Consolo, Filippo; Fiore, Gianfranco B; Pelosi, Alessandra; Reggiani, Stefano; Redaelli, Alberto
We developed a numerical model, based on multi-physics computational fluid dynamics (CFD) simulations, to assist the design process of a plastic hollow-fiber bundle blood heat exchanger (BHE) integrated within the INSPIRE(TM), a blood oxygenator (OXY) for cardiopulmonary by-pass procedures, recently released by Sorin Group Italia. In a comparative study, we analyzed five different geometrical design solutions of the BHE module. Quantitative geometrical-dependent parameters providing a comprehensive evaluation of both the hemo- and thermo-dynamics performance of the device were extracted to identify the best-performing prototypical solution. A convenient design configuration was identified, characterized by (i) a uniform blood flow pattern within the fiber bundle, preventing blood flow shunting and the onset of stagnation/recirculation areas and/or high velocity pathways, (ii) an enhanced blood heating efficiency, and (iii) a reduced blood pressure drop. The selected design configuration was then prototyped and tested to experimentally characterize the device performance. Experimental results confirmed numerical predictions, proving the effectiveness of CFD modeling as a reliable tool for in silico identification of suitable working conditions of blood handling medical devices. Notably, the numerical approach limited the need for extensive prototyping, thus reducing the corresponding machinery costs and time-to-market. PMID:25890509
MENU Return to Web version Cardiopulmonary Resuscitation (CPR) Cardiopulmonary Resuscitation (CPR) What is CPR? Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that involves chest compressions and giving ...
Naesholm, Karolina; Walletun, Haakan [ZW Energiteknik, Nykoeping (Sweden)
In a majority of district heating distribution networks by-passes (between supply and return pipe) are installed in order to avoid system stops or risk for freezing in low flow sections in wintertime on one hand and for reason of supplying minimum design temperatures on the other hand. However, the choice of the by-pass valve type can influence the costs caused by the by-pass. Manually operated valves very often deliver higher flows than necessary for the intended service function. Too high by-pass flows result in unwanted high system temperatures, implying higher heat losses. Different local investigations have shown that it is possible to use instead thermostat-controlled valves resulting in important reductions of operating costs. The objective of this project was to elaborate a method for investigating by-passes in a systematic and methodical way, similarly how it is done for substations. Another objective was to raise the technical 'status' of the by-pass as a component. By-passes have a big impact on the distribution capacity of a network and hence should get more attention than normally is the case. In this report, different types of by-passes are described. Furthermore, also the way how different energy companies operate them is analysed. The project has among others resulted in a proposed operation and maintenance method for by-passes. This method can be summarised as follows: Make an inventory and documentation of all by-passes in a district heating network. Question the need for by-passes in every case, make flow calculations for the given point. To each motivated by-pass, a calculated design flow value should be assigned. Adjust the flow by means of a correct valve dimension. Install temperature sensors in fixed by-passes. Control each by-pass at least twice a year. Operate the system for periods with changed supply temperature and/or changed differential pressure and log the temperatures in different sections. Analyse sections in more detail
Ricardo W. Muotri
Full Text Available Objectives: 1 To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2 to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder.
Freedman, A P; Pelias, A; Johnston, R F; Goel, I P; Hakki, H I; Oslick, T; Shinnick, J P
An adult case of pulmonary alveolar proteinosis presented with an arterial oxygen tension of 27 mmHg (3.6 kPa) while breathing air. Dangerous hypoxaemia during lung lavage was avoided by using partial cardiopulmonary bypass.
THE ROYAL College of Nursing (RCN), Resuscitation Council (UK) and British Medical Association (BMA) have issued a new edition of their guidance on when to attempt cardiopulmonary resuscitation (CPR). PMID:25369953
Jonáš, Pavel; Elsner, W.; Mazur, Oton; Uruba, Václav; Wysocki, M.
-, č. 80 (2009), s. 16-19. ISSN N R&D Projects: GA AV ČR(CZ) IAA200760614; GA MŠk MEB050810 Institutional research plan: CEZ:AV0Z20760514 Keywords : turbulent spot * boundary layer * by-pass transition * turbulent spot detection Subject RIV: BK - Fluid Dynamics
Pomini, F; Mercogliano, D; Cavalletti, C; Caruso, A; Pomini, P
The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. Maternal mortality was 2.9%. Embryofetal mortality was 20.2%. Examining only the last 40 patients, maternal and embryofetal mortality were 0.0% and 12.5%, respectively. Embryofetal mortality was 24.0% when hypothermia was used, compared with 0.0% while operating in normothermia. Maternal mortality did not change. The use of hypothermia during cardiopulmonary bypass provoked uterine contractions in several patients. Hypothermia decreases O2 exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation. PMID:8561577
Life sciences research in the cardiopulmonary discipline must identify possible consequences of space flight on the cardiopulmonary system, understand the mechanisms of these effects, and develop effective and operationally practical countermeasures to protect crewmembers inflight and upon return to a gravitational environment. The long-range goal of the NASA Cardiopulmonary Discipline Research Program is to foster research to better understand the acute and long-term cardiovascular and pulmonary adaptation to space and to develop physiological countermeasures to ensure crew health in space and on return to Earth. The purpose of this Discipline Plan is to provide a conceptual strategy for NASA's Life Sciences Division research and development activities in the comprehensive area of cardiopulmonary sciences. It covers the significant research areas critical to NASA's programmatic requirements for the Extended-Duration Orbiter, Space Station Freedom, and exploration mission science activities. These science activities include ground-based and flight; basic, applied, and operational; and animal and human research and development. This document summarizes the current status of the program, outlines available knowledge, establishes goals and objectives, identifies science priorities, and defines critical questions in the subdiscipline areas of both cardiovascular and pulmonary function. It contains a general plan that will be used by both NASA Headquarters Program Offices and the field centers to review and plan basic, applied, and operational (intramural and extramural) research and development activities in this area.
Mukul Chandra Kapoor
Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.
Prisk, G. K.; Guy, H. J.; Elliott, A. R.; West, J. B.
The lung is profoundly affected by gravity. The absence of gravity (microgravity) removes the mechanical stresses acting on the lung paranchyma itself, resulting in a reduction in the deformation of the lung due to its own weight, and consequently altering the distribution of fresh gas ventilation within the lung. There are also changes in the mechanical forces acting on the rib cage and abdomen, which alters the manner in which the lung expands. The other way in which microgravity affects the lung is through the removal of the gravitationally induced hydrostatic gradients in vascular pressures, both within the lung itself, and within the entire body. The abolition of a pressure gradient within the pulmonary circulation would be expected to result in a greater degree of uniformity of blood flow within the lung, while the removal of the hydrostatic gradient within the body should result in an increase in venous return and intra-thoracic blood volume, with attendant changes in cardiac output, stroke volume, and pulmonary diffusing capacity. During the 9 day flight of Spacelab Life Sciences-1 (SLS-1) we collected pulmonary function test data on the crew of the mission. We compared the results obtained in microgravity with those obtained on the ground in both the standing and supine positions, preflight and in the week immediately following the mission. A number of the tests in the package were aimed at studying the anticipated changes in cardiopulmonary function, and we report those in this communication.
Shrestha, Munik Kumar
Epidemic processes are common out-of-equilibrium phenomena of broad interdisciplinary interest. In this thesis, we show how message-passing approach can be a helpful tool for simulating epidemic models in disordered medium like networks, and in particular for estimating the probability that a given node will become infectious at a particular time. The sort of dynamics we consider are stochastic, where randomness can arise from the stochastic events or from the randomness of network structures. As in belief propagation, variables or messages in message-passing approach are defined on the directed edges of a network. However, unlike belief propagation, where the posterior distributions are updated according to Bayes' rule, in message-passing approach we write differential equations for the messages over time. It takes correlations between neighboring nodes into account while preventing causal signals from backtracking to their immediate source, and thus avoids "echo chamber effects" where a pair of adjacent nodes each amplify the probability that the other is infectious. In our first results, we develop a message-passing approach to threshold models of behavior popular in sociology. These are models, first proposed by Granovetter, where individuals have to hear about a trend or behavior from some number of neighbors before adopting it themselves. In thermodynamic limit of large random networks, we provide an exact analytic scheme while calculating the time dependence of the probabilities and thus learning about the whole dynamics of bootstrap percolation, which is a simple model known in statistical physics for exhibiting discontinuous phase transition. As an application, we apply a similar model to financial networks, studying when bankruptcies spread due to the sudden devaluation of shared assets in overlapping portfolios. We predict that although diversification may be good for individual institutions, it can create dangerous systemic effects, and as a result
Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi
Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.
Alsatli, Raed A.
This review article is going to elaborate on the description, components, and advantages of mini-cardiopulmonary bypass (mini-CPB), with special reference to the anesthetic management and fast track anesthesia with mini-CPB. There are several clinical advantages of mini-CPB like, reduced inflammatory reaction to the pump, reduced need for allogenic blood transfusion and lower incidence of postoperative neurological complications. There are certainly important points that have to be considered...
Mishkin, Barbara H.; And Others
Describes a simulated interdisciplinary role rehearsal for cardiopulmonary arrest to prepare nurses to function effectively. Includes needs analysis, program components, and responses of program participants. (Author)
Wright, Kenneth H.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Wong, Frankie; Wu, Gordon
By-Pass diodes are a key design feature of solar arrays and system design must be robust against local heating, especially with implementation of larger solar cells. By-Pass diode testing was performed to aid thermal model development for use in future array designs that utilize larger cell sizes that result in higher string currents. Testing was performed on a 56-cell Advanced Triple Junction solar array coupon provided by SSL. Test conditions were vacuum with cold array backside using discrete by-pass diode current steps of 0.25 A ranging from 0 A to 2.0 A.
Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass
Lund University Cardiopulmonary Assist System (LUCAS) is a mechanical device providing automatic 5 cm deep chest compressions and active decompressions back to normal anatomical position with a frequency of 100 per minute, and a duty cycle of 50%, i.e., LUCAS is constructed to give chest compressions according to the latest international guidelines in cardiopulmonary resuscitation (CPR). The aim of the thesis was to study cardiac arrest using different porcine models of ventricular fi...
Alexandre C. Zago; Cristine E. Nunes; Viviane R. da Cunha; Euler Manenti; Luís Carlos Bodanese
Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of...
Ma, Chi; Zhu, Zhe; Wang, Xu; Zhao, Gang; Liu, Xiaoliang; Li, Rui
The American Heart Association and the European Resuscitation Council recently recommended that vasopressin can be used for cardiopulmonary resuscitation, instead of epinephrine. However, the guidelines do not discuss the effects of vasopressin during cerebral resuscitation. In this study, we intraperitoneally injected epinephrine and/or vasopressin during cardiopulmonary resuscitation in a rat model of asphyxial cardiac arrest. The results demonstrated that, compared with epinephrine alone, ...
扁虱是莱姆关节炎的罪魁祸首。研究人员为了弄明白何处扁虱最猖獗, 不惜以身作饵,他们发现:The ticks were all over the log surface。因此告诫人 们:Avoid sitting on logs。
Khalid S. Al-Rababa
Full Text Available Switching-off the parallel working pump units causes sudden discharge changes in parallel pipe lines, as a result of that hydraulic shocks takes place. The damping of these shocks can be achieved by the installation of the by-pass devices between the parallel lines of the piping system. The analytical calculations demonstrate that the reduction in hydraulic shocks reaches 40% and considerable part of the electric power (from 5 up to 21% is economized by using the by-pass devices, the duration of pressure decline decreases by more than 1,5 times. Comparison of the calculations based on the developed algorithm with the results of practical studies at the pumping station (Syrdarya has shown good convergence of analytical and experimental outcomes.
Jonáš, Pavel; Mazur, Oton; Uruba, Václav
Praha : Ústav termomechaniky AV ČR, 2006 - (Jonáš, P.; Uruba, V.), s. 67-70 ISBN 80-87012-01-1. [Colloquium Fluid Dynamics 2006. Praha (CZ), 25.10.2006-27.10.2006] R&D Projects: GA AV ČR(CZ) IAA200760614 Institutional research plan: CEZ:AV0Z20760514 Keywords : by-pass transition * wall-friction intermittency * conditioned averaging Subject RIV: BK - Fluid Dynamics
Full Text Available Abstract Background Neurologic deficits after cardiac surgery are common complications. Aim of this prospective observational pilot study was to investigate the incidence of postoperative cognitive deficit (POCD after cardiac surgery, provided that relevant decrease of cerebral oxygen saturation (cSO2 is avoided during cardiopulmonary bypass. Methods cSO2 was measured by near infrared spectroscopy in 35 patients during cardiopulmonary bypass. cSO2 was kept above 80% of baseline and above 55% during anesthesia including cardiopulmonary bypass. POCD was tested by trail making test, digit symbol substitution test, Ray's auditorial verbal learning test, digit span test and verbal fluency test the day before and 5 days after surgery. POCD was defined as a decline in test performance that exceeded - 20% from baseline in two tests or more. Correlation of POCD with lowest cSO2 and cSO2 - threshold were determined explorative. Results POCD was observed in 43% of patients. Lowest cSO2 during cardiopulmonary bypass was significantly correlated with POCD (p = 0.015, r2 = 0.44, without Bonferroni correction. A threshold of 65% for cSO2 was able to predict POCD with a sensitivity of 86.7% and a specificity of 65.0% (p = 0.03, without Bonferroni correction. Conclusions Despite a relevant decrease of cerebral oxygen saturation was avoided in our pilot study during cardiopulmonary bypass, incidence of POCD was comparable to that reported in patients without monitoring. A higher threshold for cSO2 may be needed to reduce the incidence of POCD.
Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci
Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.
Morris, Richard W; Pybus, David A
In this paper we describe a high-fidelity perfusion simulation system intended for use in the training and continuing education of perfusionists. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator can be positioned on an operating table and physically connected to the circuit of the institutional heart-lung machine. The institutional monitoring system is used to display the arterial and central venous pressures, the ECG and the nasopharyngeal temperature using appropriate connections. The simulator is able to reproduce the full spectrum of normal and abnormal events that may present during the course of cardiopulmonary bypass. The system incorporates a sophisticated blood gas model that accurately predicts the behavior of a modern, hollow-fiber oxygenator. Output from this model is displayed in the manner of an in-line blood gas electrode and is updated every 500 msecs. The perfusionist is able to administer a wide variety of drugs during a simulation session including: vasoconstrictors (metaraminol, epinephrine and phenylephrine), a vasodilator (sodium nitroprusside), chronotropes (epinephrine and atropine), an inotrope (epinephrine) and modifiers of coagulation (heparin and protamine). Each drug has a pharmacokinetic profile based on a three-compartment model plus an effect compartment. The simulation system has potential roles in the skill training of perfusionists, the development of crisis management protocols, the certification and accreditation of perfusionists and the evaluation of new perfusion equipment and/or techniques. PMID:18293807
The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass temperature controller. 870... Cardiopulmonary bypass temperature controller. (a) Identification. A cardiopulmonary bypass temperature controller is a device used to control the temperature of the fluid entering and leaving a heat exchanger....
