Sample records for accurately reflect cardiac

  1. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    DEFF Research Database (Denmark)

    Westhall, Erik; Rossetti, Andrea O; van Rootselaar, Anne-Fleur;


    OBJECTIVE: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. METHODS: In this cohort study, 4 EEG specialists...... patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present...

  2. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest (United States)

    Rossetti, Andrea O.; van Rootselaar, Anne-Fleur; Wesenberg Kjaer, Troels; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Rosén, Ingmar; Åneman, Anders; Erlinge, David; Gasche, Yvan; Hassager, Christian; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matt P.; Cronberg, Tobias


    Objective: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. Methods: In this cohort study, 4 EEG specialists, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3–5 until 180 days. Results: Eight TTM sites randomized 202 patients. EEGs were recorded in 103 patients at a median 77 hours after cardiac arrest; 37% had a highly malignant EEG and all had a poor outcome (specificity 100%, sensitivity 50%). Any malignant EEG feature had a low specificity to predict poor prognosis (48%) but if 2 malignant EEG features were present specificity increased to 96% (p EEG was found in 1% of the patients with a poor outcome. Conclusions: Highly malignant EEG after rewarming reliably predicted poor outcome in half of patients without false predictions. An isolated finding of a single malignant feature did not predict poor outcome whereas a benign EEG was highly predictive of a good outcome. PMID:26865516

  3. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    DEFF Research Database (Denmark)

    Westhall, Erik; Rossetti, Andrea O; van Rootselaar, Anne-Fleur


    OBJECTIVE: To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. METHODS: In this cohort study, 4 EEG specialists......, blinded to outcome, evaluated prospectively recorded EEGs in the Target Temperature Management trial (TTM trial) that randomized patients to 33°C vs 36°C. Routine EEG was performed in patients still comatose after rewarming. EEGs were classified into highly malignant (suppression, suppression...... with periodic discharges, burst-suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of malignant features). Poor outcome was defined as best Cerebral Performance Category score 3-5 until 180 days. RESULTS: Eight TTM sites randomized 202...

  4. Apparatus designed for very accurate measurement of the optical reflection. (United States)

    Piombini, Hervé; Voarino, Philippe


    The described instrument is a new reflectometer designed to check the normal specular reflectance of 40,000 reflectors necessary for the Laser Megajoule (LMJ). This new reflectometer has a high accuracy over the 400-950 nm wavelength range and allows the delicate measurement of shaped parts. The measurements are relative and several reference mirrors, which are low loss dielectric mirrors [R(lambda)>99.9%], are used for the standardization. The apparatus gives an excellent repeatability (spectrophotometers, our facility and its components are described. The methodology of focusing and calibration are explained. The capabilities of our device are illustrated through some measurements realized on flat or shaped samples.

  5. Measuring solar reflectance Part I: Defining a metric that accurately predicts solar heat gain

    Energy Technology Data Exchange (ETDEWEB)

    Levinson, Ronnen; Akbari, Hashem; Berdahl, Paul


    Solar reflectance can vary with the spectral and angular distributions of incident sunlight, which in turn depend on surface orientation, solar position and atmospheric conditions. A widely used solar reflectance metric based on the ASTM Standard E891 beam-normal solar spectral irradiance underestimates the solar heat gain of a spectrally selective 'cool colored' surface because this irradiance contains a greater fraction of near-infrared light than typically found in ordinary (unconcentrated) global sunlight. At mainland U.S. latitudes, this metric RE891BN can underestimate the annual peak solar heat gain of a typical roof or pavement (slope {le} 5:12 [23{sup o}]) by as much as 89 W m{sup -2}, and underestimate its peak surface temperature by up to 5 K. Using R{sub E891BN} to characterize roofs in a building energy simulation can exaggerate the economic value N of annual cool-roof net energy savings by as much as 23%. We define clear-sky air mass one global horizontal ('AM1GH') solar reflectance R{sub g,0}, a simple and easily measured property that more accurately predicts solar heat gain. R{sub g,0} predicts the annual peak solar heat gain of a roof or pavement to within 2 W m{sup -2}, and overestimates N by no more than 3%. R{sub g,0} is well suited to rating the solar reflectances of roofs, pavements and walls. We show in Part II that R{sub g,0} can be easily and accurately measured with a pyranometer, a solar spectrophotometer or version 6 of the Solar Spectrum Reflectometer.

