice were initially viable, but developed severe cardiac contractility defects, dilated cardiomyopathy, and thrombosis over time, resulting in high rates of lethality after 6 months of age. These symptoms were accompanied by severe ultrastructural defects in cardiac myofibrils, seen in the newborns and far preceding the onset of cardiomyopathy, suggesting that these defects were primary and likely underlay the development of the future heart defects. Several major sarcomeric proteins were arginylated in vivo. Moreover, Ate1 deletion in the hearts resulted in a significant reduction of active and passive myofibril forces, suggesting that arginylation is critical for both myofibril structural integrity and contractility. Thus, arginylation is essential for maintaining the heart function by regulation of the major myofibril proteins and myofibril forces, and its absence in the heart muscle leads to progressive heart failure through cardiomyocyte-specific defects. PMID:22626847

  5. Maintaining confidentiality: health care's ongoing dilemma.

    PubMed

    Dowd, S B; Dowd, L P

    1996-09-01

    Confidentiality of patient information is an ethical obligation of health care professionals. The exercise of confidentiality is not a simple process; it is dynamic rather than static and must be upgraded with changes in technology. This article discusses some of the common issues that arise in maintaining confidentiality in the health care environment, including spoken and written breaches of confidentiality, use of the computer, confidentiality as an ethical rather than legal obligation, and the use of programs in health care institutions to maintain confidentiality. PMID:10159637

  6. The beat goes on: Cardiac pacemaking in extreme conditions.

    PubMed

    Wilson, Christopher M; Cox, Georgina K; Farrell, Anthony P

    2015-08-01

    In order for an animal to survive, the heart beat must go on in all environmental conditions, or at least restart its beat. This review is about maintaining a rhythmic heartbeat under the extreme conditions of anoxia (or very severe hypoxia) and high temperatures. It starts by considering the primitive versions of the protein channels that are responsible for initiating the heartbeat, HCN channels, divulging recent findings from the ancestral craniate, the Pacific hagfish (Eptatretus stoutii). It then explores how a heartbeat can maintain a rhythm, albeit slower, for hours without any oxygen, and sometimes without autonomic innervation. It closes with a discussion of recent work on fishes, where the cardiac rhythm can become arrhythmic when a fish experiences extreme heat. PMID:25178563

  7. Output characteristics of Stirling thermoacoustic engine

    Microsoft Academic Search

    Daming Sun; Limin Qiu; Bo Wang; Yong Xiao; Liang Zhao

    2008-01-01

    A thermoacoustic engine (TE), which converts thermal energy into acoustic power by the thermoacoustic effect, shows several advantages due to the absence of moving parts, such as high reliability and long lifetime associated with reduced manufacturing costs. Power output and efficiency are important criteria of the performance of a TE. In order to increase the acoustic power output and thermal

  8. Computer Output Microfilm and Library Catalogs.

    ERIC Educational Resources Information Center

    Meyer, Richard W.

    Early computers dealt with mathematical and scientific problems requiring very little input and not much output, therefore high speed printing devices were not required. Today with increased variety of use, high speed printing is necessary and Computer Output Microfilm (COM) devices have been created to meet this need. This indirect process can…

  9. VF CWEB OUTPUT 1 The Voting Farm

    E-print Network

    VF CWEB OUTPUT 1 The Voting Farm A Distributed Class for Software Voting V1.5 by Vincenzo De Florio Katholieke Universiteit Leuven Departement Elektrotechniek Afdeling ESAT/ACCA #12;2 CWEB OUTPUT VF 1. VotingFarm module connected to one user module and to a farm of fellow voters arranged into a cliqu´e. User Module

  10. The pagesel package "Selecting shipout output pages"

    E-print Network

    Mintmire, John W.

    The pagesel package "Selecting shipout output pages" 1999/04/13, v1.1 Heiko Oberdiek1 Abstract With this package single pages or page areas can be selected for output. Contents 1 Usage 1 1.1 Page selecting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1.1 Options for selecting pages . . . . . . . . . . . . . . . . . . 2 1.1.2 Examples

  11. Transient Expression Assays for Quantifying Signaling Output

    E-print Network

    Sheen, Jen

    Chapter 16 Transient Expression Assays for Quantifying Signaling Output Yajie Niu and Jen Sheen Abstract The protoplast transient expression system has become a powerful and popular tool for studying the output of various signaling pathways. Key words: Arabidopsis, Mesophyll protoplast, Transient expression

  12. Efficient input—output model representations

    Microsoft Academic Search

    Herschel Rabitz; Ömer F. Ali?; Jeffrey Shorter; Kyurhee Shim

    1999-01-01

    A family of multivariate representations is presented to capture the input—output relationships of physical systems with many input variables. The high-dimensional model representations (HDMR) are based on the ansatz that for most physical systems, only relatively low order correlations of the input variables will have an impact on the output. Application of the HDMR tools can dramatically reduce the computational

  13. Nonlinear internal models for output regulation

    Microsoft Academic Search

    C. I. Byrnes; A. Isidori

    2003-01-01

    In this paper we show how nonlinear internal models can be effectively used in the design of output regulators for nonlinear systems. This result provides a significant enhancement of the non-equilibrium theory for output regulation, which we have presented in the recent paper entitled \\

  14. Nonlinear internal models for output regulation

    Microsoft Academic Search

    C. I. Byrnes; A. Isidori

    2004-01-01

    In this note, we show how nonlinear internal models can be effectively used in the design of output regulators for nonlinear systems. This result provides a significant enhancement of the nonequilibrium theory for output regulation, which we have presented in a recent paper.

  15. OUTPUT REGULATION OF NONLINEAR NEUTRAL SYSTEMS

    E-print Network

    Fridman, Emilia

    OUTPUT REGULATION OF NONLINEAR NEUTRAL SYSTEMS Emilia Fridman1 Department of Electrical Engineering, Tel-Aviv University Ramat-Aviv, Tel-Aviv 69978, Israel emilia@eng.tau.ac.il Summary. Output regulation regulation, regulator equations, center manifold 1 Introduction One of the most important problems in control

  16. Rich Tactile Output on Mobile Devices

    Microsoft Academic Search

    Alireza Sahami; Paul Holleis; Albrecht Schmidt; Jonna Häkkilä

    2008-01-01

    In this paper we assess the potential of rich tactile notifications on mobile phones. Many mobile phone users use vibration output for various types of notification on their phone. Currently, tactile output in phones is limited to one single actuator that can potentially present patterns based on different vibration intensity over time. To explore the possible design space, we conducted

  17. DIST/AVC Out-Put Definition.

    ERIC Educational Resources Information Center

    Wilkinson, Gene L.