Chandler, Marjorie L
Although there are known detrimental effects of obesity on the heart and lungs, few data exist showing obesity as risk factor for cardiopulmonary disorders in dogs and cats. It is probable that increased abdominal fat is detrimental as it is in humans, and there is evidence of negative effects of increased intrathoracic fat. As well as physical effects of fat, increased inflammatory mediators and neurohormonal effects of obesity likely contribute to cardiopulmonary disorders. Weight loss in overweight individuals improves cardiac parameters and exercise tolerance. Obesity in patients with obstructive airway disorders is recognized to increase disease severity. PMID:27264052
Hoad, N A; Crawford, I C
Long waiting lists for coronary artery by-pass grafting often mean that patients have to endure a prolonged period of pre-operative disability, a known poor prognostic factor for their future quality of life and employment prospects. A survey of 60 patients who attended a post-operative rehabilitation course designed to restore their fitness and self-esteem, and hence their quality of life, has shown encouraging results. When questioned a mean 16 months later, 85 per cent are working and sign...
Sigurdsson, Haftor Örn; Kær, Søren Knudsen
Numerical and experimental study is performed to evaluate the reactant by-pass flow in a catalytic plate reactor with a coated wire mesh catalyst for steam reforming of methane for hydrogen generation. By-pass of unconverted methane is evaluated under different wire mesh catalyst width to reactor...
Vedel, Anne G; Holmgaard, Frederik; Rasmussen, Lars Simon;
coronary vessel and/or valve disease and who are undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients are stratified by age and surgical procedure and are randomised 1:1 to either an increased mean arterial pressure (70-80 mmHg) or 'usual practice' (40-50 mmHg) during cardiopulmonary...... caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided by the...... cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. METHODS/DESIGN: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients with...
F. Mohsenzadeh, J. Nouri, A. Ranjbar, M. Mohammadian Fazli, A. A. Babaie
Full Text Available Air pollution is a major problem in the industrial areas. Cement dust is one of the important environmental pollutants. In this study the possibility of dust recycling especially kiln dust which has significant importance regarding air pollution in the cement plant, was examined. Tehran cement factory is one of the most important Iranian factories which is located in Tehran. This factory produces high volume of pollutants that are released to in environment. The possibility of reusing of kiln by pass returned dust has been examined in this factory. Different percentages of kiln by-pass dust of this factory were added to products and outcomes of its presence in parameters such as chemical compound, granulation, primary and final catch time, volume expansion, consumed water and resistance of mortar were surveyed. The result indicated that by adding the amounts of 3-8 dust the mortar resistance increase, but adding more than 15%, the mortar resistance has been decreased. Survey in consumed water proved that adding dust to cement, the trend for consuming water is decreased. After dust addition dust, primary and final catch time were compared in different samples and data which showed decrease in dust added samples. Cements with dust added showed increase in auto clave expansion. Overally, results proved that, the best percentage rate of dust addition to the cement was 15%.
Mahmood, Sarah; Bilal, Haris; Zaman, Mahvash; Tang, Augustine
A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is a fully heparin bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit?’ Altogether more than 792 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of...
A three year project designed to determine the value of a health program incorporating a cardiopulmonary fitness program is described. The instructional programs were in heart health, pulmonary health, nutrition, and physical fitness. A noncompetitive exercise and fitness period was employed in addition to the normal physical education time.…
Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.
Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high al
Zago Alexandre C.
Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.
Sorensen, H.R.; Husum, B.; Waaben, J.; Andersen, K.; Andersen, L.I.; Gefke, K.; Kaarsen, A.L.; Gjedde, A.
Emboli in the brain microvasculature may inhibit brain activity during cardiopulmonary bypass. Such hypothetical blockade, if confirmed, may be responsible for the reduction of cerebral metabolic rate for glucose observed in animals subjected to cardiopulmonary bypass. In previous studies of cerebral blood flow during bypass, brain microcirculation was not evaluated. In the present study in animals (pigs), reduction of the number of perfused capillaries was estimated by measurements of the capillary diffusion capacity for hydrophilic tracers of low permeability. Capillary diffusion capacity, cerebral blood flow, and cerebral metabolic rate for glucose were measured simultaneously by the integral method, different tracers being used with different circulation times. In eight animals subjected to normothermic cardiopulmonary bypass, and seven subjected to hypothermic bypass, cerebral blood flow, cerebral metabolic rate for glucose, and capillary diffusion capacity decreased significantly: cerebral blood flow from 63 to 43 ml/100 gm/min in normothermia and to 34 ml/100 gm/min in hypothermia and cerebral metabolic rate for glucose from 43.0 to 23.0 mumol/100 gm/min in normothermia and to 14.1 mumol/100 gm/min in hypothermia. The capillary diffusion capacity declined markedly from 0.15 to 0.03 ml/100 gm/min in normothermia but only to 0.08 ml/100 gm/min in hypothermia. We conclude that the decrease of cerebral metabolic rate for glucose during normothermic cardiopulmonary bypass is caused by interruption of blood flow through a part of the capillary bed, possibly by microemboli, and that cerebral blood flow is an inadequate indicator of capillary blood flow. Further studies must clarify why normal microvascular function appears to be preserved during hypothermic cardiopulmonary bypass.
Brockherde, Felix; Burke, Kieron; Müller, Klaus-Robert
Last year, at least 30,000 scientific papers used the Kohn-Sham scheme of density functional theory to solve electronic structure problems in a wide variety of scientific fields, ranging from materials science to biochemistry to astrophysics. Machine learning holds the promise of learning the kinetic energy functional via examples, by-passing the need to solve these equations. This should yield substantial savings in computer time, allowing either larger systems or longer time-scales to be tackled. Attempts to machine-learn this functional have been limited by the need to find its derivative. The present work overcomes this difficulty, by learning the density-potential map directly. Both the improved accuracy and lower computational cost is demonstrated on DFT calculations of small molecules.
In the event of an accident arising in an EDF (Electricite de France) pressurized water reactor, the IPSN Emergency Technical Centre (CTC) would be entrusted to provide the safety authorities with technical assistance. As pad of this responsibility it would analyse and forecast the barriers status (fuel clad, reactor coolant system, containment building), and the related safety functions (subcriticality, water inventory, primary pressure and temperature control, confinement). Its assignments would also require it to evaluate the kinetics and magnitude of a possible fission products release, in progress or to come, so as to advise necessary counter measures in order to ensure the surrounding population's protection, should the occasion arise. A realistic assessment of the release requires a good knowledge of the containment quality. It is therefore important to detect potential isolation faults (isolation failure or by-pass of the third barrier) as soon as possible. Once these leaks are identified, the plant operator will set required corrective arrangements rapidly. The CTC would follow up his actions closely. If none of them happen to be effective, containment leakage would be taken into account when estimating releases. Work of the emergency team lies indeed in two main points: early localization of isolation failure or containment by-pass; following up of the plant operator actions meant to remedy the problem. In order to meet these two requirements IPSN has developed an expert system named ALIBABA. Part one presents its advantages, whereas part two describes the expert system. Part three deals with the software environment and part four offers an example of the help provided by ALIBABA
Harris, P L; Woollard, K; Bartoli, A; Makey, A R
Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed. PMID:6968314
Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references
HAN Pei-li; FU Qing-lin; ZHANG Xin-zhong; ZHANG-Jie; QIN Yuan-xu; CUI Yu
Objective To explore the detrimental influence of normothermic and hypothermic cardiopulmonary by-pass during open - heart surgery on immunity function,cytokines and complements. Methods Forty patients with con-genital or rheumatic heart disease were randomized to receive the two strategies: normothermie CPB (study group) andhypothermic CPB (control group) ,20 cases in each group. Venous blood samples were collected at each time points ofpreoperation, end of CPB, day 1,4,7,14 postoperatively to examine the plasma level of IL - 2, TNF - α, C3, C4, IgG,IgM, IgA, CD3, CD4, CD8. Results IL -2 in both groups decreased significantly at day 1,4, and returned to normal atday 7 postoperatively. IL - 2 in control group was significantly lower than that in study group postoperatively. TNF - α intwo groups was all higher at time points of end of CPB,day 1,4 postoperatively;in study group,it returned to normallevel at day 7 postoperatively, whereas in control group, it was still higher at day 7 postoperatively than that before oper-ation ,and returned to normal at day 14 postoperatively. C3 in study group was significantly lower at time points of endof CPB,day 1,7 postoperatively than that in control group;C3 in both groups was all higher at time points of end ofCPB, day 1,4 postoperatively;in study group, it returned to normal level at day 7 postoperatively, whereas in controlgroup,it was still higher at day 7 postoperatively than that before operation and returned to normal at day 14 postopera-tively. CA in study group at time points of end of CPB, day 1 postoperatively was significantly lower than that in controlgroup;C4 in both groups was all lower at time points of end of CPB, day 1,4 postoperatively than that before operation.The results showed that IgA after operation in both groups was significantly lower than that before operation, and re-turned to normal at day 7 postoperatively;IgA in study group at day 1 postoperatively was higher than that in controlgroup. IgG in
Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.
M Adib Hajbaghery; H. Akbari; GA. Mousavi
Background: During recent years, cardiopulmonary resuscitation (CPR) in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and unt...
Mulligan, Ryan P.; Hanson, Jeffrey L.
Wave and current measurements from a cross-shore array of nearshore sensors in Duck, NC, are used to elucidate the balance of alongshore momentum under energetic wave conditions with wide surf zones, generated by passing hurricanes that are close to and far from to the coast. The observations indicate that a distant storm (Hurricane Bill, 2009) with large waves has low variability in directional wave characteristics resulting in alongshore currents that are driven mainly by the changes in wave energy. A storm close to the coast (Hurricane Earl, 2010), with strong local wind stress and combined sea and swell components in wave energy spectra, has high variability in wave direction and wave period that influence wave breaking and nearshore circulation as the storm passes. During both large wave events, the horizontal current shear is strong and radiation stress gradients, bottom stress, wind stress, horizontal mixing, and cross-shore advection contribute to alongshore momentum at different spatial locations across the nearshore region. Horizontal mixing during Hurricane Earl, estimated from rotational velocities, was particularly strong suggesting that intense eddies were generated by the high horizontal shear from opposing wind-driven and wave-driven currents. The results provide insight into the cross-shore distribution of the alongshore current and the connection between flows inside and outside the surf zone during major storms, indicating that the current shear and mixing at the interface between the surf zone and shallow inner shelf is strongly dependent on the distance from the storm center to the coast.
Ling Xianzhang; Zhang Feng; Zhu Zhanyuan; Ding Lin; Hu Qinli
The vibration characteristics and attenuation of the subgrade caused by passing trains in a seasonally frozen region of Daqing, China are investigated. Three field experiments were conducted during different times through the year, in normal, freezing and thawing periods, respectively, and the influence of the season, train speed and train type, is described in this paper. The results show that: (l) the vertical component is the greatest among the three components of the measured vibration near the rail track, and as the distance to the railway track increases, the dominant vibration depends on the season. (2) Compared with the vibration in the normal period, the vertical and longitudinal vibrations increase while the lateral vibration decreases in the freezing period. However, in the thawing period, the vertical and longitudinal vibrations decrease, and the lateral vibration increases. (3) As train speeds increase, the subgrade vibration increases. (4) The vibration induced by a freight train is greater than by a passenger train. These observations provide a better understanding of the vibration and dynamic stability of the subgrade and may be useful in developing criteria for railway and building construction in cold regions.
In this paper one considered improving the EWS (emergency water supply system) by-pass line in order to replace current manual operated valve with an self operated valve. This change is necessary in order to reduce the human error events in operation of the system in case of a DBE (design basis earthquake). The paper describes a theoretical and practical operation of a system using self regulating flow rate valves. Basically, the elimination of a possible human error in operating a system is important for nuclear safety in case of a DBE because it makes it avoidable in normal reactor cooling systems. The paper describes checking of the functioning of this equipment in operating conditions, investigating how it responds to various operating regimes. (authors)
Tadayyon, Maedeh; Zarrinabadi, Nourollah; Ketabi, Saeed
Dealing with learners who prefer to take the back seat and avoid classroom participation can be every teacher's nightmare. This lack of participation may cause teacher frustration, and possibly the only way to reduce this lack of participation is to access the concept of avoidance strategy. Avoidance strategy is the abandonment of a classroom task…
Full Text Available Abstract Background The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations. Methods The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG. Sixty-four patients were given 3 g of magnesium sulphate (MgSO4 [20 ml = 24.32 mEq/L Mg+2] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1. Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg on first post-operative day (Group 2. After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group had 100 cc. isotonic 0.9% as placebo, during the same time periods. Results In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015. There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026. Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed. Conclusion Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this
Pawlik, Michael T.; Seyfried, Timo F.; Riegger, Christian; Klingler, Werner; Selig, Christoph
Research on cardiac resuscitation has led to various changes in the techniques and drug administration involved in modern advanced life support. Besides improving primary cardiac survival, interest is increasingly focused on a favourable neurological outcome. However, until now there has been no on-site equipment to support the clinical observations of the cardiopulmonary resuscitation (CPR) team. Bispectral index (BIS) monitoring has been used for avoiding awareness during anaesthesia for ma...
The use of a multiple gas rebreathing method for the measurement of cardiopulmonary function in mechanically ventilated neonates was evaluated. The following indices of cardiopulmonary function were assessed in 20 piglets (mean weight, 2.3 kg): (1) pulmonary capillary blood flow ...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass cardiotomy return sucker. 870.4420 Section 870.4420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Surgical Devices § 870.4420 Cardiopulmonary bypass cardiotomy...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass pump tubing. 870.4390... bypass pump tubing. (a) Identification. A cardiopulmonary bypass pump tubing is polymeric tubing which is used in the blood pump head and which is cyclically compressed by the pump to cause the blood to...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary prebypass filter. 870.4280 Section... prebypass filter. (a) Identification. A cardiopulmonary prebypass filter is a device used during priming of... bypass. The device is not used to filter blood. (b) Classification. Class II (performance standards)....
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...
Faravan, Amir; Mohammadi, Nooredin; Alizadeh Ghavidel, Alireza; Toutounchi, Mohammad Zia; Ghanbari, Ameneh; Mazloomi, Mehran
Introduction: Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology. Methods: In this descriptive study, data was collected from 48 Iranian public hospitals and educational health centers through a researcher-created questionnaire. The data collection questionnaire assessed the standards which are recommended by American Society of Extracorporeal Technology. Results: Findings showed that appropriate measurements were carried out by the perfusion technology staffs to prevent the hemodilution and avoid the blood transfusion and unnecessary blood products, determine the initial dose of heparin based on one of the proposed methods, monitor the anticoagulants based on ACT measurement, and determine the additional doses of heparin during the cardiopulmonary bypass based on ACT or protamine titration. It was done only in 4.2% of hospitals and health centers. Conclusion: Current practices of cardiopulmonary perfusion technology in Iran are inappropriate based on the standards of American Society of Cardiovascular Perfusion. This represents the necessity of authorities’ attention to the validation programs and development of the caring standards on one hand and continuous assessment of using these standards on the other hand. PMID:27489600
Jonáš, Pavel; Hladík, Ondřej; Mazur, Oton; Uruba, Václav
Warsaw, Poland: University of Warsaw, 2011 - (Bajer, K.; Kopeč, J.; Podziemski, P.), s. 82-82 ISSN N. [European turbulence conference /13./. Warsaw (PL), 12.09.2011-15.09.2011] R&D Projects: GA ČR GA101/08/1112; GA ČR GAP101/10/1230 Institutional research plan: CEZ:AV0Z20760514 Keywords : boundary layer by-pass transition * effect of free stream turbulence * effect of surface roughness * joint effect on by-pass transition Subject RIV: BK - Fluid Dynamics www.etc13.fuw.edu.pl
Whitcomb, John J; Blackman, Virginia Schmied
In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR. PMID:17179837
Christiansen, Claus Behrend; Berg, Ronan M G; Plovsing, Ronni;
Background Cerebral hemodynamic disturbances in the peri- or postoperative period may contribute to postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). We therefore examined dynamic cerebral autoregulation (d......CA) post-CPB and changes in neurocognitive function in patients that had undergone CABG. Materials and Methods We assessed dCA by transfer function analysis of spontaneous oscillations between arterial blood pressure and middle cerebral artery blood flow velocity measured by transcranial Doppler ultrasound...