  6. Computational chemical imaging for cardiovascular pathology: chemical microscopic imaging accurately determines cardiac transplant rejection.

    Directory of Open Access Journals (Sweden)

    Saumya Tiwari

    Full Text Available Rejection is a common problem after cardiac transplants leading to significant number of adverse events and deaths, particularly in the first year of transplantation. The gold standard to identify rejection is endomyocardial biopsy. This technique is complex, cumbersome and requires a lot of expertise in the correct interpretation of stained biopsy sections. Traditional histopathology cannot be used actively or quickly during cardiac interventions or surgery. Our objective was to develop a stain-less approach using an emerging technology, Fourier transform infrared (FT-IR spectroscopic imaging to identify different components of cardiac tissue by their chemical and molecular basis aided by computer recognition, rather than by visual examination using optical microscopy. We studied this technique in assessment of cardiac transplant rejection to evaluate efficacy in an example of complex cardiovascular pathology. We recorded data from human cardiac transplant patients' biopsies, used a Bayesian classification protocol and developed a visualization scheme to observe chemical differences without the need of stains or human supervision. Using receiver operating characteristic curves, we observed probabilities of detection greater than 95% for four out of five histological classes at 10% probability of false alarm at the cellular level while correctly identifying samples with the hallmarks of the immune response in all cases. The efficacy of manual examination can be significantly increased by observing the inherent biochemical changes in tissues, which enables us to achieve greater diagnostic confidence in an automated, label-free manner. We developed a computational pathology system that gives high contrast images and seems superior to traditional staining procedures. This study is a prelude to the development of real time in situ imaging systems, which can assist interventionists and surgeons actively during procedures.

  7. Multivariate Criteria Most Accurately Distinguish Cardiac from Noncardiac Causes of Dyspnea. (United States)

    Ahmad, Mirza Nubair; Yusuf, Syed Hasan; Ullah, Rafath; Ahmad, Mirza Mujadil; Ellis, Mary K; Yousaf, Haroon; Paterick, Timothy E; Ammar, Khawaja Afzal


    Cardiopulmonary exercise testing provides oxygen pulse as a continuous measure of stroke volume, which is superior to other stress-testing methods in which systolic function is measured at baseline and at peak stress. However, the optimal peak oxygen pulse criterion for distinguishing cardiac from noncardiac causes of exercise limitation is unknown. In comparing several peak oxygen pulse criteria against the clinical standard of cardiopulmonary exercise testing, we retrospectively studied 54 consecutive patients referred for cardiopulmonary exercise testing. These exercise tests included measurement of oxygen consumption, carbon dioxide production, breathing reserve, arterial blood gases at baseline and at peak stress, exercise electrocardiogram, heart rate, and blood pressure response. Results were blindly interpreted and patients were categorized as members either of our Cardiac Group (abnormal result secondary to cardiac causes of exercise limitation) or of our Noncardiac Group (normal or abnormal result secondary to any noncardiac cause of exercise limitation). The accuracy of the peak oxygen pulse criteria ranged from 50% for univariate criterion (≤15 mL/beat), to 61% for oxygen pulse curve pattern, to 63% for bivariate criterion (≤15 mL/beat for men, ≤10 mL/beat for women), to as high as 81% for a multivariate criterion. All multivariate criteria outperformed oxygen pulse curve pattern, univariate, and bivariate criteria. This is the first study to evaluate the optimal peak oxygen pulse criterion for differentiating cardiac from noncardiac causes of exercise limitation. Multivariate criteria (especially a criterion incorporating age, sex, height, and weight) should be used preferentially, as opposed to the commonly used univariate and bivariate criteria.