    The first stage of development of a management information system for DIST/AVC (Division of Instructional Technology/Audio-Visual Center) is the definition of out-put units. Some constraints on the definition of output units are: 1) they should reflect goals of the organization, 2) they should reflect organizational structure and procedures, and…

  18. Atom Laser with a cw Output Coupler

    Microsoft Academic Search

    Immanuel Bloch; Theodor W. Hänsch; Tilman Esslinger

    1999-01-01

    We demonstrate a continuous output coupler for magnetically trapped atoms. Over a period of up to 100 ms, a collimated and monoenergetic beam of atoms is continuously extracted from a Bose-Einstein condensate. The intensity and kinetic energy of the output beam of this atom laser are controlled by a weak rf field that induces spin flips between trapped and untrapped

  19. Programmed Evolution for Optimization of Orthogonal Metabolic Output in Bacteria

    PubMed Central

    Eckdahl, Todd T.; Campbell, A. Malcolm; Heyer, Laurie J.; Poet, Jeffrey L.; Blauch, David N.; Snyder, Nicole L.; Atchley, Dustin T.; Baker, Erich J.; Brown, Micah; Brunner, Elizabeth C.; Callen, Sean A.; Campbell, Jesse S.; Carr, Caleb J.; Carr, David R.; Chadinha, Spencer A.; Chester, Grace I.; Chester, Josh; Clarkson, Ben R.; Cochran, Kelly E.; Doherty, Shannon E.; Doyle, Catherine; Dwyer, Sarah; Edlin, Linnea M.; Evans, Rebecca A.; Fluharty, Taylor; Frederick, Janna; Galeota-Sprung, Jonah; Gammon, Betsy L.; Grieshaber, Brandon; Gronniger, Jessica; Gutteridge, Katelyn; Henningsen, Joel; Isom, Bradley; Itell, Hannah L.; Keffeler, Erica C.; Lantz, Andrew J.; Lim, Jonathan N.; McGuire, Erin P.; Moore, Alexander K.; Morton, Jerrad; Nakano, Meredith; Pearson, Sara A.; Perkins, Virginia; Parrish, Phoebe; Pierson, Claire E.; Polpityaarachchige, Sachith; Quaney, Michael J.; Slattery, Abagael; Smith, Kathryn E.; Spell, Jackson; Spencer, Morgan; Taye, Telavive; Trueblood, Kamay; Vrana, Caroline J.; Whitesides, E. Tucker

    2015-01-01

    Current use of microbes for metabolic engineering suffers from loss of metabolic output due to natural selection. Rather than combat the evolution of bacterial populations, we chose to embrace what makes biological engineering unique among engineering fields – evolving materials. We harnessed bacteria to compute solutions to the biological problem of metabolic pathway optimization. Our approach is called Programmed Evolution to capture two concepts. First, a population of cells is programmed with DNA code to enable it to compute solutions to a chosen optimization problem. As analog computers, bacteria process known and unknown inputs and direct the output of their biochemical hardware. Second, the system employs the evolution of bacteria toward an optimal metabolic solution by imposing fitness defined by metabolic output. The current study is a proof-of-concept for Programmed Evolution applied to the optimization of a metabolic pathway for the conversion of caffeine to theophylline in E. coli. Introduced genotype variations included strength of the promoter and ribosome binding site, plasmid copy number, and chaperone proteins. We constructed 24 strains using all combinations of the genetic variables. We used a theophylline riboswitch and a tetracycline resistance gene to link theophylline production to fitness. After subjecting the mixed population to selection, we measured a change in the distribution of genotypes in the population and an increased conversion of caffeine to theophylline among the most fit strains, demonstrating Programmed Evolution. Programmed Evolution inverts the standard paradigm in metabolic engineering by harnessing evolution instead of fighting it. Our modular system enables researchers to program bacteria and use evolution to determine the combination of genetic control elements that optimizes catabolic or anabolic output and to maintain it in a population of cells. Programmed Evolution could be used for applications in energy, pharmaceuticals, chemical commodities, biomining, and bioremediation. PMID:25714374

  20. Programmed evolution for optimization of orthogonal metabolic output in bacteria.

    PubMed

    Eckdahl, Todd T; Campbell, A Malcolm; Heyer, Laurie J; Poet, Jeffrey L; Blauch, David N; Snyder, Nicole L; Atchley, Dustin T; Baker, Erich J; Brown, Micah; Brunner, Elizabeth C; Callen, Sean A; Campbell, Jesse S; Carr, Caleb J; Carr, David R; Chadinha, Spencer A; Chester, Grace I; Chester, Josh; Clarkson, Ben R; Cochran, Kelly E; Doherty, Shannon E; Doyle, Catherine; Dwyer, Sarah; Edlin, Linnea M; Evans, Rebecca A; Fluharty, Taylor; Frederick, Janna; Galeota-Sprung, Jonah; Gammon, Betsy L; Grieshaber, Brandon; Gronniger, Jessica; Gutteridge, Katelyn; Henningsen, Joel; Isom, Bradley; Itell, Hannah L; Keffeler, Erica C; Lantz, Andrew J; Lim, Jonathan N; McGuire, Erin P; Moore, Alexander K; Morton, Jerrad; Nakano, Meredith; Pearson, Sara A; Perkins, Virginia; Parrish, Phoebe; Pierson, Claire E; Polpityaarachchige, Sachith; Quaney, Michael J; Slattery, Abagael; Smith, Kathryn E; Spell, Jackson; Spencer, Morgan; Taye, Telavive; Trueblood, Kamay; Vrana, Caroline J; Whitesides, E Tucker