Cavanagh, S J
The knowledge and skills surrounding the practice of cardiopulmonary resuscitation (CPR) have become essential to intensive care nurses and to nurses in general. With formalized training and refresher courses becoming more common in this country, it is evident that after relatively short periods of time the knowledge and skills acquired at such courses may be lost. While much consideration has been given to the content of both Basic and Advanced Cardiac Life Support (BCLS and ACLS) courses, relatively little attention has been paid to the educational issues surrounding CPR training. This paper explores some of these issues from the perspective of adult learning (andragogy). Research is cited from a wide range of sources to illustrate that CPR skill and knowledge deterioration is not unique to nursing, and that educational techniques exist which may improve current educational practices. PMID:2329270
Spiro, Jon; Theodosiou, Maria; Doshi, Sagar
Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices. PMID:24494769
SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping
Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.
Three dimensional computational fluid dynamic (CFD) calculations for a 1/12 sector of a prismatic block through the core of a prismatic very high temperature gas-cooled reactor (VHTR) were conducted to investigate the influence of gap geometry on flow and temperature distributions in the reactor core using commercial CFD code FLUENT. Parametric calculations changing the gap width in a whole core length model of fuel and reflector columns were performed. The simulations show the effects of core by-pass flows in the heated core region by comparing results for several gap widths including zero gap width. The calculation results underline the importance of considering inter-column gap width for the evaluation of maximum fuel temperatures and temperature gradients in fuel blocks. It is shown that temperatures of core outlet flow from gaps and channels are strongly affected by the gap width of by-pass flow in the reactor core. (author)
Three dimensional computational fluid dynamic (CFD) calculations of a typical prismatic very high temperature gas-cooled reactor (VHTR) were conducted to investigate the influence of gap geometry on flow and temperature distributions in the reactor core using commercial CFD code FLUENT. Parametric calculations changing the gap width in a whole core length model of fuel and reflector columns were performed. The simulations show the effects of core by-pass flows in the heated core region by comparing results for several gap widths including zero gap width. The calculation results underline the importance of considering inter-column gap width for the evaluation of maximum fuel temperatures and temperature gradients in fuel blocks. In addition, it is shown that temperatures of core outlet flow from gaps and channels are strongly affected by the gap width of by-pass flow in the reactor core.
Jonáš, Pavel; Mazur, Oton; Uruba, Václav
Praha: Ústav termomechaniky AV ČR, 2001 - (Poživilová, A.; Masák, J.), s. 317-318 ISBN 80-85918-64-1. [National Conference with International Participation Engineering Mechanics 2001. Svratka (CZ), 14.05.2001-17.05.2001] R&D Projects: GA ČR GA101/00/1057 Keywords : by-pass transition Subject RIV: BK - Fluid Dynamics
Hladík, Ondřej; Jonáš, Pavel; Mazur, Oton; Uruba, Václav
Budapest : Budapest University of Technology and Economics, 2012 - (Vad, J.), s. 963-970 ISBN 978-963-08-4587-8. [International Conference on Fluid Flow Technologies /15./. Budapest (HU), 04.09.2012-07.09.2012] R&D Projects: GA ČR GAP101/12/1271 Institutional support: RVO:61388998 Keywords : by-pass transition * conditional analysis of the wall friction * CTA * rough wall boundary layer * transitional intermittency factor Subject RIV: BK - Fluid Dynamics
... bypass oxygenator. (a) Identification. A cardiopulmonary bypass oxygenator is a device used to exchange gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...
The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs
Cyanotic congenital heart disease comprises a diverse spectrum of anatomical pathologies. Common to all, however, is chronic hypoxia before these lesions are operated upon when cardiopulmonary bypass is initiated. A range of functional and structural adaptations take place in the chronically hypoxic heart, which, whilst protective in the hypoxic state, are deleterious when the availability of oxygen to the myocardium is suddenly improved. Conventional cardiopulmonary bypass delivers hyperoxic...
Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Ozcelik, Gokhan; Yorgancioglu, Cem
Electrical failure during cardiopulmonary bypass is a crisis situation for the cardiac surgical team. Fortunately, it has a low incidence with low morbidity and mortality rates. Notwithstanding, institutional preventative and management measures should be taken. Here, we report a case of electrical failure during cardiopulmonary bypass, which was successfully managed during the surgery, allowing the patient to recover uneventfully. These unwanted complications can only be managed by promoting awareness and putting in place strategies against them. PMID:27516788
Kudo, Takako; Kaga, Akimune; Akagi, Kozo; Iwahashi, Hideki; Makino, Hiromitsu; WATANABE, YOKO; Kawamura, Takae; Sato, Taiju; Shinozaki, Tsuyoshi; Miwa, Shinya; Okazaki, Nobuo; Kure, Shigeo; Nakae, Shingi
Background Cardiopulmonary arrest in pregnancy has a very high maternal and fetal mortality rate. We report a case of successful maternal and neonatal survival in association with emergency cesarean section of a schizophrenic pregnant patient. To our knowledge, this is the first reported case of cardiopulmonary arrest in a pregnant woman with schizophrenia. Case presentation The parents were Japanese. The mother was 39 years old and had no history of prior pregnancy. Her admission to our hosp...
Siminelakis Stavros N
Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.
To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95% CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95% CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95% CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95% CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95% CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95% CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95% CI = 0.85-0.96, p-value = 0.001), and total atropine dose given during CPR (odds ratio = 0.68, 95% CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio 8.69, 95% CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95% CI = 0.87-0.98, p-value = 0.01) were associated with survival at
Malhotra, Rajeev; Bakken, Kristian; D'Elia, Emilia; Lewis, Gregory D
Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET) precisely defines maximum exercise capacity through measurement of peak oxygen uptake (VO2). Peak VO2 values have a critical role in informing patient selection for advanced HF interventions such as heart transplantation and ventricular assist devices. Oxygen uptake and ventilatory patterns obtained during the submaximal portion of CPET are also valuable to recognize because of their ease of ascertainment during low-level exercise, relevance to ability to perform activities of daily living, independence from volitional effort, and strong relationship to prognosis in HF. The ability of peak VO2 and other CPET variables to be measured reproducibly and to accurately reflect HF severity is increasingly recognized and endorsed by scientific statements. Integration of CPET with invasive hemodynamic monitoring and cardiac imaging during exercise provides comprehensive characterization of multisystem reserve capacity that can inform prognosis and the need for cardiac interventions. Here, we review both practical aspects of conducting CPETs in patients with HF for clinical and research purposes as well as interpretation of gas exchange patterns across the spectrum of preclinical HF to advanced HF. PMID:27289406
Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.
Douglas, M E; Downs, J B
IMV is a combination of spontaneous and mechanical ventilation. For numerous reasons, IMV is potentially more advantageous than conventional techniques. By maintaining spontaneous breathing, mechanical augmentation can be titrated to adjust alveolar minute ventilation levels to normal, thereby decreasing the incidence of respiratory alkalemia. There are major differences between the cardiopulmonary effects of IMV and conventional mechanical ventilation. Spontaneous inspiration decreases Ppl and results in better distribution of inspired gas, a better V/Q, and less physiological dead space. In addition, transmural filling pressures, venous return, and cardiac output are more normal than during conventional mechanical ventilation. Maintenance of spontaneous ventilation lowers mean Paw and pulmonary vascular resistance. If venous admixture occurs, it can be minimized by titrating PEEP. Thus, more effective therapy for hypoxemia is possible. If spontaneous breathing is to persist and be efective, work-of-breathing must be minimized. This can be accomplished best when a continuous flow of gas provides optimal CPAP to maintain FRC and to minimize the effects of decreased compliance without depressing cardiac function. PMID:7007253
... Names Personality disorder - avoidant References American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. ...
Gaizauskiene, A.; Gurevicius, R
STUDY OBJECTIVE--The study aimed to analyse avoidable mortality in Lithuania as an index of the quality of health care and to assess trends in avoidable mortality from 1970-90. SETTING AND PARTICIPANTS--All deaths of Lithuanian residents aged between 0 and 64 years between 1970 and 1990 were analysed. MEASUREMENTS AND MAIN RESULTS--Twenty seven per cent of all deaths in this age group were avoidable. Avoidable deaths were grouped into preventable and treatable ones. Treatable causes of death ...
The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management during Cardiopulmonary Bypass
Engelman, Richard; Baker, Robert A.; Likosky, Donald S.; Grigore, Alina; Dickinson, Timothy A.; Shore-Lesserson, Linda; Hammon, John W.
Abstract: To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation. PMID:26543248
Tygon tubing is a co-polymer polyvinyl chloride. This tubing is used throughout the circuit of our heart-lung by-pass machines and had been sterilized by autoclaving or exposure to ethylene oxide gas. Tubing sterilized by autoclaving was noted to have a decrease in tensile strength and the transparency of the tubing was affected. Sterilization by ethylene oxide had the disadvantage that gas was often present in the lumen of the tube when connected to the machine. Lengths of Tygon tubing were sterilized by gamma radiation at varying radiation levels and temperatures. Bacteriological studies were done on the tubing and estimation of tensile strength carried out. We have found that a level of radiation of 2. 5 to 3. 0 Mrad at 20°C produces little or no change in tensile strength and the tubing remains bacteriologically sterile. Tygon tubing sterilized in this way has now been used in over sixty heart-lung by-pass machine operations. (author)
Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho
OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat
Nagaoka, Shunji; Eno, Yuko; Ohira, Yoshinobu
Cardio-pulmonary reflex, which our cardiac activity is synchronized to the respiration by autonomic nervous system regulation, is called as "respiratory sinus arrhythmia" and commonly found in adult. The physiological function of the espiratory sinus arrhythmia is considered to maximize the gas exchange during respiration cycle. This respiration induced heart rate variability (RHRV) is only found in mammals and avian showing a remarkable postnatal development, whereas no RHRV in aquatic species such as fish or amphibian. To elucidate our hypothesis that gravity exposure may plays a key role in the postnatal development of RHRV as well as its evolutional origin in these ground animals, we have studied effects of hypergravity (2G) on the postnatal development of RHRV using rat. Pregnant Wister rats were kept in centrifugal cages system for 38 days from 6th days of pregnant mother to have neonates until 23 days old. Electrocardiograph was recorded from the neonates in 2 to 23 days old in 2G group with simultaneous control (1G) group. The RHRV analysis was performed by calculating a component of Fourier power spectral coincide with the respiration frequency. In both groups, averaged resting heart rate gradually increase from 2 to 23 days old. When comparing the heart rate between the two groups, the 2G group indicated significantly lower (240± 8 bpm) than 1G control (326±21 bpm, p¡0.001) in 2 days old, where as no significance in 23 days old. The RHRV of 2 days old neonates in both groups indicated very small magnitude but significantly lower in 2G group than 1G control (p¡0.01). The RHRV gradually increase during the first 2 weeks and then rapid increased to reached 45 fold of magnitude in 1G control, whereas 69 fold in 2G group. The results strongly suggested that the postnatal innervation from respiration to cardiovascular centers was gravity dependent.
Kim, Dong Hee; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won
Background The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). Methods Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. Results Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). Conclusion These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients. PMID:27525236
Full Text Available Abstract Background Acute posthypoxic myoclonus (PHM can occur in patients admitted after cardiopulmonary resuscitation (CPR and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of the study was to investigate whether acute PHM originates from cortical or subcortical structures, using somatosensory evoked potential (SEP and electroencephalogram (EEG. Methods Patients with acute PHM (focal myoclonus or status myoclonus within 72 hours after CPR were retrospectively selected from a multicenter cohort study. All patients were treated with hypothermia. Criteria for cortical origin of the myoclonus were: giant SEP potentials; or epileptic activity, status epilepticus, or generalized periodic discharges on the EEG (no back-averaging was used. Good outcome was defined as good recovery or moderate disability after 6 months. Results Acute PHM was reported in 79/391 patients (20%. SEPs were available in 51/79 patients and in 27 of them (53% N20 potentials were present. Giant potentials were seen in 3 patients. EEGs were available in 36/79 patients with 23/36 (64% patients fulfilling criteria for a cortical origin. Nine patients (12% had a good outcome. A broad variety of drugs was used for treatment. Conclusions The results of this study show that acute PHM originates from subcortical, as well as cortical structures. Outcome of patients admitted after CPR who develop acute PHM in this cohort was better than previously reported in literature. The broad variety of drugs used for treatment shows the existing uncertainty about optimal treatment.
Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.
Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro
Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Roller-type cardiopulmonary bypass blood pump. 870... Roller-type cardiopulmonary bypass blood pump. (a) Identification. A roller-type cardiopulmonary bypass blood pump is a device that uses a revolving roller mechanism to pump the blood through...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonroller-type cardiopulmonary bypass blood pump... Nonroller-type cardiopulmonary bypass blood pump. (a) Identification. A nonroller-type cardiopulmonary bypass blood pump is a device that uses a method other than revolving rollers to pump the blood...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass arterial line blood filter... Cardiopulmonary bypass arterial line blood filter. (a) Identification. A cardiopulmonary bypass arterial line blood filter is a device used as part of a gas exchange (oxygenator) system to filter...
Della Corte, A; Hagedorn, Dietrich; Turtu, S; Basile, G L; Catitti, A; Chiarelli, S; Di Ferdinando, E; Taddia, G; Talli, M; Verdini, L; Viola, R
A dedicated facility prepared by ENEA (Italian Agency for Energy and Environment) for the cryogenic testing of by-pass diodes for the protection of the CERN Large Hadron Collider main magnets will be described. This experimental activity is in the frame of a contract awarded to OCEM, an Italian firm active in the field of electronic devices and power supplies, in collaboration with ENEA, for the manufacture and testing of all the diode stacks. In particular, CERN requests the measurement of the reverse and forward voltage diode characteristics at 300 K and 77 K, and endurance test cycles at liquid helium temperature. The experimental set-up at ENEA and data acquisition system developed for the scope will be described and the test results reported. (3 refs).
Onyeaso, Adedamola Olutoyin
Background/Objective: For effective bystander cardiopulmonary resuscitation (CPR), retention of CPR skills after the training is central. The objective of this study was to find out how much of the CPR skills a group of Nigerian secondary school students would retain six weeks after their first exposure to the conventional CPR training. Materials…
Objectives: This study evaluates the influence of Cardiopulmonary Resuscitation (CPR) on the components of quality of life (QOL) of patients after discharge from the hospital. Design: Extracted from a prospective national survey on Dutch intensive care units (ICUs). Setting: Thirty-six ICUs of both
Objective: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Design: Cohort study Place and Duration of Study: The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. Patients and Methods: This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitation cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications for mortality. Period of follow-up was until hospital discharge. Results: Seventy-eight patients were enrolled; 59 (75.6%) climbed > 1 flight of stairs, 19 (24.3%) climbed 1 flight and 40% in those patients who climbed < 1 flight. The group that climbed < 1 flight tended to have complications associated with poor reserves of the cardiopulmonary systems; i.e. pulmonary edema, exacerbation of underlying lung disease. The relative risk of developing complications, if unable to climb at least 1 flight of stairs, was calculated to be 1.8 (95% CI 0.7 - 4.6). Conclusion: Stair climbing can be a useful pre-operative tool to predict the risk of postoperative cardiopulmonary complications. (author)
Whitlock, Richard P; Chan, Simon; Devereaux, P J;
We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myo...