  8. An efficient method for accurate segmentation of LV in contrast-enhanced cardiac MR images (United States)

    Suryanarayana K., Venkata; Mitra, Abhishek; Srikrishnan, V.; Jo, Hyun Hee; Bidesi, Anup


    Segmentation of left ventricle (LV) in contrast-enhanced cardiac MR images is a challenging task because of high variability in the image intensity. This is due to a) wash-in and wash-out of the contrast agent over time and b) poor contrast around the epicardium (outer wall) region. Current approaches for segmentation of the endocardium (inner wall) usually involve application of a threshold within the region of interest, followed by refinement techniques like active contours. A limitation of this method is under-segmentation of the inner wall because of gradual loss of contrast at the wall boundary. On the other hand, the challenge in outer wall segmentation is the lack of reliable boundaries because of poor contrast. There are four main contributions in this paper to address the aforementioned issues. First, a seed image is selected using variance based approach on 4D time-frame images over which initial endocardium and epicardium is segmented. Secondly, we propose a patch based feature which overcomes the problem of gradual contrast loss for LV endocardium segmentation. Third, we propose a novel Iterative-Edge-Refinement (IER) technique for epicardium segmentation. Fourth, we propose a greedy search algorithm for propagating the initial contour segmented on seed-image across other time frame images. We have experimented our technique on five contrast-enhanced cardiac MR Datasets (4D) having a total of 1097 images. The segmentation results for all 1097 images have been visually inspected by a clinical expert and have shown good accuracy.

  9. Standardization of vitrinite reflectance measurements in shale petroleum systems: How accurate are my Ro data? (United States)

    Hackley, Paul C.


    Vitrinite reflectance generally is considered the most robust thermal maturity parameter available for application to hydrocarbon exploration and petroleum system evaluation. However, until 2011 there was no standardized methodology available to provide guidelines for vitrinite reflectance measurements in shale. Efforts to correct this deficiency resulted in publication of ASTM D7708-11: Standard test method for microscopical determination of the reflectance of vitrinite dispersed in sedimentary rocks. In 2012-2013, an interlaboratory exercise was conducted to establish precision limits for the measurement technique. Six samples, representing a wide variety of shale, were tested in duplicate by 28 analysts in 22 laboratories from 14 countries. Samples ranged from immature to overmature (Ro 0.31-1.53%), from organic-rich to organic-lean (1-22 wt.% total organic carbon), and contained Type I (lacustrine), Type II (marine), and Type III (terrestrial) kerogens. Repeatability values (difference between repetitive results from same operator, same conditions) ranged from 0.03-0.11% absolute reflectance, whereas reproducibility values (difference between results obtained on same test material by different operators, different laboratories) ranged from 0.12-0.54% absolute reflectance. Repeatability and reproducibility degraded consistently with increasing maturity and decreasing organic content. However, samples with terrestrial kerogens (Type III) fell off this trend, showing improved levels of reproducibility due to higher vitrinite content and improved ease of identification. Operators did not consistently meet the reporting requirements of the test method, indicating that a common reporting template is required to improve data quality. The most difficult problem encountered was the petrographic distinction of solid bitumens and low-reflecting inert macerals from vitrinite when vitrinite occurred with reflectance ranges overlapping the other components. Discussion among

  10. Accurate wavelength prediction of photonic crystal resonant reflection and applications in refractive index measurement

    DEFF Research Database (Denmark)

    Hermannsson, Pétur Gordon; Vannahme, Christoph; Smith, Cameron L. C.


    and superstrate materials. The importance of accounting for material dispersion in order to obtain accurate simulation results is highlighted, and a method for doing so using an iterative approach is demonstrated. Furthermore, an application for the model is demonstrated, in which the material dispersion...... of a liquid is extracted from measured resonance wavelengths....

  11. Rapid and accurate estimation of blood saturation, melanin content, and epidermis thickness from spectral diffuse reflectance.