    2015-01-01

    Current use of microbes for metabolic engineering suffers from loss of metabolic output due to natural selection. Rather than combat the evolution of bacterial populations, we chose to embrace what makes biological engineering unique among engineering fields - evolving materials. We harnessed bacteria to compute solutions to the biological problem of metabolic pathway optimization. Our approach is called Programmed Evolution to capture two concepts. First, a population of cells is programmed with DNA code to enable it to compute solutions to a chosen optimization problem. As analog computers, bacteria process known and unknown inputs and direct the output of their biochemical hardware. Second, the system employs the evolution of bacteria toward an optimal metabolic solution by imposing fitness defined by metabolic output. The current study is a proof-of-concept for Programmed Evolution applied to the optimization of a metabolic pathway for the conversion of caffeine to theophylline in E. coli. Introduced genotype variations included strength of the promoter and ribosome binding site, plasmid copy number, and chaperone proteins. We constructed 24 strains using all combinations of the genetic variables. We used a theophylline riboswitch and a tetracycline resistance gene to link theophylline production to fitness. After subjecting the mixed population to selection, we measured a change in the distribution of genotypes in the population and an increased conversion of caffeine to theophylline among the most fit strains, demonstrating Programmed Evolution. Programmed Evolution inverts the standard paradigm in metabolic engineering by harnessing evolution instead of fighting it. Our modular system enables researchers to program bacteria and use evolution to determine the combination of genetic control elements that optimizes catabolic or anabolic output and to maintain it in a population of cells. Programmed Evolution could be used for applications in energy, pharmaceuticals, chemical commodities, biomining, and bioremediation. PMID:25714374

  1. Spectral broadening using a polarization-maintaining photonic crystal fiber by an optical parametric amplifier

    Microsoft Academic Search

    Yongqin Yu; Shuangchen Ruan; Chenlin Du; Jihong Zhao; Jianchun Zeng

    2006-01-01

    Supercontinuum was generated in a polarization-maintaining (PM) PCF. The main advantage with the PM-PCF is the preservation of the state of polarization of the field propagating. For several applications, it is essential that the output has a well-defined polarization. In addition, the preserved polarization enhances the nonlinear interactions so that less power is required to generate the SC. The field

  2. Bayesian Sensitivity Analysis of a Cardiac Cell Model Using a Gaussian Process Emulator

    PubMed Central

    Chang, Eugene T Y; Strong, Mark; Clayton, Richard H

    2015-01-01

    Models of electrical activity in cardiac cells have become important research tools as they can provide a quantitative description of detailed and integrative physiology. However, cardiac cell models have many parameters, and how uncertainties in these parameters affect the model output is difficult to assess without undertaking large numbers of model runs. In this study we show that a surrogate statistical model of a cardiac cell model (the Luo-Rudy 1991 model) can be built using Gaussian process (GP) emulators. Using this approach we examined how eight outputs describing the action potential shape and action potential duration restitution depend on six inputs, which we selected to be the maximum conductances in the Luo-Rudy 1991 model. We found that the GP emulators could be fitted to a small number of model runs, and behaved as would be expected based on the underlying physiology that the model represents. We have shown that an emulator approach is a powerful tool for uncertainty and sensitivity analysis in cardiac cell models. PMID:26114610

  3. Cardiac arrest: resuscitation and reperfusion.

    PubMed

    Patil, Kaustubha D; Halperin, Henry R; Becker, Lance B

    2015-06-01

    The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and prevention of reperfusion injury, as this holds the promise of restoring life to many patients for whom our current therapies fail. PMID:26044255

  4. Patient-specific modeling of cardiac electromechanics in dyssynchronous heart failure

    E-print Network

    Shin, Jun Seob

    2009-01-01

    Cardiac Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Background 1.1 Cardiac Physiology 1.1.1 Cardiac Anatomyand physiology, is an excellent tool for finite element modeling in cardiac

  5. Cardiac arrest in kearns-sayre syndrome.

    PubMed

    van Beynum, Ingrid; Morava, Eva; Taher, Marjan; Rodenburg, Richard J; Karteszi, Judit; Toth, Kalman; Szabados, Eszter

    2012-01-01

    The prognosis of progressive ophthalmoplegia in patients with large-scale mitochondrial DNA deletions is highly variable and almost unpredictable. The risk to develop cardiac involvement and sudden cardiac death is strikingly high, especially in patients with Kearns-Sayre syndrome (KSS). The most typical cardiac complications of the disease are conduction defects, which usually begin with left anterior fascicular block with or without right bundle branch block (RBBB), progressing sometimes rapidly to complete atrioventricular block. Other cardiac manifestations reported are first or second degree of AV block, QT prolongation, torsades de pointes ventricular tachycardia, and rarely dilated cardiomyopathy. Most frequently syncope, sometimes even sudden cardiac death, is the first clinical sign of the cardiac disease in KSS. Due to these life-threatening cardiac conditions, patients should be carefully monitored for cardiac signs and symptoms and pacemaker implantation should be suggested early to avoid sudden cardiac arrest in KSS.Here, we present two cases of KSS with life-threatening syncope due to complete atrioventricular block. To emphasize the importance of an early pacemaker implantation, we review the literature on cardiac complications in KSS in the last 20 years. In almost all of the reviewed cases, ophthalmoplegia or ptosis was present before the cardiac manifestations. In most of the cases, syncope was the first symptom of the cardiac involvement. There was no correlation between the age of the onset of the disease and the onset of cardiac manifestations.With our current report, we increase awareness for life-threatening cardiac complications in patients with KSS. PMID:23430846

  6. Maintaining Clones through Eclipse Refactoring Extensions

    E-print Network

    Gray, Jeffrey G.