Lindner, K. H.; Haak, T; Keller, A; Bothner, U.; Lurie, K. G.
OBJECTIVE: To assess whether plasma endothelin, adrenaline, noradrenaline, arginine vasopressin, adrenocorticotropin, and cortisol concentrations were higher during cardiopulmonary resuscitation in patients in whom resuscitation was successful than in those in whom it failed, and to measure the concentrations of these hormones in the immediate post-resuscitation phase. DESIGN: Prospective, descriptive study. SETTING: Emergency medical service at a university hospital. PATIENTS: 60 patients wi...
Akinci, Emine; Ramadan, Hayri; Yuzbasioglu, Yucel; Coskun, Figen
Objective: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm. Methods: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients’ PetCO2 values were recorded. Results: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes. Conclusion: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived. PMID:24639823
Thomason, Timothy C.
Certain psychological treatments should be avoided, and a list of such treatments would provide valuable guidance for counselors, as well as potential clients. It is well established that some therapies are potentially dangerous, and some fringe therapies are highly unlikely to help clients beyond a placebo effect. This article provides an…
Follis, Rose M; Carter, Bruce D
In this issue of Neuron, Redmond et al. (2016) identify junction adhesion molecule 2 (JAM2) as an inhibitor of somatodendritic myelination in spinal cord neurons, thereby elucidating how myelin forms on axons but avoids dendrites and cell bodies. PMID:27537479
Knowledge of poisonous plants is extremely important for home owners, gardeners, farmers, hunters, hikers, and the rest of the general public. Among the most important plants to avoid in the Delta Region are poison ivy, bull nettle, eastern black nightshade, Queen Ann’s lace, jimsonweed, and trumpe...
Grindstaff, Terry L.; Saliba, Susan A.
Writing a scientific manuscript can be a consuming, but rewarding task with a number of intrinsic and extrinsic benefits. The ability to write a scientific manuscript is typically not an emphasized component of most entry‐level professional programs. The purpose of this overview is to provide authors with suggestions to improve manuscript quality and to provide mechanisms to avoid common manuscript mistakes that are often identified by journal reviewers and editors.
Within the next two decades Indonesia aspires to generate prosperity, avoid a middle-income trap and leave no one behind as it tries to catch up with high-income economies. These are ambitious goals. Realizing them requires sustained high growth and job creation, as well as reduced inequality. Can Indonesia achieve them? This report argues that the country has the potential to rise and bec...
Kurimoto, Yoshihiko; Kano, Hitoshi; Yama, Naoya; Nara, Satoshi; Hase, Mamoru; Asai, Yasufumi
Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients. PMID:17342366
Degos disease (DD) is a rare obstructive vasculopathy characterized by distinctive skin lesions. Involvement of the soles, palms and genitalia is rare. In most cases disease has an unfavorable course and involves gastrointestinal tract, central nervous system and occasionally other organs. Pleural and pericardial involvements are usually minor manifestations with prolonged course. Death occurs in approximately 50% of the patients usually due to intestinal perforation or central nervous system bleeding. We describe a 48-year-old man of lethal systemic DD. Widespread skin lesions with involvement of palm plantar surfaces, genitalia and scalp were ignored for 3 years, whereas the disease revealed its own malignant nature. The disorder progressed to nervous, gastrointestinal and cardiopulmonary system that led to death after 5 months from onset of systemic involvement as severe restrictive cardio-pulmonary insufficiency. Autopsy showed diffuse fibrotic changes in serial membranes and internal organs. (author)
Thiessen, Steven; Vanhorebeek, Ilse; Van den Berghe, Greet
Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. The optimal blood glucose target, whether or not glycemic control should be initiated already intraoperatively, and whether or not perioperative glucose administration affects the impact of glycemic control on ischemia-reperfusion damage remain open questions. Hypoglycemia, the risk of which is increased with glycemic control, is also associated with adverse outcomes. However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population. PMID:26060029
Witting, N; Mensah, A; Køber, L;
OBJECTIVES: To assess skeletal muscle weakness and progression as well as the cardiopulmonary involvement in oculopharyngeal muscular dystrophy (OPMD). MATERIALS AND METHODS: Cross-sectional study including symptomatic patients with genetically confirmed OPMD. Patients were assessed by medical...... history, ptosis, ophthalmoplegia, facial and limb strength, and swallowing capability. Cardiopulmonary function was evaluated using forced expiratory capacity in 1 s (FEV1), electrocardiogram (ECG), Holter monitoring, and echocardiography. RESULTS: We included 13 symptomatic patients (six males, mean age......; 64 years (41-80) from 8 families. Ptosis was the first symptom in 8/13 patients followed by limb weakness in the remaining 5 patients Dysphagia was never the presenting symptom. At the time of examination, all affected patients had ptosis or had previously been operated for ptosis, while...
Wohlfart Björn; Paskevicius Audrius; Sjöberg Trygve; Liao Qiuming; Steen Stig
Abstract Background Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005) for cardiopulmonary resuscitation (CPR). The aim of the present study was to compare manual CPR with LUCAS-CPR. Methods 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8) or LUCAS-...
Rings, D M; Muir, W W
The cardiopulmonary effects of an intramuscular xylazine (0.088 mg/kg)-ketamine (4.4 mg/kg) drug combination were evaluated in calves. Heart rate, central venous and mean pulmonary artery blood pressures, and cardiac output did not change after drug administration. Mean arterial blood pressure decreased significantly (P less than 0.05) 15 minutes after drug administration. Respiratory frequency increased significantly (P less than 0.05) whereas arterial partial pressure of oxygen (PaO2) decre...
Wang, Jin; Ma, Li; Lu, Yuan-qiang
Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest. This appreciation produced immense efforts by professional organizations to train laypeople for CPR skills. However, the rate of CPR training is low and varies widely across communities. Several strategies are used in order to improve the rate of CPR training and are performed in some advanced countries. The Chinese CPR training in communities could gain enlightenment from them.
Lakshmi Rajeswaran; Valerie J Ehlers
Background: In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations.Objective: The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills.Method: A pre-test, intervention and re-test ...
Walker, W. S.; Reid, K G; Hider, C F; Davidson, I. A.; Boulton, F. E.; Yap, P L
Two insulin dependent diabetics with previous anaphylactic like (anaphylactoid) reactions to protamine underwent successful cardiopulmonary bypass for coronary artery surgery. Platelet concentrates instead of protamine were used to neutralise their systemic heparinisation. In both cases the anaphylactoid reactions first became apparent after administration of protamine sulphate at the end of cardiac catheterisation. These cases show that adverse reactions to protamine need not be a contraindi...
Robert Curran; Sasha Sorr; Eva Aquino
Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim′s chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers′ wrists of less than 10% of those seen during the performance of chest compressions significantl...
Saiyad, Shaista M; Saiyad, Mubassir; Pandya, Charu J
Context: Students should be exposed to early clinical scenario so that they start developing competency-based learning right from their MBBS 1st year. Medical Council of India has recognized this need and has suggested early clinical exposure of MBBS 1st year students in their document Vision 2015. Medical education in India needs change for achieving desired competencies. It has been concluded that Indian medical undergraduates have inadequate knowledge in cardiopulmonary resuscitation (CPR)...
Bhavani Shankar Kodali; Urman, Richard D.
Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 ). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlat...
Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and ...
苏肇伉; 周成斌; 张海波; 祝忠群
Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P＜0.05). The fetal catecholamine and cortisol levels increased significantly (P＜0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P＜0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.
AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000
O' Neill, John M.; McBride, Kieran D
AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.
Metz, Samuel; Hacker, Jerriann
We examined the influence of the addition of dextrose to crystalloid cardiopulmonary bypass priming solution. Ten patients received only lactated Ringer's solution during the perioperative period and as their cardiopulmonary bypass priming solution, while ten others, managed identically in all other respects, received only 5% dextrose in lactated Ringer's solution (D 5LR). During cardiopulmonary bypass, patients who did not receive glucose required more supplementary fluid (20.0 vs 2.2 ml Kg−...
Yan, Sherry H. F.; Xu, Yuexiao
Recently, Chen et al. derived the generating function for partitions avoiding right nestings and posed the problem of finding the generating function for partitions avoiding right crossings. In this paper, we derive the generating function for partitions avoiding right crossings via an intermediate structure of partial matchings avoiding 2-right crossings and right nestings. We show that there is a bijection between partial matchings avoiding 2-right crossing and right nestings and partitions...
This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP
Offiah, Curtis E; Dean, Jonathan
Post-mortem cross-sectional imaging in the form of CT and, less frequently, MRI is an emerging facility in the evaluation of cause-of-death and human identification for the coronial service as well as in assisting the forensic investigation of suspicious deaths and homicide. There are marked differences between the radiological evaluation and interpretation of the CT and MRI features of the live patient (i.e. antemortem imaging) and the evaluation and interpretation of post-mortem CT and MRI appearances. In addition to the absence of frequently utilized tissue enhancement following intravenous contrast administration in antemortem imaging, there are a number of variable changes which occur in the tissues and organs of the body as a normal process following death, some of which are, in addition, affected significantly by environmental factors. Many patients and victims will also have undergone aggressive attempts at cardiopulmonary resuscitation in the perimortem period which will also significantly alter post-mortem CT and MRI appearances. It is paramount that the radiologist and pathologist engaged in the interpretation of such post-mortem imaging are familiar with the appropriate non-pathological imaging changes germane to death, the post-mortem interval and cardiopulmonary resuscitation in order to avoid erroneously attributing such changes to trauma or pathology. Some of the more frequently encountered radiological imaging considerations of this nature will be reviewed. PMID:26562099
Homayoun, Seraji; Colbaugh, Richard; Glass, Kristin
Simple and direct control scheme enables redundant robot to avoid obstacles in workspace. In proposed scheme, called "configuration control", degrees of freedom used to configure robot to satisfy set of inequality constraints representing avoidance of obstacles, while simultaneously making end effector follow desired trajectory. Provides capability to avoid obstacles in dynamically varying environment where apriori planning of tasks not feasible.
Bartels, Bart; Takken, Tim; Blank, A. Christian; van Moorsel, Huib; van der Pol, W. Ludo; de Groot, Janke F.
Purpose: To determine exercise response during cardiopulmonary exercise testing in children and adolescents with dystrophinopathies. Methods: Exercise response on the cardiopulmonary exercise test (CPET) was compared with a standard care test protocol. Results: Nine boys (aged 10.8 +/- 4.7 years) wi
... blood filter. 870.4270 Section 870.4270 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Devices § 870.4270 Cardiopulmonary bypass cardiotomy suction line blood filter. (a) Identification. A cardiopulmonary bypass cardiotomy suction line blood filter is a device used as part of a gas exchange...
Monish S Raut
Full Text Available An 11-year-old child, a known case of sickle cell anaemia with a history suggestive of sickling crisis in the past was scheduled for surgical pulmonary valvotomy. Pre-operative blood transfusion and hydroxyurea were administered. Pre-operative blood transfusion is indicated in sickle cell disease patients to raise the haematocrit level and lower sickle haemoglobin (HbS levels. Before the start of cardiopulmonary bypass (CPB, exchange transfusion was performed to reduce HbS level and raise adult haemoglobin level. Hypothermia was prevented by employing normothermic CPB.
Digital subtraction cardiopulmonary angiography using FCR was performed on 46 patients including lung cancer, mediastinal tumor, giant bullous formation and others. The images of digital subtraction for pulmonary artery, pulmonary vein and thoracic aorta were studied by comparing to the conventional pulmonary angiogram. Good images of pulmonary artery due to digital subtraction were obtained in 80 % of the 45 cases. This method needed only half volume of contrast media compared to the conventional for obtaining good images and thus reduced side effect. Therefore this method seems to be an usefull pre-operative examination in various chest diseases, especially in case of lung cancer. (author)
Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.
The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.
Full Text Available Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim′s chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers′ wrists of less than 10% of those seen during the performance of chest compressions significantly strain the scapholunate ligament. Biomechanical research should be performed to further evaluate this possible correlation. Compensation for worker injury maybe involved.
Dilek Sevimli; Fuat Kocyigit
AIM: The purpose of this study is to investigate the changes in cardiopulmonary system stimulated by aerobic exercise in different age group of children and to find out in which age group aerobic exercise is more effective. METHOD: Totally, 76 children participated in this study. Ages of the participants ranged between 1117, and mean age was 14.08±0.65. Participants were divided into three groups according to their age range. There were 23 in the first and second and 30 participant...
Full Text Available Abstract A treatment strategy of a difficult and unusual problem is presented. We are reporting a case of a patient who had a documented allergy to heparin and required Cardiac surgery for an ASD closure. The anticoagulation regime used during cardiopulmonary bypass was lepirudin based. This report indicates that r-hirudin provides effective anticoagulation, however unless ECT is monitoring, post operative hemorrhage is encountered. Therefore this case is unique not only because of its rarity but also by the fact that it presents the caveats encountered when ECT is not available.
Asteroid 2011 AG5 will impact on Earth in 2040. (See Donald K. Yoemans, ``Asteroid 2011 AG5 - A Reality Check,'' NASA-JPL, 2012) In 2011, The author say: the dark hole will take the dark comet to impact our solar system in 20 years, and give a systemic model between the sun and its companion-dark hole to explain why were there periodicity mass extinction on earth. (see Dayong Cao, BAPS.2011.CAL.C1.7, BAPS.2011.DFD.LA.24, BAPS.2012.APR.K1.78 and BAPS.2011.APR.K1.17) The dark Asteroid 2011 AG5 (as a dark comet) is made of the dark matter which has a space-time (as frequence-amplitude square) center- a different systemic model from solar systemic model. It can asborb the space-time and wave. So it is ``dark.'' When many dark matters hit on our earth, they can break our atom structure and our genetic code to trigger the Mass Extinction. In our experiments, consciousness can change the systematic model and code by a life-informational technology. So it can change the output signals of the solar cell. (see Dayong Cao, BAPS.2011.MAR.C1.286 and BAPS.2012.MAR.P33.14) So we will develop the genetic code of lives to evolution and sublimation, will use the dark matter to change the systemic model between dark hole and sun and will avoid next extinction.
The application of the internal friction damping nondestructive evaluation technique for detecting incipient cracking in critical components, by-pass lines and piping systems in boiling water reactors
A technical feasibility program of utilizing an internal friction damping (IFD) nondestructive evaluation (NDE) technique under laboratory and field conditions for piping systems has been initiated. The applicability of the IFD-NDE technique for four inch (10.1 cm) stainless steel by-pass lines and ten inch (25.4 cm) feedwater lines has been established. The overall objectives of the program include: 1. application of the IFD-NDE technique for four inch (10.1 cm) stainless steel lines that simulate by-pass lines, 2. application of the IFD-NDE technique to full size feedwater lines in an on-line boiling water reactor, 3. evaluate the feasibility of utilizing the IFD-NDE technique as an incipient crack detection method for laboratory stress corrosion cracking tests. (orig.)