    We present a method to determine chromophore concentrations, blood saturation, and epidermal thickness of human skin from diffuse reflectance spectra. Human skin was approximated as a plane-parallel slab of variable thickness supported by a semi-infinite layer corresponding to the epidermis and dermis, respectively. The absorption coefficient was modeled as a function of melanin content for the epidermis and blood content and oxygen saturation for the dermis. The scattering coefficient and re...

  12. Cardiac troponins I and T: molecular markers for early diagnosis, prognosis, and accurate triaging of patients with acute myocardial infarction. (United States)

    Tiwari, Ram P; Jain, Anubhav; Khan, Zakir; Kohli, Veena; Bharmal, R N; Kartikeyan, S; Bisen, Prakash S


    Acute myocardial infarction (AMI) is the leading cause of death worldwide, with early diagnosis still being difficult. Promising new cardiac biomarkers such as troponins and creatine kinase (CK) isoforms are being studied and integrated into clinical practice for early diagnosis of AMI. The cardiac-specific troponins I and T (cTnI and cTnT) have good sensitivity and specificity as indicators of myocardial necrosis and are superior to CK and its MB isoenzyme (CK-MB) in this regard. Besides being potential biologic markers, cardiac troponins also provide significant prognostic information. The introduction of novel high-sensitivity troponin assays has enabled more sensitive and timely diagnosis or exclusion of acute coronary syndromes. This review summarizes the available information on the potential of troponins and other cardiac markers in early diagnosis and prognosis of AMI, and provides perspectives on future diagnostic approaches to AMI.

  13. Hydrogen sulfide detection based on reflection: from a poison test approach of ancient China to single-cell accurate localization. (United States)

    Kong, Hao; Ma, Zhuoran; Wang, Song; Gong, Xiaoyun; Zhang, Sichun; Zhang, Xinrong


    With the inspiration of an ancient Chinese poison test approach, we report a rapid hydrogen sulfide detection strategy in specific areas of live cells using silver needles with good spatial resolution of 2 × 2 μm(2). Besides the accurate-localization ability, this reflection-based strategy also has attractive merits of convenience and robust response when free pretreatment and short detection time are concerned. The success of endogenous H2S level evaluation in cellular cytoplasm and nuclear of human A549 cells promises the application potential of our strategy in scientific research and medical diagnosis.

  14. Pulse Densitometer Indocyanine Green Dilution Curves : A Simple Applicable and Accurate Method for Determination of Cardiac Shunts

    NARCIS (Netherlands)

    Bergstra, Arend; Hoendermis, Elke S.; Talsma, Melle D.; Mook, Gerrit A.; Zijlstra, Willem G.; Berger, Rolf M. F.


    Objective. Adequate hemodynamic evaluation is crucial in the management of patients with congenital heart disease. Although non-invasive diagnostic tools have reduced the need for invasive procedures, cardiac catheterization is still mandatory for absolute quantification of pressures, flows and vasc

  15. Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography: comparison with cine magnetic resonance imaging. (United States)

    Belge, Bénédicte; Coche, Emmanuel; Pasquet, Agnès; Vanoverschelde, Jean-Louis J; Gerber, Bernhard L


    Retrospective reconstruction of ECG-gated images at different parts of the cardiac cycle allows the assessment of cardiac function by multi-detector row CT (MDCT) at the time of non-invasive coronary imaging. We compared the accuracy of such measurements by MDCT to cine magnetic resonance (MR). Forty patients underwent the assessment of global and regional cardiac function by 16-slice MDCT and cine MR. Left ventricular (LV) end-diastolic and end-systolic volumes estimated by MDCT (134+/-51 and 67+/-56 ml) were similar to those by MR (137+/-57 and 70+/-60 ml, respectively; both P=NS) and strongly correlated (r=0.92 and r=0.95, respectively; both P<0.001). Consequently, LV ejection fractions by MDCT and MR were also similar (55+/-21 vs. 56+/-21%; P=NS) and highly correlated (r=0.95; P<0.001). Regional end-diastolic and end-systolic wall thicknesses by MDCT were highly correlated (r=0.84 and r=0.92, respectively; both P<0.001), but significantly lower than by MR (8.3+/-1.8 vs. 8.8+/-1.9 mm and 12.7+/-3.4 vs. 13.3+/-3.5 mm, respectively; both P<0.001). Values of regional wall thickening by MDCT and MR were similar (54+/-30 vs. 51+/-31%; P=NS) and also correlated well (r=0.91; P<0.001). Retrospectively gated MDCT can accurately estimate LV volumes, EF and regional LV wall thickening compared to cine MR.