    Maintaining Clones through Eclipse Refactoring Extensions Robert Tairas (tairasr@cis.uab.edu) Jeff and Information Sciences University of Alabama at Birmingham · Clone detection tools provide an automated way to discover sections of duplicated code. · Clone analysis helps determine a group of clones to remove

  7. Women's work. Maintaining a healthy body weight.

    PubMed

    Welch, Nicky; Hunter, Wendy; Butera, Karina; Willis, Karen; Cleland, Verity; Crawford, David; Ball, Kylie

    2009-08-01

    This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of 'managing health' comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers' attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health. PMID:19446587

  8. Pedagogical Practices: Nurturing and Maintaining Democratic Habits

    ERIC Educational Resources Information Center

    Hubler-Larimore, Lucretia Marie

    2011-01-01

    This case study examined the pedagogical practices of four teachers of one public elementary school whose mission seeks to nurture and maintain democratic habits for participation in a democratic society. Historically, public schools have been charged with the duty of preparing young minds to live within in a democratic society and as such this…

  9. Improving Avionics Fiber Optic Network Reliability & Maintainability

    Microsoft Academic Search

    Mark W. Beranek; Anthony R. Avak

    2007-01-01

    Work is ongoing at NAVAIR to understand how avionics fiber optic BIT technology can help reduce military aviation platform fiber optic network life cycle and total ownership cost. Operational availability enhancements via comprehensive supportability programs combined with keen attentiveness to reliability and maintainability metrics are driving the avionics fiber optic BIT value proposition. Avionics fiber optic BIT technology is expected

  10. THE COMPUTERIZED COMPREHENSIBILITY SYSTEM MAINTAINER'S GUIDE

    Microsoft Academic Search

    David E. Kieras

    Abstract The Computerized Comprehensibility System (CCS) generates a critique of the comprehensibility of a technical document, using techniques and results from AI and cognitive psychology. This report is a guide for the maintainer or developer of CCS. It is not intended as a tutorial on the mechanisms used in CCS, but to allow the qualified programmer to rapidly understand the

  11. Maintaining Interest in Operator Requal Training.

    ERIC Educational Resources Information Center

    Lapp, H. J., Jr.

    A study reviewed operator training programs at Oyster Creek Nuclear Generating Station to determine their interface with plant operations and to devise new ways of maintaining interest in requalification (requal) training. The operator training review committee that was formed to implement the review documented over 100 issues and concerns…

  12. Means for maintaining the substitutability of LNG

    Microsoft Academic Search

    R. C. Proctor; R. W. Parrish

    1967-01-01

    Substitutability as applied to liquid natural gas (LNG) is a method of reducing vaporization of the more volatile components and thus maintaining the heating value at a desirable level. A continuous process is described for cooling LNG below the boiling point of its most volatile component. A large-scale storage tank is provided with adequate space in the top for a

  13. Maintaining Hope in the Face of Evil.

    ERIC Educational Resources Information Center

    Miller, Geri

    2002-01-01

    P. G. Zimbardo (2001) and M. E. P. Seligman (in an interview with S. Carpenter, 2001) discuss evil and hope in response to the September 11, 2001, disaster. The implications for counseling are presented with an emphasis on how counselors can maintain hope for themselves and their clients in the face of evil. (Author)

  14. Halema'uma'u Maintains Basic Geometry

    USGS Multimedia Gallery

    The lava lake at Halema'uma'u has maintained the same basic geometry since February of this year. This thermal image was taken during a helicopter overflight, and shows the lava surface deep within the vent cavity. The lava surface is kidney-shaped and approximately 60 x 90 meters in size, and situa...

  15. Maintaining osmotic balance with an aglomerular kidney

    Microsoft Academic Search

    M. Danielle McDonald; Martin Grosell

    2006-01-01

    The gulf toadfish, Opsanus beta, is a marine teleost fish with an aglomerular kidney that is highly specialized to conserve water. Despite this adaptation, toadfish have the ability to survive when in dilute hypoosmotic seawater environments. The objectives of this study were to determine the joint role of the kidney and intestine in maintaining osmotic and ionic balance and to

  16. WEB Maintainers Meetup Web Branding Committee

    E-print Network

    Florida, University of

    WEB Maintainers Meetup UF/IFAS DEPARTMENT #12; Web Branding Committee Introduction and TERMINALFOUR (T4) recap Preparation Page layouts Questions #12;WEB BRANDING COMMITTEE what we heard #12;Some) is the new UF Web Content Management System (WCMS) chosen for the next five years. T4 allows non

  17. Web Maintainers Forum 29 August 2013

    E-print Network

    Hickman, Mark

    1 Web Maintainers Forum 29 August 2013 Agenda Welcome and introduction Web team Update My Baker, WCMS Project Manager) Questions Web team update Web team site rebranded http://www.canterbury.ac.nz/web/ When was the last time you visited the web team site: August? June or July? 2013? 2012? Never

  18. Storage Temperatures Necessary to Maintain Cheese Safety

    Microsoft Academic Search

    JAY RUSSELL BISHOP; MARIANNE SMUKOWSKI

    SUMMARY Available information on bacterial pathogen growth, stasis, and death in cheeses was reviewed and evaluated to determine storage temperatures necessary to maintain product safety. In view of the variety and large volume of cheeses consumed throughout the world, the incidence of foodborne outbreaks associated with cheeses is extremely low. Research revealed that the inherent characteristics of most cheeses create

  19. Anisotropic polarization maintaining optical fiber ring resonators

    Microsoft Academic Search

    Zacharias K. Ioannidis; Raj Kadiwar; Ian P. Giles

    1996-01-01

    Suppression of the polarization drift of optical fiber ring resonators is investigated both theoretically and experimentally by employing anisotropy in a polarization maintaining fiber ring. A general analytic expression for the transmission of the device is derived allowing the fiber modes to exhibit any combination of polarization crosstalk, differential loss or differential coupling. The analysis shows that a moderate level

  20. Maintainability design of ship electronic system

    Microsoft Academic Search

    A. Kras; J. Susanj

    2005-01-01

    Maintainabilify of any ship electronic system is the ease, economy, safety and accuracy with which the necessaly maintenance of the system is undertaken and can be measured either in terms of probability or in terms of the level of resouxes required to maintain the system. It therefore has a direct efect on the ability of the system to satisfjl the

  1. Ultrasound image guidance of cardiac interventions

    NASA Astrophysics Data System (ADS)

    Peters, Terry M.; Pace, Danielle F.; Lang, Pencilla; Guiraudon, Gérard M.; Jones, Douglas L.; Linte, Cristian A.

    2011-03-01

    Surgical procedures often have the unfortunate side-effect of causing the patient significant trauma while accessing the target site. Indeed, in some cases the trauma inflicted on the patient during access to the target greatly exceeds that caused by performing the therapy. Heart disease has traditionally been treated surgically using open chest techniques with the patient being placed "on pump" - i.e. their circulation being maintained by a cardio-pulmonary bypass or "heart-lung" machine. Recently, techniques have been developed for performing minimally invasive interventions on the heart, obviating the formerly invasive procedures. These new approaches rely on pre-operative images, combined with real-time images acquired during the procedure. Our approach is to register intra-operative images to the patient, and use a navigation system that combines intra-operative ultrasound with virtual models of instrumentation that has been introduced into the chamber through the heart wall. This paper illustrates the problems associated with traditional ultrasound guidance, and reviews the state of the art in real-time 3D cardiac ultrasound technology. In addition, it discusses the implementation of an image-guided intervention platform that integrates real-time ultrasound with a virtual reality environment, bringing together the pre-operative anatomy derived from MRI or CT, representations of tracked instrumentation inside the heart chamber, and the intra-operatively acquired ultrasound images.