A 49-year-old male, who had undergone mitral valve replacement with mechanical cardiac valve and coronary arterial by-pass grafting six years previously, was admitted to our hospital with acute dyspnea. Transesophageal echocardiography revealed that one of the leaflets of the prosthetic valve was entirely immobilized in the closed position, and an immobile soft tissue mass was detected on the ventricular side of the obstructed leaflet. We performed re-replacement using a 29-mm mechanical pros...
Jun-min Chu; Qing-yu Wu; Jian-ping Xu
Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (ECTCPA) without cardiopulmonary bypass (CPB).Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (noCPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period.Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appeared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P=0.04) and hospital stay (P= 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P= 0.004) in no-CPB group compared with CPB group.Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.
Ward, Richard; Wing, Sarah; Bassingthwaighte, James; Neal, Maxwell
Circuit models have been used extensively in physiology to describe cardiopulmonary function. Such models are being used in the DARPA Virtual Soldier (VS) Project* to predict the response to injury or physiological stress. The most complex model consists of systemic circulation, pulmonary circulation, and a four-chamber heart sub-model. This model also includes baroreceptor feedback, airway mechanics, gas exchange, and pleural pressure influence on the circulation. As part of the VS Project, Oak Ridge National Laboratory has been evaluating various cardiopulmonary circuit models for predicting the effects of injury to the heart. We describe, from a physicist's perspective, the concept of building circuit models, discuss both unstressed and stressed models, and show how the stressed models are used to predict effects of specific wounds. *This work was supported by a grant from the DARPA, executed by the U.S. Army Medical Research and Materiel Command/TATRC Cooperative Agreement, Contract # W81XWH-04-2-0012. The submitted manuscript has been authored by the U.S. Department of Energy, Office of Science of the Oak Ridge National Laboratory, managed for the U.S. DOE by UT-Battelle, LLC, under contract No. DE-AC05-00OR22725. Accordingly, the U.S. Government retains a non-exclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purpose.
Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 ± 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations
Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.
Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.
Dean, J M; Koehler, R C; Schleien, C L; Michael, J R; Chantarojanasiri, T; Rogers, M C; Traystman, R J
We studied alterations of chest geometry during conventional cardiopulmonary resuscitation in anesthetized immature swine. Pulsatile force was applied to the sternum in increments to determine the effects of increasing compression on chest geometry and intrathoracic vascular pressures. In 2-wk- and 1-mo-old piglets, permanent changes in chest shape developed due to incomplete recoil of the chest along the anteroposterior axis, and large intrathoracic vascular pressures were generated. In 3-mo-old animals, permanent chest deformity did not develop, and large intrathoracic vascular pressures were not produced. We propose a theoretical model of the chest as an elliptic cylinder. Pulsatile displacement along the minor axis of an ellipse produces a greater decrease in cross-sectional area than displacement of a circular cross section. As thoracic cross section became less circular due to deformity, greater changes in thoracic volume, and hence pressure, were produced. With extreme deformity at high force, pulsatile displacement became limited, diminishing pressure generation. We conclude that changes in chest geometry are important in producing intrathoracic intravascular pressure during conventional cardiopulmonary resuscitation in piglets. PMID:3610916
Savic, B.M.; Zivanovic, T. [Univ. of Belgrade (Yugoslavia). Faculty of Mechanical Engineering; Perkovic, B. [Electric Power Industry of Serbia, Belgrade (Yugoslavia). Power Generation and Transmission Dept.
Additional power demands and some component failures at the high pressure heat exchangers system are two usual reasons for the operation in the regimes with by-pass of high pressure heat exchangers. This way the power output increase with the unchanged fresh steam rate could be very useful in practice because of its short-time response on electricity system demands, especially important in the circumstances of the steam boiler unavailability to produce the greater fresh steam rate and to retain such production for a longer period of time. Shortage of data about the operating conditions and operation costs for these regimes for two referent steam turbine units is certainly one of the important reasons for making this analysis. But, one comparative analysis of the operation in these regimes is yet more interesting having in mind that the reference units are practically of the same power, but different configurations. This analysis has been done on the basis of the regimes calculations for different variants of high pressure heat exchangers shut-off. The influences of the changes of cooling conditions in the condensers on the operating regimes with by-pass of high pressure heat exchangers have also been included. The potentially limiting factors during operation in the regimes with by-pass of high pressure heat exchangers have been discussed.
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent $\
Grigori, Laura; Moufawad, Sophie
In this paper we present a communication avoiding ILU0 preconditioner for solving large linear systems of equations by using iterative Krylov subspace methods. Recent research has focused on communication avoiding Krylov subspace methods based on so called s-step methods. However there is no communication avoiding preconditioner yet, and this represents a serious limitation of these methods. Our preconditioner allows to perform s iterations of the iterative method with no communication, throu...
Grimmett, Geoffrey R.; Holroyd, Alexander E; Peres, Yuval
The connective constant mu of a graph is the exponential growth rate of the number of n-step self-avoiding walks starting at a given vertex. A self-avoiding walk is said to be forward (respectively, backward) extendable if it may be extended forwards (respectively, backwards) to a singly infinite self-avoiding walk. It is called doubly extendable if it may be extended in both directions simultaneously to a doubly infinite self-avoiding walk. We prove that the connective constants for forward,...
Rohn, D A; Davis, K L; Mehlhorn, U; Allen, S J; Laine, G A
We investigated the relation between left ventricular dysfunction and myocardial edema in dogs with heartworm (Dirofilaria immitis) infection that were undergoing cardiopulmonary bypass. Dogs with and without D immitis were anesthetized by continuous thiopental infusion and were mechanically ventilated. Sonomicrometry crystals were placed on the long and short axes of the left ventricle, and a Millar pressure transducer was placed in the left ventricular chamber. Pressure-volume loops were digitized and continuously recorded. Dogs with and without D immitis were placed on standard hypothermic cardiopulmonary bypass, with 1 hour of aortic cross-clamp. Wet-to-dry weight ratio corrected for residual blood volume was used to quantitate the volume of myocardial edema. Preload recruitable stroke work was used as a preload-independent index of systolic function. Tau, the isovolumic relaxation time constant, was determined to assess diastolic relaxation. Dogs with D immitis had increased baseline myocardial wet-to-dry weight ratio. After cardiopulmonary bypass, myocardial edema increased in all dogs. Acute edema attributable to cardiopulmonary bypass decreased preload recruitable stroke work in all dogs of both groups, and dogs with D immitis could not be weaned from cardiopulmonary bypass. Myocardial edema increased diastolic relaxation times (tau) in dogs with and without D immitis. We conclude that cardiopulmonary bypass and heartworm infection induce myocardial edema. This edema compromises left ventricular systolic and diastolic function making D immitis an important confounding factor in weaning dogs from cardiopulmonary bypass. PMID:7717590
Anthony J. Guttmann
Full Text Available We have produced extended series for prudent self-avoiding walks on the square lattice. These are subsets of self-avoiding walks. We conjecture the exact growth constant and critical exponent for the walks, and show that the (anisotropic generating function is almost certainly not differentiably-finite.
Guttmann, Anthony J.; Dethridge, John C.
We have produced extended series for prudent self-avoiding walks on the square lattice. These are subsets of self-avoiding walks. We conjecture the exact growth constant and critical exponent for the walks, and show that the (anisotropic) generating function is almost certainly not differentiably-finite.
Levine-MacCombie, Joyce; Koss, Mary P.
Determined that acknowledged and unacknowledged acquaintance rape victims and rape avoiders could be discriminated by situational variables and response strategies. Avoiders were less likely to have experienced passive or internalizing emotions at the time of the assault, perceived the assault as less violent, and were more likely to have utilized…
Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.;
The evolution of the human in caring for others is reflected in the development of cardiopulmonary resuscitation (CPR). Superstition, divine intervention and finally science have contributed to the development of a technique which may allow any person to save anothers life. Fully 50% of the first...... presentation of coronary artery disease is sudden death, typically in (western) men. [Anonymous, 2000, ID-469] However, achieving a clear understanding of why CPR saves some lives remains shrouded in mist; mist made even thicker by contradictory reports, different school of thought and persistently low...... survival rates. Despite the suggestion that much remains unclear, CPR is not new. An early report, in an 18 year old woman, of CPR as performed today, initially known as closed-chest cardiac resuscitation (CCCR), dates from 1858 [Husveti, ID-649]. Following airway obstruction and hypoxia, cardiac arrest...
Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B;
BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during...... individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines for...... Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify...
Nakamura, Iwao; Hori, Shingo; Funabiki, Tomohiro; Sekine, Kazuhiko; Kimura, Hiroyuki; Fujishima, Seitaro; Aoki, Katsunori; Kuribayashi, Sachio; Aikawa, Naoki
Anaphylactoid reactions to iodinated contrast media can cause life-threatening events and even death. A 44-year-old woman presented with cardiopulmonary arrest (CPA) immediately following the administration of nonionic iodinated contrast media for an intravenous pyelography. Her cardiac rhythm during CPA was asystole. She was successfully resuscitated by the radiologists supported by paged emergency physicians using the prompt intravenous administration of 1 mg of epinephrine. Neither laryngeal edema nor bronchial spasm was observed during the course of treatment, and she was discharged on the 4th day without any complications. The patient did not have a history of allergy, but had experienced a myocardial infarction and aortitis. She had undergone 11 angiographies and had been taking a beta-adrenergic receptor antagonist. Planned emergency medical backup is advisable to ensure resuscitation in the event of an anaphylactoid reaction to the use of contrast media in-hospital settings. PMID:12009227
Full Text Available Abstract Background Optimal manual closed chest compressions are difficult to give. A mechanical compression/decompression device, named LUCAS, is programmed to give compression according to the latest international guidelines (2005 for cardiopulmonary resuscitation (CPR. The aim of the present study was to compare manual CPR with LUCAS-CPR. Methods 30 kg pigs were anesthetized and intubated. After a base-line period and five minutes of ventricular fibrillation, manual CPR (n = 8 or LUCAS-CPR (n = 8 was started and run for 20 minutes. Professional paramedics gave manual chest compression's alternating in 2-minute periods. Ventilation, one breath for each 10 compressions, was given to all animals. Defibrillation and, if needed, adrenaline were given to obtain a return of spontaneous circulation (ROSC. Results The mean coronary perfusion pressure was significantly (p Conclusions LUCAS-CPR gave significantly higher coronary perfusion pressure and significantly fewer rib fractures than manual CPR in this porcine model.
Harms, Hans; Tolbod, Lars Poulsen; Kero, Tanja;
index, the central circulatory turnover (CCT) which represents the fractional exchange of blood per stroke within the cardiopulmonary blood pool and can be measured from any dynamic PET scan. Methods: Data from 111 clinical patients were analysed retrospectively. Patients underwent a 6-min 15O...... and RV time-activity curves were extracted after which their first-pass peaks were isolated and the centroid of each peak was obtained. Mean pulmonary transit time (MPTT, min) was defined as the difference between the LV centroid and the RV centroid and CCT was defined as 1/(MPTT*heart rate). Results.......001). Decrease of CCT was especially pronounced in severely ischemic patients already at rest Conclusion: Pulmonary transit times and central circulatory turnover can be measured automatically using dynamic PET. Since both are correlated with severity of myocardial ischemia already at rest, they appear to...
Starr, Lois J; Grange, Dorothy K; Delaney, Jeffrey W; Yetman, Anji T; Hammel, James M; Sanmann, Jennifer N; Perry, Deborah A; Schaefer, G Bradley; Olney, Ann Haskins
Myhre syndrome, a connective tissue disorder characterized by deafness, restricted joint movement, compact body habitus, and distinctive craniofacial and skeletal features, is caused by heterozygous mutations in SMAD4. Cardiac manifestations reported to date have included patent ductus arteriosus, septal defects, aortic coarctation and pericarditis. We present five previously unreported patients with Myhre syndrome. Despite varied clinical phenotypes all had significant cardiac and/or pulmonary pathology and abnormal wound healing. Included herein is the first report of cardiac transplantation in patients with Myhre syndrome. A progressive and markedly abnormal fibroproliferative response to surgical intervention is a newly delineated complication that occurred in all patients and contributes to our understanding of the natural history of this disorder. We recommend routine cardiopulmonary surveillance for patients with Myhre syndrome. Surgical intervention should be approached with extreme caution and with as little invasion as possible as the propensity to develop fibrosis/scar tissue is dramatic and can cause significant morbidity and mortality. PMID:26420300
Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic [EMF] and radiomicrosphere [RMS]) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal
Yang, Ming-Chun; Chen, Chun-An; Chiu, Hsin-Hui; Chen, Ssu-Yuan; Wang, Jou-Kou; Lin, Ming-Tai; Chiu, Shuenn-Nan; Lu, Chun-Wei; Huang, Shu-Chien; Wu, Mei-Hwan
Background Patients with repaired tetralogy of Fallot (TOF) usually experience progressive right ventricle (RV) dysfunction due to pulmonary regurgitation (PR). This could further worsen the cardiopulmonary function. This study aimed to compare the changes in patient exercise cardiopulmonary test and cardiac magnetic resonance imaging, and consider the implication of these changes. Methods Our study examined repaired TOF patients who underwent cardiopulmonary exercise test (CPET) to obtain maximal (peak oxygen consumption, peak VO2) and submaximal parameters (oxygen uptake efficiency plateau, oxygen uptake efficiency plateau (OUEP), and ratio of minute ventilation to carbon dioxide production, VE/VCO2 slope). Additionally, the hemodynamic status was assessed by using cardiac magnetic resonance. Criteria for exclusion included TOF patients with pulmonary atresia, atrioventricular septal defect, or absence of pulmonary valve syndrome. Results We enrolled 158 patients whose mean age at repair was 7.8 ± 9.1 years (range 0.1-49.2 years) and the mean patient age at CPET was 29.5 ± 12.2 years (range 7.0-57.0 years). Severe PR (PR fraction ≥ 40%) in 53 patients, moderate in 55, and mild (PR fraction 163 ml/m2. The mean left ventricular ejection fraction (LVEF) was 63 ± 8%, left ventricular end-diastolic volume index (LVEDVi) was 65 ± 12 ml/m2, and LVESVi was 25 ± 14 ml/m2. CPET revealed significantly decreased peak VO2 (68.5 ± 14.4% of predicted), and fair OUEP (90.3 ± 14.1% of predicted) and VE/VCO2 slope (27.1 ± 5.3). PR fraction and age at repair were negatively correlated with maximal and submaximal exercise indicators (peak VO2 and OUEP). Left ventricular (LV) function and size were positively correlated with peak VO2 and OUEP. Conclusions The results of CPET showed that patients with repaired TOF had a low maximal exercise capacity (peak VO2), but a fair submaximal exercise capacity (OUEP and VE/VCO2 slope), suggesting limited exercise capability in high
In this work the core grid by-pass orifices inlet pressure drop of the new core of the R A6 reactor are experimentally studied.The experiments are performed using a 1:1 scale mock-up of an external fuel element cell.Different gaps between fuel elements are considered in order to take into account the design allowances. Different flows are considered to take into account the normal operation flow range.Measurement uncertainties are included.The results will be used to calculate the core flow distribution
May, James E.; Linehan, Rev. Daniel
At the request of the Massachusetts Department of Public Works, seismic and geologic studies were made for the projected Braintree-Weymouth By-Pass grade separation at Liberty Street in Braintree, Massachusetts. The work was performed in order to furnish data that would aid the engineers in preparing estimates of the quantity of bedrock to be excavated for this project. The study represents part of a cooperative program of the Massachusetts Department of Public Works and the United States Geological Survey. The work was performed in May 1949.