  16. Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography. Comparison with cine magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Belge, Benedicte; Pasquet, Agnes; Vanoverschelde, Jean-Louis J. [Universite Catholique de Louvain, Division of Cardiology, Brussels (Belgium); Coche, Emmanuel [Universite Catholique de Louvain, Division of Radiology, Brussels (Belgium); Gerber, Bernhard L. [Universite Catholique de Louvain, Division of Cardiology, Brussels (Belgium); Cliniques Universitaires St. Luc UCL, Department of Cardiology, Woluwe St. Lambert (Belgium)


    Retrospective reconstruction of ECG-gated images at different parts of the cardiac cycle allows the assessment of cardiac function by multi-detector row CT (MDCT) at the time of non-invasive coronary imaging. We compared the accuracy of such measurements by MDCT to cine magnetic resonance (MR). Forty patients underwent the assessment of global and regional cardiac function by 16-slice MDCT and cine MR. Left ventricular (LV) end-diastolic and end-systolic volumes estimated by MDCT (134{+-}51 and 67{+-}56 ml) were similar to those by MR (137{+-}57 and 70{+-}60 ml, respectively; both P=NS) and strongly correlated (r=0.92 and r=0.95, respectively; both P<0.001). Consequently, LV ejection fractions by MDCT and MR were also similar (55{+-}21 vs. 56{+-}21%; P=NS) and highly correlated (r=0.95; P<0.001). Regional end-diastolic and end-systolic wall thicknesses by MDCT were highly correlated (r=0.84 and r=0.92, respectively; both P<0.001), but significantly lower than by MR (8.3{+-}1.8 vs. 8.8{+-}1.9 mm and 12.7{+-}3.4 vs. 13.3{+-}3.5 mm, respectively; both P<0.001). Values of regional wall thickening by MDCT and MR were similar (54{+-}30 vs. 51{+-}31%; P=NS) and also correlated well (r=0.91; P<0.001). Retrospectively gated MDCT can accurately estimate LV volumes, EF and regional LV wall thickening compared to cine MR. (orig.)

  17. Contribution of Occupational Therapy in cardiac rehabilitation: intervention, challenges and reflections

    Directory of Open Access Journals (Sweden)

    Alba Vila Paz


    Full Text Available Introduction: Cardiovascular disease increases the prevalence of disability and mortality in Western countries. In Spain, it is the main health problem of the adult population. Objective: To understand the professional role of Occupational Therapy in cardiac rehabilitation, in the different stages of intervention, as well as the standardized instruments currently available for evaluation. Method: Review and narrative analysis of the literature on Occupational Therapy and cardiac rehabilitation. The search in the Medline database did not locate any article; in the IME database, a study was identified. In addition, a manual search of articles, books and other academic works of relevance in this intervention area was conducted. Results: Regaining independence and autonomy in occupations and significant roles is the main goal of Occupational Therapy. The intervention follows a holistic paradigm, focused on achieving an active, healthy, social and productive life, according to the needs of each person. Individualized counselling and training actions include incorporating the principles of energy conservation, ergonomic analysis, simplification of tasks and the use of technology and environmental adaptations. In the evaluation of occupational performance, the therapist can use the generic scales FIM, Barthel and COPM in the absence of specific tools for this population; SF-36 is an important instrument to analyze quality of life. Conclusion: The relevance of OT in the promotion of autonomy argues the need to involve this professional in cardiac rehabilitation strategies, in order to promote educational and practical approaches focused on human occupation.