  2. An Optimized and Simplified System of Mouse Embryonic Stem Cell Cardiac Differentiation for the Assessment of Differentiation Modifiers

    PubMed Central

    Hartman, Matthew E.; Librande, Jason R.; Medvedev, Ivan O.; Ahmad, Rabiah N.; Moussavi-Harami, Farid; Gupta, Pritha P.; Chien, Wei-Ming; Chin, Michael T.

    2014-01-01

    Generating cardiomyocytes from embryonic stem cells is an important technique for understanding cardiovascular development, the origins of cardiovascular diseases and also for providing potential reagents for cardiac repair. Numerous methods have been published but often are technically challenging, complex, and are not easily adapted to assessment of specific gene contributions to cardiac myocyte differentiation. Here we report the development of an optimized protocol to induce the differentiation of mouse embryonic stem cells to cardiac myocytes that is simplified and easily adapted for genetic studies. Specifically, we made four critical findings that distinguish our protocol: 1) mouse embryonic stem cells cultured in media containing CHIR99021 and PD0325901 to maintain pluripotency will efficiently form embryoid bodies containing precardiac mesoderm when cultured in these factors at a reduced dosage, 2) low serum conditions promote cardiomyocyte differentiation and can be used in place of commercially prepared StemPro nutrient supplement, 3) the Wnt inhibitor Dkk-1 is dispensable for efficient cardiac differentiation and 4) tracking differentiation efficiency may be done with surface expression of PDGFR? alone. In addition, cardiac mesodermal precursors generated by this system can undergo lentiviral infection to manipulate the expression of specific target molecules to assess effects on cardiac myocyte differentiation and maturation. Using this approach, we assessed the effects of CHF1/Hey2 on cardiac myocyte differentiation, using both gain and loss of function. Overexpression of CHF1/Hey2 at the cardiac mesoderm stage had no apparent effect on cardiac differentiation, while knockdown of CHF1/Hey2 resulted in increased expression of atrial natriuretic factor and connexin 43, suggesting an alteration in the phenotype of the cardiomyocytes. In summary we have generated a detailed and simplified protocol for generating cardiomyocytes from mES cells that is optimized for investigating factors that affect cardiac differentiation. PMID:24667642

  3. Temperature acclimation modifies Na+ current in fish cardiac myocytes.

    PubMed

    Haverinen, Jaakko; Vornanen, Matti

    2004-07-01

    The present study was designed to test the hypothesis that temperature acclimation modifies sarcolemmal Na+ current (INa) of the fish cardiac myocytes differently depending on the animal's lifestyle in the cold. Two eurythermal fish species with different physiological strategies for surviving in the cold, a cold-dormant crucian carp (Carassius carassius L.) and a cold-active rainbow trout (Oncorhynchus mykiss), were used in acclimation experiments. The INa of carp and trout were also compared with INa of a cold stenothermal burbot (Lota lota). In accordance with the hypothesis, cold-acclimation decreased the density of INa in crucian carp and increased it in rainbow trout, suggesting depression of impulse conduction in cold-acclimated carp and positive compensation of impulse propagation in cold-acclimated trout. The steady-state activation curve of trout INa was shifted by 6 mV to more negative voltages by cold acclimation, which probably lowers the stimulus threshold for action potentials and further improves cardiac excitability in the cold. In burbot myocytes, the INa density was high and the position of the steady-state activation curve on the voltage axis was even more negative than in trout or carp myocytes, suggesting that the burbot INa is adapted to maintain high excitability and conductivity in the cold. The INa of the burbot heart differed from those of carp and trout in causing four times larger charge influx per excitation, which suggests that INa may also have a significant role in cardiac excitation-contraction coupling of the burbot heart. In summary, INa of fish cardiac myocytes shows thermal plasticity that is different in several respects in cold-dormant and cold-active species and thus has a physiologically meaningful role in supporting the variable life styles and habitat conditions of each species. PMID:15235011

  4. Blood pressure is maintained during dehydration by hypothalamic paraventricular nucleus-driven tonic sympathetic nerve activity.

    PubMed

    Holbein, Walter W; Bardgett, Megan E; Toney, Glenn M

    2014-09-01

    Resting sympathetic nerve activity (SNA) consists primarily of respiratory and cardiac rhythmic bursts of action potentials. During homeostatic challenges such as dehydration, the hypothalamic paraventricular nucleus (PVN) is activated and drives SNA in support of arterial pressure (AP). Given that PVN neurones project to brainstem cardio-respiratory regions that generate bursting patterns of SNA, we sought to determine the contribution of PVN to support of rhythmic bursting of SNA during dehydration and to elucidate which bursts dominantly contribute to maintenance of AP. Euhydrated (EH) and dehydrated (DH) (48 h water deprived) rats were anaesthetized, bilaterally vagotomized and underwent acute PVN inhibition by bilateral injection of the GABA-A receptor agonist muscimol (0.1 nmol in 50 nl). Consistent with previous studies, muscimol had no effect in EH rats (n = 6), but reduced mean AP (MAP; P < 0.001) and integrated splanchnic SNA (sSNA; P < 0.001) in DH rats (n = 6). Arterial pulse pressure was unaffected in both groups. Muscimol reduced burst frequency of phrenic nerve activity (P < 0.05) equally in both groups without affecting the burst amplitude-duration integral (i.e. area under the curve). PVN inhibition did not affect the amplitude of the inspiratory peak, expiratory trough or expiratory peak of sSNA in either group, but reduced cardiac rhythmic sSNA in DH rats only (P < 0.001). The latter was largely reversed by inflating an aortic cuff to restore MAP (n = 5), suggesting that the muscimol-induced reduction of cardiac rhythmic sSNA in DH rats was an indirect effect of reducing MAP and thus arterial baroreceptor input. We conclude that MAP is largely maintained in anaesthetized DH rats by a PVN-driven component of sSNA that is neither respiratory nor cardiac rhythmic. PMID:24973410