A triplex digital flight control system was installed in a NASA F-8C airplane to provide fail operate, full authority control. The triplex digital computers and interface circuitry process the pilot commands and aircraft motion feedback parameters according to the selected control laws, and they output the surface commands as an analog signal to the servoelectronics for position control of the aircraft's power actuators. The system and theory of operation of the computer by pass and servoelectronics are described and an automated ground test for each axis is included.
Cotter, P E
while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.
Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.
National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...
Full Text Available Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the test. It also reveals the results of recently published clinical trials on the use of cardiopulmonary exercise test in patients with cardiovascular disease and in the working population. The study included variability of respiratory parameters during the cardiopulmonary exercise test and after its completion, as well as their impact on the prognostic value. In addition, the results of a study involving an optimal choice of interval training on the basis of oxygen consumption at peak exercise are summarized. Med Pr 2014;65(5:665–674
Małgorzata Kurpesa; Katarzyna Jerka; Alicja Bortkiewicz
Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the tes...
Raasch, David; Austin, Jon; Tallman, Richard
Simulator exercises are used at Midwestern University to augment academic and laboratory training toward consolidating particular skills, increasing situation awareness, and preparing the student for practice within the team environment of an operating room. This paper describes an enhanced cardiopulmonary bypass simulator consisting of a self-priming hemodynamic reservoir that includes an inline flow meter. A typical cardiopulmonary bypass adult perfusion circuit was assembled using a roller...
Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Ucar, Halil Ibrahim; Yorgancioglu, Cem; Salman, Nevriye; Utku Unal, Ertekin
Introduction Cardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia–reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount...
National Aeronautics and Space Administration — Using biologically-inspired neuromorphic optic flow algorithms is a novel approach in collision avoidance for UAS. Traditional computer vision algorithms rely on...
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent ν. However, there is no power law correction to the exponential number growth for this new model, i.e. the critical exponent γ = 1 exactly in any dimension. In addition, the number growth has no analytic corrections to scaling, and we have convincing numerical evidence to support the conjecture that the amplitude for the number growth is a universal quantity. The technique by which end-effects are eliminated may be generalized to other models of polymers such as interacting self-avoiding walks.
We introduce a self-avoiding walk model for which end-effects are completely eliminated. We enumerate the number of these walks for various lattices in dimensions two and three, and use these enumerations to study the properties of this model. We find that endless self-avoiding walks have the same connective constant as self-avoiding walks, and the same Flory exponent ν. However, there is no power law correction to the exponential number growth for this new model, i.e. the critical exponent γ = 1 exactly in any dimension. In addition, the number growth has no analytic corrections to scaling, and we have convincing numerical evidence to support the conjecture that the amplitude for the number growth is a universal quantity. The technique by which end-effects are eliminated may be generalized to other models of polymers such as interacting self-avoiding walks. (paper)
Failure of photovoltaic systems because of serious damage is an increasing phenomenon. Especially in older systems, faulty projecting and installation may have costly late effects. Insurance companies reckon that most cases of damage and failure could easily be avoided. (orig.)
A method for allowing a robot to avoid objects along a programmed path: first, a field of view for an electronic imager of the robot is established along a path where the electronic imager obtains the object location information within the field of view; second, a population coded control signal is then derived from the object location information and is transmitted to the robot; finally, the robot then responds to the control signal and avoids the detected object.
Camilleri, Elizabeth; Rohde, Peter P.; Twamley, Jason
Quantum walks exhibit many unique characteristics compared to classical random walks. In the classical setting, self-avoiding random walks have been studied as a variation on the usual classical random walk. Classical self-avoiding random walks have found numerous applications, most notably in the modeling of protein folding. We consider the analogous problem in the quantum setting. We complement a quantum walk with a memory register that records where the walker has previously resided. The w...
Alstadsæter, Annette; Jacob, Martin
This paper analyzes the sources of heterogeneity in legal tax avoidance strategies across individuals. Three conditions are required for a taxpayer to participate in tax avoidance: incentive, access, and awareness. Using rich Swedish administrative panel data with a unique link between corporate and individual tax returns, we analyze individual participation in legal tax planning around the 2006 Swedish tax reform. Our results suggest that closely held corporations are utilized to facilitate ...
Full Text Available Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre and the adjacent sulfidic surface creek (El Azufre, we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve and wild-caught (i.e., predator-experienced individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1 that predator avoidance is still functional in extremophile Poecilia spp. and (2 that predator recognition and avoidance reactions have a strong genetic basis.
Torrijos, V; Gonzalo, O G; Trueba-Santiso, A; Ruiz, I; Soto, M
Hybrid constructed wetlands (CWs) including subsurface horizontal flow (HF) and vertical flow (VF) steps look for effective nitrification and denitrification through the combination of anaerobic/anoxic and aerobic conditions. Several CW configurations including several configurations of single pass systems (HF + HF, VF + VF, VF + HF), the Bp(VF + HF) arrangement (with feeding by-pass) and the R(HF + VF) system (with effluent recirculation) were tested treating synthetic domestic wastewater. Two HF/VF area ratios (AR) were tested for the VF + HF and Bp(VF + HF) systems. In addition, a R(VF + VF) system was tested for the treatment of a high strength industrial wastewater. The percentage removal of TSS, COD and BOD5 was usually higher than 95% in all systems. The single pass systems showed TN removal below the threshold of 50% and low removal rates (0.6-1.2 g TN/m(2) d), except the VF + VF system which reached 63% and 3.5 g TN/m(2) d removal but only at high loading rates. Bp(VF + HF) systems required by-pass ratios of 40-50% and increased TN removal rates to approximately 50-60% in a sustainable manner. Removal rates depended on the AR value, increasing from 1.6 (AR 2.0) to 5.2 g TN/m(2) d (AR 0.5), both working with synthetic domestic wastewater. On real domestic wastewater the Bp (VF + HF) (AR 0.5 and 30% by-pass) reached 2.5 g TN/m(2) d removal rate. Effluent recirculation significantly improved the TN removal efficiency and rate. The R(HF + VF) system showed stable TN removals of approximately 80% at loading rates ranging from 2 to 8 g TN/m(2) d. High TN removal rates (up to 73% TN and 8.4 g TN/m(2) d) were also obtained for the R(VF + VF) system treating industrial wastewater. PMID:27441816
Sasaki, Y; Kawai, T; Nishiyama, K; Murayama, Y; Toda, S; Wada, T; Kitaura, K; Sato, S; Kadowaki, M; Kanki, Y
A pulsatile pump driven by a coil spring, which was designed and constructed by us, is described in this report. It consists of two main parts, a disposable blood chamber and a driving section. The blood chamber has two leaflet valves and a piston, which is covered with two bellofram rolling diaphragms and moves into the housing to draw in and eject the blood. The driving section consists of three cams, an electric motor and a coil spring. The ejection force is wholly produced by the compressed coil spring and is transmitted to the piston in the blood chamber by a rod. This pump allows the ejection pressure, the beat rates, and the stroke volume all to be changed independently. The performance of the pump was tested by using a circulation model where the beat rate was adjusted from 30 to 250 bpm. The output subsequently increased from 0.8 l/min to 5.7 l/min and the stroke volume, from 20.4 ml to 36.7 ml. This new pump has been used for clinical cardiopulmonary bypasses in 24 patients of open heart surgery and the pressure traces during perfusion resembled those of the patients' own hearts. PMID:3230723
Lederman, Zohar; Garasic, Mirko; Piperberg, Michelle
Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient's best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient's point of view. Since the patient requires CPR, he is invariably unconscious and therefore incompetent. We discuss the Autonomy Principle and the Three-Tiered process for surrogate decision making, as well as the Beneficence Principle and show that these are limited in providing us with an adequate tool for decision making in this particular case. Rather, we rely on a novel principle (or, rather, a novel specification of an existing principle) and a novel integrated model for surrogate decision making. We show that this model is more satisfactory in taking the patient's true wishes under consideration and encourages a joint decision making process by all parties involved. PMID:23557910
Bhavani Shankar Kodali
Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.
Full Text Available Background. In IPF, defects in lung mechanics and gas exchange manifest with exercise limitation due to dyspnea, the most prominent and disabling symptom. Aim. To evaluate the role of exercise testing through the 6MWT (6-minute walk test and CPET (cardiopulmonary exercise testing in the survival of patients with IPF. Methods. This is a prospective, observational study evaluating in 25 patients the relationship between exercise variables through both the 6MWT and CPET and survival. Results. By the end of the observational period 17 patients were alive (33% mortality. Observation ranged from 9 to 64 months. VE/VCO2 slope (slope of relation between minute ventilation and CO2 production, VO2 peak/kg (peak oxygen consumption/kg, VE/VCO2 ratio at anaerobic threshold, 6MWT distance, desaturation, and DLCO% were significant predictors of survival while VE/VCO2 slope and VO2 peak/kg had the strongest correlation with outcome. The optimal model for mortality risk estimation was VO2 peak/kg + DLCO% combined. Furthermore, VE/VCO2 slope and VO2 peak/kg were correlated with distance and desaturation during the 6MWT. Conclusion. The integration of oxygen consumption and diffusing capacity proved to be a reliable predictor of survival because both variables reflect major underlying physiologic determinants of exercise limitation.
Full Text Available Background: In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations.Objective: The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills.Method: A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple choice questionnaire and checklist were used to collect data.Results: All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted.Conclusion: The significantly low levels of registered nurses’ CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses.
Mäkinen, M.; Castrén, M.; Nurmi, J.; Niemi-Murola, L.
Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers' attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D), Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N = 185) focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree). Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse's Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation). Cronbach's alphas were 0.92–0.51. Statistics were Student's t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p Nurse's Role (p CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills. PMID:27144027
Full Text Available BACKGROUND: After cardiac surgery acute kidney injury (AKI is a common and serious condition carrying significant costs and is independently associated with increased morbidity and mortality. During cardiopulmonary bypass (CPB surgery, modifiable factors may contri bute to post - operative AKI. Their prevention might be a potential target for nephroprotection and any other morbidity after cardiac surgery. METHODS AND MATERIAL : The objective of the present study was to identify and determine whether intraoperative hypot ension or any other cofactor are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End - stage renal disease. On basis of this patients were divided into two groups according to rise in serum creatinine >0.3 mg/dl till 72 hrs postoperatively. Group B patients have developed AKI (n=34 and the remaining patients were in Group A. RESULT : In our study we have found that mean arterial pressure during CPB were less in group B patients compare to group A patients which was statistically significant (p<0.001. And in this group ICU stay and mortality rate were also high compare to group A pati ent who had not developed AKI. CONCLUSION: Lower MAP during CPB is associated with development of postoperative renal derangement, leads to increase ICU stay and mortality. Larger studies are required to further support the evidence
Full Text Available Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers’ attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D, Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland (N=185 focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree. Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse’s Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation. Cronbach’s alphas were 0.92–0.51. Statistics were Student’s t-test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (p<0.01. Participants scoring high on Hesitation scale (p<0.01 were less confident about their Nurse’s Role (p<0.01 and Nontechnical Skills (p<0.01. Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills.
Dr. Nagla Hamdi Kamal Khalil El- Meanawi
Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.
Hulstijn, J.H.; de Marchena, E.
This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is that Dutch learners of English would tend not to avoid English phrasal verbs, since phrasal verbs also exist in Dutch. It was hypothesized, however, that Dutch learners of English as a second langua...
Sanders Stephen P
Full Text Available Abstract Background Transcranial Doppler Ultrasound (TCD is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV. This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB. Methodology We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring". Discussion Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption. Conclusion In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.
Full Text Available The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960′s when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL and to highlight the salient points in the literature and in the senior author′s experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.
Plagiarism means taking the work of another and presenting it as one's own, resulting in potential upset for the original author and disrepute for the professions involved. This article aims to explore the issue of plagiarism and some mechanisms for detection and avoidance. PMID:19186631
The purpose of this paper is to provide undergraduate students with an introductory resource focusing on plagiarism avoidance. It sets out to identify often confusing associated nuances. From the perspective of paraphrasing, the requirements attaching to the necessary provision of proper citations are explored. The paper concludes by pondering the topic of reliability of sources.
J.H. Hulstijn; E. Marchena
This article follows up on a study by Dagut and Laufer (1985), who found that Hebrew learners of English avoid phrasal verbs, such as ‘let down’, while preferring one-word verbs, such as ‘;disappoint’, since phrasal verbs do not exist in Hebrew. A corollary derived from Dagut and Laufer's study is t
Aymen N Naguib
Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental
Vener, J. M.; Simonson, S. R.; Stocks, J.; Evettes, S.; Bailey, K.; Biagini, H.; Jackson, C. G. R.; Greenleaf, J. E.; Dalton, Bonnie P. (Technical Monitor)
The purpose of this study was to investigate cardiopulmonary responses to supine cycling with concomitant +G(sub z) acceleration using the NASA/Ames Human Powered Short-Arm Centrifuge (HPC). Subjects were eight consenting males (32+/-5 yrs, 178+/-5 cm, 86.1+/- 6.2 kg). All subjects completed two maximal exercise tests on the HPC (with and without acceleration) within a three-day period. A two tailed t-test with statistical significance set at p less than or equal to 0.05 was used to compare treatments. Peak acceleration was 3.4+/-0.1 G(sub z), (head to foot acceleration). Peak oxygen uptake (VO2(sub peak) was not different between treatment groups (3.1+/-0.1 Lmin(exp -1) vs. 3.2+/-0.1 Lmin(exp -1) for stationary and acceleration trials, respectively). Peak HR and pulmonary minute ventilation (V(sub E(sub BTPS))) were significantly elevated (p less than or equal to 0.05) for the acceleration trial (182+/-3 BPM (Beats per Minute); 132.0+/-9.0 Lmin(exp -1)) when compared to the stationary trial (175+/-3 BPM; 115.5+/-8.5 Lmin(exp -1)). Ventilatory threshold expressed as a percent of VO2(sub peak) was not different for acceleration and stationary trials (72+/-2% vs. 68+/-2% respectively). Results suggest that 3.4 G(sub z) acceleration does not alter VO2(sub peak) response to supine cycling. However, peak HR and V(sub E(sub BTPS)) response may be increased while ventilatory threshold response expressed as a function of percent VO2(sub peak) is relatively unaffected. Thus, traditional exercise prescription based on VO2 response would be appropriate for this mode of exercise. Prescriptions based on HR response may require modification.
Clare C. W. Yu; Au, Chun T.; Lee, Frank Y.F.; So, Raymond C.H.; Wong, John P.S.; Mak, Gary Y.K.; Chien, Eric P.; Alison M. McManus
Background Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters i...