  5. Measuring cardiac waste: the premier cardiac waste measures.

    PubMed

    Lowe, Timothy J; Partovian, Chohreh; Kroch, Eugene; Martin, John; Bankowitz, Richard

    2014-01-01

    The authors developed 8 measures of waste associated with cardiac procedures to assist hospitals in comparing their performance with peer facilities. Measure selection was based on review of the research literature, clinical guidelines, and consultation with key stakeholders. Development and validation used the data from 261 hospitals in a split-sample design. Measures were risk adjusted using Premier's CareScience methodologies or mean peer value based on Medicare Severity Diagnosis-Related Group assignment. High variability was found in resource utilization across facilities. Validation of the measures using item-to-total correlations (range = 0.27-0.78), Cronbach ? (.88), and Spearman rank correlation (0.92) showed high reliability and discriminatory power. Because of the level of variability observed among hospitals, this study suggests that there is opportunity for facilities to design successful waste reduction programs targeting cardiac-device procedures. PMID:23719033

  6. High output piezo/triboelectric hybrid generator.

    PubMed

    Jung, Woo-Suk; Kang, Min-Gyu; Moon, Hi Gyu; Baek, Seung-Hyub; Yoon, Seok-Jin; Wang, Zhong-Lin; Kim, Sang-Woo; Kang, Chong-Yun

    2015-01-01

    Recently, piezoelectric and triboelectric energy harvesting devices have been developed to convert mechanical energy into electrical energy. Especially, it is well known that triboelectric nanogenerators have a simple structure and a high output voltage. However, whereas nanostructures improve the output of triboelectric generators, its fabrication process is still complicated and unfavorable in term of the large scale and long-time durability of the device. Here, we demonstrate a hybrid generator which does not use nanostructure but generates much higher output power by a small mechanical force and integrates piezoelectric generator into triboelectric generator, derived from the simultaneous use of piezoelectric and triboelectric mechanisms in one press-and-release cycle. This hybrid generator combines high piezoelectric output current and triboelectric output voltage, which produces peak output voltage of ~370 V, current density of ~12 ?A · cm(-2), and average power density of ~4.44 mW · cm(-2). The output power successfully lit up 600 LED bulbs by the application of a 0.2 N mechanical force and it charged a 10 ?F capacitor to 10 V in 25 s. Beyond energy harvesting, this work will provide new opportunities for developing a small, built-in power source in self-powered electronics such as mobile electronics. PMID:25791299

  7. Control of cardiac function and noise from a decaying power spectrum

    NASA Astrophysics Data System (ADS)

    Kember, G. C.; Armour, J. A.; Fenton, G. A.; Malhotra, A.

    2004-08-01

    Evidence is presented that adds to the debate surrounding the question: To what extent does neural control of cardiac output exploit noise? The transduction capability of cardiac afferent neurons, situated in and adjacent to the heart, is vital to feedback in control of cardiac function. An analysis of in situ cardiac afferent activity shows evidence of independent and exponentially distributed interspike intervals. An anatomical basis for such memoryless interspike intervals ultimately derives from the fact that each afferent neuron is associated with a field of sensory neurites, or bare nerve endings, that transduce local chemical and mechanical stimuli in a many-to-one fashion. As such, cardiac afferent neurons and their sensory neurite inputs are respectively modeled here by the Hodgkin-Huxley equations forced by “red” noise (decaying power spectrum) perturbing an otherwise constant subthreshold input. A variable barrier competition model is derived from these equations in order to address the question: How are noisy inputs being processed by sensory neurons to cause each spike? It is found that ion channels are responsible for significant input “whitening” (increased spectral power at higher frequency) through differentiation of the inputs. Such whitening is a means to distinguish low-frequency control signals from otherwise red noise fluctuations. Furthermore, spiking occurs when backward moving averages of the whitened inputs, over a window of the order of the sodium activation time scale, exceed an approximately constant barrier.

  8. Cardiac hypertrophy associated with impaired regulation of cardiac ryanodine receptor by calmodulin and S100A1

    PubMed Central

    Yamaguchi, Naohiro; Chakraborty, Asima; Huang, Tai-Qin; Xu, Le; Gomez, Angela C.; Pasek, Daniel A.

    2013-01-01

    The cardiac ryanodine receptor (RyR2) is inhibited by calmodulin (CaM) and S100A1. Simultaneous substitution of three amino acid residues (W3587A, L3591D, F3603A; RyR2ADA) in the CaM binding domain of RyR2 results in loss of CaM inhibition at submicromolar (diastolic) and micromolar (systolic) Ca2+, cardiac hypertrophy, and heart failure in Ryr2ADA/ADA mice. To address whether cardiac hypertrophy results from the elimination of CaM and S100A1 inhibition at diastolic or systolic Ca2+, a mutant mouse was generated with a single RyR2 amino acid substitution (L3591D; RyR2D). Here we report that in single-channel measurements RyR2-L3591D isolated from Ryr2D/D hearts lost CaM inhibition at diastolic Ca2+ only, whereas S100A1 regulation was eliminated at both diastolic and systolic Ca2+. In contrast to the ?2-wk life span of Ryr2ADA/ADA mice, Ryr2D/D mice lived longer than 1 yr. Six-month-old Ryr2D/D mice showed a 9% increase in heart weight-to-body weight ratio, modest changes in cardiac morphology, and a twofold increase in atrial natriuretic peptide mRNA levels compared with wild type. After 4-wk pressure overload with transverse aortic constriction, heart weight-to-body weight ratio and atrial natriuretic peptide mRNA levels increased and echocardiography showed changes in heart morphology of Ryr2D/D mice compared with sham-operated mice. Collectively, the findings indicate that the single RyR2-L3591D mutation, which distinguishes the effects of diastolic and systolic Ca2+, alters heart size and cardiac function to a lesser extent in Ryr2D/D mice than the triple mutation in Ryr2ADA/ADA mice. They further suggest that CaM inhibition of RyR2 at systolic Ca2+ is important for maintaining normal cardiac function. PMID:23666671

  9. [Value of the association of blood cardioplegia and energetic warm reperfusion in cardiac transplantation].