Cameron, D E; Reitz, B A; Carson, B S; Long, D M; Dufresne, C R; Vander Kolk, C A; Maxwell, L G; Tilghman, D M; Nichols, D G; Wetzel, R C
Occipitally joined craniopagus Siamese twins were separated with the use of cardiopulmonary bypass and hypothermic circulatory arrest. The 7-month-old infants shared a large sagittal venous sinus that precluded conventional neurosurgical approach because of risk of exsanguination and air embolism. After craniotomy and preliminary exposure of the sinus, each twin underwent sternotomy and total cardiopulmonary bypass with deep hypothermia. Hypothermic circulatory arrest allowed safe division and subsequent reconstruction of the sinus remnants. Several unusual problems were encountered, including transfusion of a large blood volume from one extracorporeal circuit to the other through the common venous sinus, deleterious warming of the exposed brain during circulatory arrest, and thrombosis of both pump oxygenators. Both infants survived, although recovery was complicated in each by neurologic injury, cranial wound infection, and hydrocephalus. This case demonstrates the valuable supportive role of cardiopulmonary bypass and hypothermic circulatory arrest in the management of complex surgical problems of otherwise inoperable patients. PMID:2682024
S. I. Suskov
Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications.
Moreira Daniel Martins
Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.
Muhammad Usman Keerio
Full Text Available This paper presents a novel controlling approach forHumanoid Robot to work safely in critical situations like badlight environment using Visual Teleoperation. In this regardmodeling environments for Humanoid Teleoperation Systemis developed. Here virtual reality modeling environmentincludes development of virtual Humanoid BHR-2, andvirtual objects like table etc. The main goal of this work is toenhance our visual teleoperation system for BHR-2 in orderto avoid any collision during real time operation. SoftwareMaya is used for modeling and simulations. Maya plug-insin VC++ provides efficient modeling rule, real timeinteraction, and time saving rendering approach in a virtualenvironment. In this paper the validity of proposed scheme isshown by conducting experiments using offline step overtrajectory to avoid obstacle in bad light environment.
Tordeux, Antoine; Lassarre, Sylvain
Many car-following models are developed for jam avoidance in highways. Two mechanisms are used to improve the stability: feedback control with autonomous models and increasing of the interaction within cooperative ones. In this paper, we compare the linear autonomous and collective optimal velocity (OV) models. We observe that the stability is significantly increased by adding predecessors in interaction with collective models. Yet autonomous and collective approaches are close when the speed...
Il-Horn Hann; Kai-Lung Hui; Sang-Yong Tom Lee; Ivan Png
We introduce consumer avoidance into analytical marketing research. We show that consumer efforts to conceal themselves and to deflect marketing have a crucial impact on sellers¡¯ marketing strategy. Under reasonable conditions, seller marketing is a strategic complement with consumer concealment. Hence, consumer measures to conceal themselves from marketing will increase its cost-effectiveness and lead sellers to market more. Policies that encourage consumers to conceal their identities woul...
Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user–object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods. (paper)
Dalle Ave, Anne L; Gardiner, Dale; Shaw, David M
"Organ preserving cardiopulmonary resuscitation (OP-CPR)" is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical to provide OP-CPR in a brain-dead organ donor to save organs that would otherwise be lost? To answer this question, we review the literature on brain-dead organ donors, conduct an ethical analysis, and make recommendations. We conclude that OP-CPR can benefit patients and families by fulfilling the wish to donate. However, it is an aggressive procedure that can cause physical damage to patients, and risks psychological harm to families and healthcare professionals. In a brain-dead organ donor, OP-CPR is acceptable without specific informed consent to OP-CPR, although advance discussion with next of kin regarding this possibility is strongly advised. In a patient where brain death is yet to be determined, but there is known wish for organ donation, OP-CPR would only be acceptable with a specific informed consent from the next of kin. When futility of treatment has not been established or it is as yet unknown if the patient wished to be an organ donor then OP-CPR should be prohibited, in order to avoid any conflict of interest. PMID:26073934
Hikasa, Y.; Okuyama, K; Kakuta, T; Takase, K.; Ogasawara, S
The anesthetic potency and cardiopulmonary effects of sevoflurane were compared with those of isoflurane and halothane in goats. The (mean +/- SD) minimal alveolar concentration (MAC) was 0.96 +/- 0.12% for halothane, 1.29 +/- 0.11% for isoflurane, and 2.33 +/- 0.15% for sevoflurane. Cardiopulmonary effects of sevoflurane, halothane and isoflurane were examined at end-tidal concentrations equivalent to 1, 1.5 and 2 MAC during either spontaneous or controlled ventilation (SV or CV). During SV,...
Marcos N. Samano
Full Text Available Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.
Duara Rajnish; Misra Manoranjan; Bhuyan Ritwick; Sarma P; Jayakumar Karunakaran
Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomi...
Full Text Available Sudden cardiac arrest is one of the leading causes of death in Europe. Bystanders’ early Cardio-Pulmonary Resuscitation (CPR may double or triple survival rates of out-of-hospital cardiac arrest victims. Aim: To investigate nurses’ attitude, in starting or not CPR and also the most frequent reasons that deter them from engaging in. Materials and Methods: The study had a sample of 177 nurses and assistant nurses that were working in nine hospitals of Athens. Nurses filled out the same, predetermined questionnaire, voluntarily and anonymously. The collected answers were analyzed with the help of the statistical program SPSS v.16, using x2 and Kendall’s Tau-B methods. Results: From 177 participants, 78% (137 were women and 22% (40 men with mean age 31 years (±7. According to their education, 16% (28 were Assistant Nurses, 79% (140 Registered Nurses (ATEI, AEI and 5% (9 Nurses had an MSc diploma. Nurses that had been recently trained in certified BLS courses felt more confident and were more willing to start CPR in a known victim (p=0.004 and in an unknown victim (p=0.02 comparing to nurses that had been trained a long time ago or never. Most frequent reasons nurses reported that deter them from starting CPR are the fear of a possible lawsuit (43%, the fear of harming instead of helping (30% and the fear of infectious transmission from victim to rescuer (15%. The fear of harming correlates considerably with lower ages (the younger the nurse the more is afraid, p=0.04 and also correlates substantially with the training in a certified CPR course (the more a nurse is trained, the less is afraid, p<0.001. Accordingly, the fear of infection diminishes as long as the CPR training is repeated (p=0.03. Conclusions: According to the results, there is a necessity of continuous education and re-education of nurses, in certified Basic Life Support programs. With frequent and specialized training, nurses will show more willingness to engage in an out
Full Text Available AIM: The purpose of this study is to investigate the changes in cardiopulmonary system stimulated by aerobic exercise in different age group of children and to find out in which age group aerobic exercise is more effective. METHOD: Totally, 76 children participated in this study. Ages of the participants ranged between 1117, and mean age was 14.08±0.65. Participants were divided into three groups according to their age range. There were 23 in the first and second and 30 participants in the third group, (1517, (1314 and 30 (1112 respectively. Each of the groups then was divided into two parts one of which was experimental and the other was control group. During 8 weeks, a training programme based on doing aerobic exercise lasting one hour 3 days a week was performed in the experimental groups. Before and after training, EKG, spirometer, blood pressure, heart rate, PWC 170 test of the participants, which was the data collection method, were recorded. The results obtained were compared through t test method of SPSS. RESULTS: The results revealed a decrease in the systolic blood pressure and in the heart rate of those who did exercise as opposed to those who did not do exercise in Group I. In addition, R wave height in V6 of exercise group showed a statistically significant increase. As for second group, it was determined that the R/S, at V1 derivation obtained from the participants who did exercise showed a statistically decrease as compared to those of the participants who did not do exercise. In the third group, no changes were observed in the systolic blood pressure the heart rate, R wave height in V6 and R/S although the measures of PWC 170 test, VC and FVC obtained from all training groups made a significant increase when compared to those of control groups. CONCLUSION: The results of this study revealed that of the three groups the 1517 age group was affected mostly by the aerobic exercise on kardiyopulmoner sytem. The results
Atul Khanna; George Filobbos
The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960′s when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suc...
Many car-following models are developed for jam avoidance in highways. Two mechanisms are used to improve the stability: feedback control with autonomous models and increasing of the interaction within cooperative ones. In this paper, we compare the linear autonomous and collective optimal velocity (OV) models. We observe that the stability is significantly increased by adding predecessors in interaction with collective models. Yet autonomous and collective approaches are close when the speed difference term is taking into account. Within the linear OV models tested, the autonomous models including speed difference are sufficient to maximise the stability.
Borenstein, Johann; Koren, Yoram; Levine, Simon P.
A system for guiding an autonomous or semi-autonomous vehicle through a field of operation having obstacles thereon to be avoided employs a memory for containing data which defines an array of grid cells which correspond to respective subfields in the field of operation of the vehicle. Each grid cell in the memory contains a value which is indicative of the likelihood, or probability, that an obstacle is present in the respectively associated subfield. The values in the grid cells are incremented individually in response to each scan of the subfields, and precomputation and use of a look-up table avoids complex trigonometric functions. A further array of grid cells is fixed with respect to the vehicle form a conceptual active window which overlies the incremented grid cells. Thus, when the cells in the active window overly grid cell having values which are indicative of the presence of obstacles, the value therein is used as a multiplier of the precomputed vectorial values. The resulting plurality of vectorial values are summed vectorially in one embodiment of the invention to produce a virtual composite repulsive vector which is then summed vectorially with a target-directed vector for producing a resultant vector for guiding the vehicle. In an alternative embodiment, a plurality of vectors surrounding the vehicle are computed, each having a value corresponding to obstacle density. In such an embodiment, target location information is used to select between alternative directions of travel having low associated obstacle densities.
Stephen D Simpson
Full Text Available Auditory information is widely used throughout the animal kingdom in both terrestrial and aquatic environments. Some marine species are dependent on reefs for adult survival and reproduction, and are known to use reef noise to guide orientation towards suitable habitat. Many others that forage in food-rich inshore waters would, however, benefit from avoiding the high density of predators resident on reefs, but nothing is known about whether acoustic cues are used in this context. By analysing a sample of nearly 700,000 crustaceans, caught during experimental playbacks in light traps in the Great Barrier Reef lagoon, we demonstrate an auditory capability in a broad suite of previously neglected taxa, and provide the first evidence in any marine organisms that reef noise can act as a deterrent. In contrast to the larvae of species that require reef habitat for future success, which showed an attraction to broadcasted reef noise, taxa with a pelagic or nocturnally emergent lifestyle actively avoided it. Our results suggest that a far greater range of invertebrate taxa than previously thought can respond to acoustic cues, emphasising yet further the potential negative impact of globally increasing levels of underwater anthropogenic noise.
Qin, Chaoyi; Gu, Jun; Qian, Hong; Meng, Wei
Our research letter found that circulatory mtDNA level increased after the end of CPB and positive correlations between mtDNA and peak CRP level, peak BNP level, and peak PCT level, which revealed the prognostic role of perioperative circulatory mtDNA level in patients who underwent cardiopulmonary bypass. PMID:27316503
Zanatta, Paolo; Bosco, Enrico; Salandin, Valeria; Salvador, Loris; Valfrè, Carlo; Sorbara, Carlo
Introduction Microembolic signals are usually detected with transcranial doppler during cardiac surgery. This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass. Case presentation A 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach. His past medical history included an uncontrolled hypertension,...
Stege, G.; Elshout, F.J.J. van den; Heijdra, Y.F.; Ven, M.J.T. van de; Dekhuijzen, P.N.R.; Vos, P.J.E.
BACKGROUND: Measurements of transcutaneous carbon dioxide tension (PtcCO(2)) with current devices are proven to provide clinically acceptable agreement with measurements of partial arterial carbon dioxide tension (PaCO(2)) in several settings but not during cardiopulmonary exercise testing (CPET). O
Onyeaso, Adedamola Olutoyin; Onyeaso, Chukwudi Ochi
Background: The need for training of schoolchildren on cardiopulmonary resuscitation (CPR) as potential bystander CPR providers is growing globally but Nigeria is still behind and lacks basic necessary data. Purpose: The purpose of this study was to investigate the effects of age, gender and school class on CPR skills of Nigerian secondary school…
Kjærgaard, Benedict; Bavarskis, Egidijus; Magnusdottir, Sigriður Olga;
BACKGROUND: The optimal method for out-of-hospital ventilation during cardiopulmonary rescue (CPR) is controversial. The aim of this study was to test different modes of ventilation during CPR for a prolonged period of 60 min. METHODS: Pigs were randomized to four groups after the induction of...
Boks, RH; van Herwerden, LA; Takkenberg, JJM; van Oeveren, W; Gu, YJ; Wijers, MJ; Bogers, AJJC
Background. Albumin in the priming solution precoats the surface of the cardiopulmonary bypass circuit, supposedly causing delayed adsorption of fibrinogen and reduced activation and adhesion of platelets. This action may result in lower transoxygenator resistance. Because our institution uses a col
P.W.G. Elbers; A.J. Craenen; A. Driessen; M.C. Stehouwer; L. Munsterman; M. Prins; M. van Iterson; P. Bruins; C. Ince
The microcirculation is essential for delivery of oxygen and nutrients to tissue. However, the human microvascular response to cardiopulmonary resuscitation (CPR) is unknown. We report on the first use of sidestream dark field imaging to assess the human microcirculation during CPR with a mechanical
Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.
Fiallos, M; Kissoon, N; Abdelmoneim, T; Johnson, L; Murphy, S; Lu, L; Masood, S; Idris, A
The objective of this prospective study was to assess the incidence and magnitude of fat emboli after cardiopulmonary resuscitation and intraosseous infusions. An animal laboratory at a university center was used to study 33 mixed-breed piglets. The piglets underwent hypoxic cardiac arrest followed by chest compressions and mechanical ventilation for a minimum of 30 minutes. The animals were divided in groups: group 1 (n = 5), which had no intraosseous cannulas, group 2 (n = 6), which had intraosseous cannulas with infusion, groups 3 (n = 6), 4 (n = 6), and 5 (n = 8), which had intraosseous cannulas with infusion of epinephrine, normal saline, and sodium bicarbonate respectively, and group 6 (n = 2), which was a sham group with no intraosseous cannulas and no cardiopulmonary resuscitation. At cessation of cardiopulmonary resuscitation, representative lung samples were collected from upper and lower lobes of each lung and observed for fat globules and bone marrow elements. Fat globules were seen in the peribronchial blood vessels and intravascular areas throughout all lung fields of groups 1 through 5. There was no difference in appearance or distribution of fat globules among the 5 treatment groups. Analysis of variance showed no statistical significance (P fat embolization over cardiopulmonary resuscitation alone in this animal model. The benefits of using this procedure in critically ill children as a means of rapid vascular access for resuscitation is well established. However, the risk of fat embolism in this population needs further study. PMID:9258208
Kandler, K; Jensen, M E; Nilsson, J C;
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is common and is associated with increased mortality. We wanted to investigate if the arterial pressure or the use of norepinephrine during cardiopulmonary bypass were associated with AKI. METHODS: A retrospective analysis of patients who...
Al-Sabi, Mohammad Nafi Solaiman; Kapel, Christian Moliin Outzen; Johansson, Anna; Espersen, Mia C.; Koch, Jørgen; Willesen, Jakob L.
in Denmark, and fecal samples were obtainedin October and November, 2007. For detecting gastrointestinal parasites, samples (N = 178)were examined by a commercial flotation kit (Fecalyzer®EVSCO, USA). For detection of car-diopulmonary parasites, samples (N = 181) were collected on three consecutive...