    PubMed

    Pavie, A; Bracamonte, L; Aupart, M; Bors, V; Gandjbakhch, I; Cabrol, C

    1991-06-01

    Blood cardioplegia at 8 degrees C results in cardiac standstill whilst maintaining minimal metabolic functions of the cardiac cell. Reinjection every 20 minutes allows cellular reoxygenation, the delivery of essential elements (Tham, CPD), and the elimination of products of myocardial degradation accumulated during ischemia. Before declamping the aorta, a reperfusion with warm blood (34 degrees C) containing glutamate and GTN enables restocking of the energy reserves (Krebs' cycle) and a lowering of coronary and systemic resistances. This technique used systematically if even more effective when the ischemic time is prolonged as is the case in cardiac transplantation. The 50 transplants performed since January 1989 with this form of myocardial protection were compared with 50 procedures performed in 1988 with crystalloid cardioplegia. There was no significant difference in the duration of ischemia or of cardiopulmonary bypass between the two groups. Patients benefitting from blood cardioplegia defibrillated spontaneously more frequently, required lower doses of Dopamine for shorter periods and were extubated earlier. PMID:1898213

  10. High Energy Output Marx Generator Design

    SciTech Connect

    Monty Lehmann

    2011-07-01

    High Energy Output Marx Generator Design a design of a six stage Marx generator that has a unipolar pulse waveform of 200 kA in a 50×500 microsecond waveform is presented. The difficulties encountered in designing the components to withstand the temperatures and pressures generated during the output pulse are discussed. The unique methods and materials used to successfully overcome these problems are given. The steps necessary to increase the current output of this Marx generator design to the meg-ampere region or higher are specified.

  11. GAMS program used to estimate capacity output using a distance function with both desirable and undesirable outputs, and weak disposability for the undesirable outputs.

    E-print Network

    (GOUTPUT, OBS) DEA constraint for each output CONSTR2(BOUTPUT, OBS) DEA constraint for BAD Outputs CONSTR3(FIXED, OBS) DEA constraint for Fixed Inputs CONSTR4(VAR,OBS) DEA Constraint for Variable Outputs; CONSTR

  12. Relationship of glucose and oleate metabolism to cardiac function in lipin-1 deficient (fld) mice[S

    PubMed Central

    Kok, Bernard P. C.; Kienesberger, Petra C.; Dyck, Jason R. B.; Brindley, David N.

    2012-01-01

    Lipin-1 is the major phosphatidate phosphatase (PAP) in the heart and a transcriptional coactivator that regulates fatty acid (FA) oxidation in the liver. As the control of FA metabolism is essential for maintaining cardiac function, we investigated whether lipin-1 deficiency affects cardiac metabolism and performance. Cardiac PAP activity in lipin-1 deficient [fatty liver dystrophy (fld)] mice was decreased by >80% compared with controls. Surprisingly, oleate oxidation and incorporation in triacylglycerol (TG), as well as glucose oxidation, were not significantly different in perfused working fld hearts. Despite this, [3H]oleate accumulation in phosphatidate and phosphatidylinositol was increased in fld hearts, reflecting the decreased PAP activity. Phosphatidate accumulation was linked to increased cardiac mammalian target of rapamycin complex 1 (mTORC1) signaling and endoplasmic reticulum (ER) stress. Transthoracic echocardiography showed decreased cardiac function in fld mice; however, cardiac dysfunction was not observed in ex vivo perfused working fld hearts. This showed that changes in systemic factors due to the global absence of lipin-1 could contribute to the decreased cardiac function in vivo. Collectively, this study shows that fld hearts exhibit unchanged oleate esterification, as well as oleate and glucose oxidation, despite the absence of lipin-1. However, lipin-1 deficiency increases the accumulation of newly synthesized phosphatidate and induces aberrant cell signaling. PMID:22058427

  13. Reliability and Maintainability model (RAM) user and maintenance manual. Part 2

    NASA Technical Reports Server (NTRS)

    Ebeling, Charles E.

    1995-01-01

    This report documents the procedures for utilizing and maintaining the Reliability and Maintainability Model (RAM) developed by the University of Dayton for the NASA Langley Research Center (LaRC). The RAM model predicts reliability and maintainability (R&M) parameters for conceptual space vehicles using parametric relationships between vehicle design and performance characteristics and subsystem mean time between maintenance actions (MTBM) and manhours per maintenance action (MH/MA). These parametric relationships were developed using aircraft R&M data from over thirty different military aircraft of all types. This report describes the general methodology used within the model, the execution and computational sequence, the input screens and data, the output displays and reports, and study analyses and procedures. A source listing is provided.

  14. Device Maintains Water At The Triple Point

    NASA Technical Reports Server (NTRS)

    West, J. W.; Burkett, C. G.

    1988-01-01

    Inexpensive device maintains water at 0.01 degree C for 10 weeks or longer. New device consists of four basic assemblies; small, commercial chest freezer containing insulated water tank; insulated copper cell holder; "ice switch" for cycling freezer compressor and externally-mounted air pump for circulation. Access hole in freezer lid allows triple point measurements without opening lid. Modified freezer used to calibrate standard platinum resistance thermomenters.

  15. Cardiac molecular-acclimation mechanisms in response to swimming-induced exercise in Atlantic salmon.

    PubMed

    Castro, Vicente; Grisdale-Helland, Barbara; Helland, Ståle J; Torgersen, Jacob; Kristensen, Torstein; Claireaux, Guy; Farrell, Anthony P; Takle, Harald