Objective: To constitute a normal standard of cardiopulmonary vascular diameter and size of normal adult in Lanzhou, and to compared with the other's data reported in the previous bibliography by measuring diameter and area of cardiopulmonary artery lumen of the healthy adults in Lanzhou with multislice spiral CT (MSCT). Methods: Three hundred Lanzhou adults with no cardiopulmonary disease were equally assigned to 3 groups according to their age (A group: 18-39 years, B group: 40-60 years, C group: 61-80 years; 50 females and 50 males in each group). CT data were acquired at the end of deep inspiration phase and measurements were done on 3D reconstruction image with precise landmarks. All the results were statistically analyzed. Results: The diameters and areas of the main pulmonary artery left pulmonary artery right pulmonary artery ascending aorta and descending aorta differed significantly among the 3 groups (P<0.05). In groups B and C, there were significant differences in diameters and areas of pulmonary artery left pulmonary artery and right pulmonary between different genders (P<0.05). Conclusion: Imaging standard is provided for Lanzhou adult in early diagnosis of cardiopulmonary disease. The diameters and areas of main pulmonary artery left pulmonary artery and right pulmonary artery of Lanzhou healthy adults are different from that of other regions. It may be related to the geographical environment and the state of air pollution in Lanzhou. (authors)
Tang, M; Gu, YJ; Wang, WJ; Xu, YP; Chen, CZ
Background: Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase ( MB
Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim
Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome
Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD and those with congestive heart failure (CHF. Both of these symptoms negatively impact on patients’ daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels.
TABUCHI, N; HUET, RCG; STURK, A; EIJSMAN, L; WILDEVUUR, CRH
Various clinical trials have shown that hemostasis is improved by the administration of aprotinin during cardiopulmonary bypass. However, this effect has not been proved for those patients treated preoperatively with aspirin. Therefore, a double-blind, placebo-controlled study was conducted to test
Engels, Gerwin E.; Dodonov, Mikhail; Rakhorst, Gerhard; van Oeveren, Willem; Milano, Aldo D.; Gu, Y. John; Faggian, Giuseppe
Purpose: Cardiopulmonary bypass is still a major cause of lung injury and delay in pulmonary recovery after cardiac surgery. Although it has been shown that pulsatile flow induced by intra-aortic balloon pumping is beneficial for preserving lung function, it is not clear if the same beneficial effec
Choi, Sang-Sik; Kim, Won Young; Kim, Won; Lim, Kyung-Su
Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine outp...
Increased use of renewable energy sources raise concerns about health effects of emissions from such sources. We conducted a comprehensive analysis of relative cardiopulmonary health effects of exhausts from 1) 100% soy biofuel (B100), 2) 20% soy biofuel + 80% low sulfur petroleu...
Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.
HUANG Hui-min; KONG Xiang; WANG Wei; ZHU De-ming; ZHANG Hai-bo
Objective To study if using autologous lung as a substitute of oxygenator in cardiopulmonary bypass is better than the conventional cardiopulmonary bypass with artificial oxygenator in pulmonary preservation.Methods Twelve piglets were randomly divided into two groups ( n = 6). The isolated lung perfusion model was established. The experimental animals underwent continuous lung perfusion for about 120 min. While the control animals underwent 90 min lung ischemia followed by 30 min reperfusion. Another 12 piglets were randomly divided into two groups ( n =6). The experimental animals underwent bi-ventricular bypass with autologous lung perfusion.While control animals underwent conventional cardiopulmonary bypass with artificial oxygenator. The bypass time and aortic cross clamping time were 135 min and 60 min respectively for each animal. The lung static compliance ( Cstat), alveolus-artery oxygen difference ( PA-aO2 ), TNF-α, IL-6 and wet to dry lung weight ratio (W/D) were measured. Histological and ultra-structural changes of the lung were also observed after bypass. Results After either isolated lung perfusion or cardiopulmonary bypass, the Cstat decreased, the PA-aO2 increased and the content of TNF-α increased for both groups, but the changes of experimental group were much less than those of control group. The lower W/D ratio and mild pathological changes in experimental group than those in control group were also demonstrated. Conclusion Autologous lung is able to tolerate the nonpalsatile perfusion. It can be used as a substitute to artificial ogygenator in cardiopulmonary bypass to minimize the inflammatory pulmonary injury caused mainly by ischemic reperfusion and interaction of the blood to the non-physiological surface of artificial oxygenator.
Zhoujun Kang; Hui Cao; Bing Mei
BACKGROUND: Batroxobin has been found to have protective effect on cerebral ischemia-reperfusion,and cardiopulmonary resuscitation (CPR) is the common cause of global brain ischemia-reperfusion.OBJECTIVE: To observe the effect of Batroxobin on the morphological results of cerebral cortex and hippocampus in rabbit models of CPR, and the changes of serum concentration of tumor necrosis factor alpha (TNF- α) after CPR.DESIGN: A randomized controlled observation.SETTING: Laboratory of the Department of Burns, Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: Thirty healthy New Zealand rabbits of 2.5 - 3.0 kg, either male or female, were used. Kits for TNF- α determination were provided by LIFEKEY BioMeditech Company (USA).METHODS: The experiments were carried out in the laboratory of Department of Burns, Changhai Hospital from February 2001 to January 2002. The 32 rabbits were randomly divided into sham-operated group (n=8),conventional resuscitation group (n=12) and Batroxobin-treated group (n=12). The animals in the conventional resuscitation group and Batroxobin-treated group were anesthetized, then induced into modified Pittsburg's model of mechanical ventricular fibrillation. Sham-operated group was discharged on the chest wall, which did not cause ventricular fibrillation. Conventional resuscitation group and Batroxobin-treated group were exposed to 6 minutes of cardiac arrest induced by ventricular fibrillation, then the resuscitation began. A dosage of 0.3 Bu/kg of Batroxobin was administered to the rabbits in the Batroxobin-treated group at the beginning of resuscitation. Blood sample was collected at 4 and 12 hours after CPR to determine the concentration of TNF- α in serum. After the second blood collection, brain tissue was taken out immediately,and the forms of nerve cells in cerebral cortex and hippocampal CA1 region were observed under light microscope.MAIN OUTCOME MEASURES: ① TNF-α concentration in
Atkinson, Barry; Jameson, Lisa J.; Bovill, Begoña A.; Aarons, Emma J.; Clewlow, Jodie; Lumley, Sarah; Latham, Jennie; Jenkins, Megan H.; MacGowan, Alasdair P; Simpson, Andrew J.; Ahmed, Javeed; Brooks, Timothy J.; Hewson, Roger
Highlights • Detection of hantavirus cardiopulmonary syndrome imported into Europe. • Additional evidence that Choclo hantavirus is currently circulating and causing human disease in Panama. • Novel diagnostic and sequencing assays for identifying cases of Choclo hantavirus infection.
Lili Long; Lin Xu; Zhenghui Xiao; Shixiong Hu; Ruping Luo; Hua Wang; Xiulan Lu; Zhiyue Xu; Xu Yao; Luo Zhou; Hongyu Long; Jiaoe Gong; Yanmin Song; Li Zhao; Kaiwei Luo
From 2010 to 2012, large outbreaks of EV-A71-related- hand foot and mouth disease (HFMD) occurred annually in China. Some cases had neurological complications and were closely associated with fatal cardiopulmonary collapse, but not all children with central nervous system (CNS) involvement demonstrated a poor prognosis. To identify which patients and which neurological complications are more likely to progress to cardiopulmonary failure, we retrospectively studied 1,125 paediatric inpatients ...
Hansen, Dominique; Roijackers, Ruben; Jackmaert, Lore; Robic, Boris; Hendrikx, Marc; Yilmaz, Alaaddin; Frederix, Ines; Rosseel, Michael; DENDALE, PAUL
Objective: The purpose of this work was to test the hypothesis that cardiopulmonary exercise tolerance is better preserved early after endoscopic atraumatic coronary artery bypass graft (endo-ACAB) surgery versus coronary artery bypass graft (CABG) surgery. Design: Twenty endo-ACAB surgery patients, 20 CABG surgery patients, and 15 healthy subjects executed a maximal cardiopulmonary exercise test, with assessment and comparison of cycling power output, O2 uptake, CO2 output, respiratory ...
Soo, Alan; Booth, Karen; Parissis, Haralabos
With a high risk to time ratio, the advent of cardiopulmonary bypass has facilitated greater advances in technical procedures in cardiac surgery. This, however, has not come without its own complication risk and previous near misses have been reported with regard to various technical aspects of the cardiopulmonary bypass circuit. We present a case of a failed membrane oxygenator and discuss the real-life aspects to managing this complication without added risk to the patient.
Cardiopulmonary resuscitation (CPR) is an effective way to rescue patients with cardiac arrest (CA) whose incidence rate has been increasing with the increase of cardiovascular and cerebrovascular diseases in recent years. After 50 years of exploration and practice of CPR, the survival rate on discharge of CA is far from satisfactory. While more efforts are being made to perfect CPR approach, the experience should be summarized and the misunderstanding should be avoided. We suggest that the main misunderstanding of CPR lies in stereotyped CPR procedure, CPR ventilation, CPR compression, open chest cardiac massage, CPR access, CPR back veneer and time limit are not adaptable to practice. We should work out a better method to guide CPR application in clinical practice.%心脏骤停威胁人们的生命健康,且近年随着心脑血管疾病增加其发病率逐渐攀升,心肺复苏(cardiopulmonaryresuscitation,CPR)作为抢救心脏骤停的有效方法,经过50余年的探索实践,患者的生存出院率仍不理想,故在发掘完善新方法的同时,亦应不断总结经验教训,找出CPR进程中的误区,笔者认为当前临床主要存在CPR程序“刻板化”、CPR通气“死腔化”、CPR按压“形式化”、CPR开胸“概念化”、CPR通路“单一化”、CPR背板“无声化”及CPR时限“教条化”,并结合经验积极尝试修正,以指导临床正确把握并实施CPR.
Binder, Ronald K; Wonisch, Manfred; Corra, Ugo; Cohen-Solal, Alain; Vanhees, Luc; Saner, Hugo; Schmid, Jean-Paul
Determination of an 'anaerobic threshold' plays an important role in the appreciation of an incremental cardiopulmonary exercise test and describes prominent changes of blood lactate accumulation with increasing workload. Two lactate thresholds are discerned during cardiopulmonary exercise testing and used for physical fitness estimation or training prescription. A multitude of different terms are, however, found in the literature describing the two thresholds. Furthermore, the term 'anaerobic threshold' is synonymously used for both, the 'first' and the 'second' lactate threshold, bearing a great potential of confusion. The aim of this review is therefore to order terms, present threshold concepts, and describe methods for lactate threshold determination using a three-phase model with reference to the historical and physiological background to facilitate the practical application of the term 'anaerobic threshold'. PMID:19050438
Mastenbroek, Mirjam H; Sant, Jetske Van't; Versteeg, Henneke;
BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT......-defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic...... echocardiographic responders showed improvements in ventilatory efficiency during follow-up. Multivariable repeated measures analyses revealed that, besides reverse remodeling, New York Heart Association functional class II and good patient-reported health status before implantation were the most important...
Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C
Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR. PMID:26036317
Bell, Richard; Hanif, Faisal; Prasad, Padmini; Ahmad, Niaz
Here, we present a case of a deceased-donor kidney transplant. The brain-dead donor had received a massive blood transfusion during cardiopulmonary bypass, which lead to hemolysis, hemoglobinuria, acute kidney injury, and renal replacement therapy. The kidney appeared red after in situ flush. Postoperatively, the recipient developed delayed graft function. Protocol biopsy during the postoperative period revealed the widespread deposition of heme pigment in the renal tubules. Massive blood transfusion and cardiopulmonary bypass surgery are associated with hemolysis and heme pigment deposition in the renal tubules, which subsequently lead to acute kidney injury. Kidneys from such donors appear red and, while this does not preclude transplant, are likely to develop delayed graft function. PMID:26030717
Twenty dogs exposed by inhalation in the study, Toxicity of Inhaled 239PuO2 in Beagle Dogs, were evaluated for cardiopulmonary function. Another group of 10 dogs matched by age and sex, but not exposed to 239Pu, was also given the same cardiopulmonary function tests. The plutonium-exposed dogs were 7 or more years after exposure and ten of the dogs had clinical signs and pulmonary function values indicating radiation pneumonitis-pulmonary fibrosis. The occurrence of radiation pneumonitis-pulmonary fibrosis, a nonstochastic effect, over the same time period and range of lung doses as lung cancer, a stochastic effect, complicates the estimation of lung cancer risk for inhaled plutonium. 4 references, 4 figures, 2 tables
Lee, Young Hee; Oh, Kyung Joon; Kong, In Deok; Kim, Sung Hoon; Shinn, Jong Mock; Kim, Jong Heon; Yi, Dongsoo; Lee, Jin Hyeong; Chang, Jae Seung; Kim, Tae-ho; Kim, Eun Ju
Objective To evaluate the cardiopulmonary endurance of subjects with spinal cord injury by measuring the maximal oxygen consumption with varying degrees of spinal cord injury level, age, and regular exercise. Methods We instructed the subjects to perform exercises using arm ergometer on healthy adults at 20 years of age or older with spinal cord injury, and their maximal oxygen consumption (VO2max) was measured with a metabolic measurement system. The exercise proceeded stepwise according to ...
Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max
Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the perspective of medical experts and end-users. Objective: The study aims to assess the quality of current mobile apps for cardiopulmonary resuscitation (CPR) training and real incident support from exper...
Lati, Jamil; Pellow, Vanessa; Sproule, Jeannine; Brooks, Dina; Ellerton, Cindy
Purpose: To determine the interrater reliability (IRR) of the individual items in the Paediatric Cardiopulmonary Physiotherapy (CPT) Discharge Tool. This tool identifies six critical items that physiotherapists should consider when determining a paediatric patient's readiness for discharge from CPT after upper-abdominal, cardiac, or thoracic surgery: oxygen saturation, mobility, secretion retention, discharge planning, auscultation, and signs of respiratory distress. Methods: A total of 33 pa...
Mei Po Yip; Brandon Ong; Shin Ping Tu; Devora Chavez; Brooke Ike; Ian Painter; Ida Lam; Bradley, Steven M.; Coronado, Gloria D.; Meischke, Hendrika W.
Cardiopulmonary resuscitation (CPR) is an effective intervention for prehospital cardiac arrest. Despite all available training opportunities for CPR, disparities exist in participation in CPR training, CPR knowledge, and receipt of bystander CPR for certain ethnic groups. We conducted five focus groups with Chinese immigrants who self-reported limited English proficiency (LEP). A bilingual facilitator conducted all the sessions. All discussions were taped, recorded, translated, and trans...
Dal, Umran; Sarpkaya, Dilek
Objective : The aim of the study was to determine the cardiopulmonary resuscitation (CPR) knowledge and skill levels of nursing students in North Cyprus. Methods : The study design was quasi-experimental and longitudinal. A questionnaire was applied to the students before the CPR lecture. Then the students were informed about adult CPR by the researchers and all of the students practiced CPR on a Resusci-Anne manikin. One and six months after this training the same questionnaire and skills ch...
Jung, Jin Yong; Kim, Yeonbaek; Kim, Jung-Eun
The usefulness of using the bispectral index (BIS) for monitoring during cardiopulmonary resuscitation (CPR) is not clearly understood. However, BIS has been a popular anesthetic monitoring device used during operations. The case presented is of a pregnant woman going into cardiac arrest due to an amniotic fluid embolism during a Cesarean section. CPR was performed, but neither the return of spontaneous circulation (ROSC) nor the return of consciousness was achieved, despite 50 min of effecti...