    2013-01-01

    Cardiac muscle is a principal target organ for exercise-induced acclimation mechanisms in fish and mammals, given that sustained aerobic exercise training improves cardiac output. Yet, the molecular mechanisms underlying such cardiac acclimation have been scarcely investigated in teleosts. Consequently, we studied mechanisms related to cardiac growth, contractility, vascularization, energy metabolism and myokine production in Atlantic salmon pre-smolts resulting from 10 weeks exercise-training at three different swimming intensities: 0.32 (control), 0.65 (medium intensity) and 1.31 (high intensity) body lengths s(-1). Cardiac responses were characterized using growth, immunofluorescence and qPCR analysis of a large number of target genes encoding proteins with significant and well-characterized function. The overall stimulatory effect of exercise on cardiac muscle was dependent on training intensity, with changes elicited by high intensity training being of greater magnitude than either medium intensity or control. Higher protein levels of PCNA were indicative of cardiac growth being driven by cardiomyocyte hyperplasia, while elevated cardiac mRNA levels of MEF2C, GATA4 and ACTA1 suggested cardiomyocyte hypertrophy. In addition, up-regulation of EC coupling-related genes suggested that exercised hearts may have improved contractile function, while higher mRNA levels of EPO and VEGF were suggestive of a more efficient oxygen supply network. Furthermore, higher mRNA levels of PPAR?, PGC1? and CPT1 all suggested a higher capacity for lipid oxidation, which along with a significant enlargement of mitochondrial size in cardiac myocytes of the compact layer of fish exercised at high intensity, suggested an enhanced energetic support system. Training also elevated transcription of a set of myokines and other gene products related to the inflammatory process, such as TNF?, NF?B, COX2, IL1RA and TNF decoy receptor. This study provides the first characterization of the underlying molecular acclimation mechanisms in the heart of exercise-trained fish, which resemble those reported for mammalian physiological cardiac growth. PMID:23372811

  16. Historical perspectives of cardiac electrophysiology.

    PubMed

    Lüderitz, Berndt

    2009-01-01

    The diagnosis and treatment of clinical electrophysiology has a long and fascinating history. From earliest times, no clinical symptom impressed the patient (and the physician) more than an irregular heart beat. Although ancient Chinese pulse theory laid the foundation for the study of arrhythmias and clinical electrophysiology in the 5th century BC, the most significant breakthrough in the identification and treatment of cardiac arrhythmias first occurred in this century. In the last decades, our knowledge of electrophysiology and pharmacology has increased exponentially. The enormous clinical significance of cardiac rhythm disturbances has favored these advances. On the one hand, patients live longer and thus are more likely to experience arrhythmias. On the other hand, circulatory problems of the cardiac vessels have increased enormously, and this has been identified as the primary cause of cardiac rhythm disorders. Coronary heart disease has become not just the most significant disease of all, based on the statistics for cause of death. Arrhythmias are the main complication of ischemic heart disease, and they have been directly linked to the frequently arrhythmogenic sudden death syndrome, which is now presumed to be an avoidable "electrical accident" of the heart. A retrospective look--often charming in its own right--may not only make it easier to sort through the copious details of this field and so become oriented in this universe of important and less important facts: it may also provide the observer with a chronological vantage point from which to view the subject. The study of clinical electrophysiology is no dry compendium of facts and figures, but rather a dynamic field of study evolving out of the competition between various ideas, intentions and theories. PMID:19196616

  17. Cardiac glycosides from Erysimum cheiranthoides.

    PubMed

    Lei, Z H; Yahara, S; Nohara, T; Tai, B S; Xiong, J Z; Ma, Y L

    2000-02-01

    Two new cardiac glycosides called cheiranthosides VI (2) and VII (3) were isolated together with a known one, glucoerysimoside (1) from the seeds of Erysimum cheiranthoides. Based on spectroscopic data, the structures of 2 and 3 were characterized as periplogenin 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-fucopyranoside and periplogenin 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-antiaropyranoside, respectively. PMID:10705523

  18. Detecting instabilities of cardiac rhythm.

    PubMed

    Shusterman, Vladimir; Aysin, Benhur; Ermentrout, G Bard; London, Barry; Schwartzman, David

    2003-01-01

    Diminished beat-to-beat variations in cardiac cycle lengths (CLs) are associated with poor prognosis after acute myocardial infarction and in patients with heart failure. Short-long-short sequences of cardiac cycles, or ultra-short rhythm instabilities, precede initiation of ventricular tachyarrhythmias in some patients. However, little is known about clinical or prognostic significance of abrupt short-term instabilities in CL (AICL) that occur minutes to hours before the event, in part because appropriate analytical methods are lacking. Although various techniques have been used to analyze CL changes, methods for analysis of AICL are limited. We compared performance of time domain, spectral, nonlinear, and pattern recognition techniques with respect to the detection and quantification of AICL. Because of high intra- and inter-subject variability of CL, pattern recognition techniques compared favorably to other studied methods. In continuous ambulatory ECG recordings, AICL occurred hours before spontaneous initiation of sustained atrial and ventricular arrhythmias in different patient populations. AICL were also found prior to the onset of spontaneous ventricular arrhythmias in a mouse model of congestive heart failure. To quantify AICL, we used the number of unstable orthogonal projection coefficients; this number gradually increased hours before the event. Removal of ectopic beats reduced but did not eliminate AICL. To illustrate potential physiological effects and temporal evolution of AICL, we used a simple, continuous, two-dimensional model of cardiac tissue governed by the Morris-Lecar equations. Computer simulations in this model showed that AICL may lead to gradual accumulation of spatial irregularities of the propagation wavefront giving rise to the initiation of reentry. Time-frequency analysis of the most significant eigenvectors of cardiac rhythm in subjects undergoing head-up tilt showed that AICL could indicate instabilities and unsuccessful adaptation of autonomic nervous system activity to physiological stimuli. PMID:14716638

  19. Genetics of Sudden Cardiac Death

    Microsoft Academic Search

    Alon Barsheshet; Andrew Brenyo; Arthur J. Moss; Ilan Goldenberg

    Advances in genetic testing technology have led to a proliferation of new genetic tests and accelerated developments in the\\u000a field of cardiovascular genetic medicine. These advances enhance presymptomatic diagnosis and can establish a definitive molecular\\u000a diagnosis for symptomatic patients at risk for sudden cardiac death. Most importantly, genotype-phenotype correlations can\\u000a add important information for predicting outcome and selecting treatment for

  20. Cardiac Rehabilitation in the Elderly

    Microsoft Academic Search

    Carl I. Gonzales; Lois A. Killewich

    \\u000a Rehabilitation following coronary heart events and procedures results in reduced mortality, improved risk factor profiles,\\u000a and improved quality of life. The American College of Cardiology and the American Heart Association have published specific\\u000a guidelines regarding the components of cardiac rehabilitation, which include nutritional counseling, weight management, blood\\u000a pressure management, lipid management, diabetes management, tobacco cessation, psychosocial management, physical activity\\u000a counseling,