  18. Calcium Transients Closely Reflect Prolonged Action Potentials in iPSC Models of Inherited Cardiac Arrhythmia

    Directory of Open Access Journals (Sweden)

    C. Ian Spencer


    Full Text Available Long-QT syndrome mutations can cause syncope and sudden death by prolonging the cardiac action potential (AP. Ion channels affected by mutations are various, and the influences of cellular calcium cycling on LQTS cardiac events are unknown. To better understand LQTS arrhythmias, we performed current-clamp and intracellular calcium ([Ca2+]i measurements on cardiomyocytes differentiated from patient-derived induced pluripotent stem cells (iPS-CM. In myocytes carrying an LQT2 mutation (HERG-A422T, APs and [Ca2+]i transients were prolonged in parallel. APs were abbreviated by nifedipine exposure and further lengthened upon releasing intracellularly stored Ca2+. Validating this model, control iPS-CM treated with HERG-blocking drugs recapitulated the LQT2 phenotype. In LQT3 iPS-CM, expressing NaV1.5-N406K, APs and [Ca2+]i transients were markedly prolonged. AP prolongation was sensitive to tetrodotoxin and to inhibiting Na+-Ca2+ exchange. These results suggest that LQTS mutations act partly on cytosolic Ca2+ cycling, potentially providing a basis for functionally targeted interventions regardless of the specific mutation site.

  19. Cardiac reflections and natural vibrations: Force-frequency relation recording system in the stress echo lab

    Directory of Open Access Journals (Sweden)

    Pianelli Mascia


    Full Text Available Abstract Background The inherent ability of ventricular myocardium to increase its force of contraction in response to an increase in contraction frequency is known as the cardiac force-frequency relation (FFR. This relation can be easily obtained in the stress echo lab, where the force is computed as the systolic pressure/end-systolic volume index ratio, and measured for increasing heart rates during stress. Ideally, the noninvasive, imaging independent, objective assessment of FFR would greatly enhance its practical appeal. Objectives 1 – To evaluate the feasibility of the cardiac force measurement by a precordial cutaneous sensor. 2 – To build the curve of force variation as a function of the heart rate. 3 – To compare the standard stress echo results vs. this sensor operator-independent built FFR. Methods The transcutaneous force sensor was positioned in the precordial region in 88 consecutive patients referred for exercise, dipyridamole, or pacing stress. The force was measured as the myocardial vibrations amplitude in the isovolumic contraction period. FFR was computed as the curve of force variation as a function of heart rate. Standard echocardiographic FFR measurements were performed. Results A consistent FFR was obtained in all patients. Both the sensor built and the echo built FFR identifiy pts with normal or abnormal contractile reserve. The best cut-off value of the sensor built FFR was 15.5 g * 10-3 (Sensitivity = 0.85, Specificity = 0.77. Sensor built FFR slope and shape mirror pressure/volume relation during stress. This approach is extendable to daily physiological exercise and could be potentially attractive in home monitoring systems.

  20. Assessment of a sponge layer as a non-reflective boundary treatment with highly accurate gust-airfoil interaction results (United States)

    Crivellini, A.


    This paper deals with the numerical performance of a sponge layer as a non-reflective boundary condition. This technique is well known and widely adopted, but only recently have the reasons for a sponge failure been recognised, in analysis by Mani. For multidimensional problems, the ineffectiveness of the method is due to the self-reflections of the sponge occurring when it interacts with an oblique acoustic wave. Based on his theoretical investigations, Mani gives some useful guidelines for implementing effective sponge layers. However, in our opinion, some practical indications are still missing from the current literature. Here, an extensive numerical study of the performance of this technique is presented. Moreover, we analyse a reduced sponge implementation characterised by undamped partial differential equations for the velocity components. The main aim of this paper relies on the determination of the minimal width of the layer, as well as of the corresponding strength, required to obtain a reflection error of no more than a few per cent of that observed when solving the same problem on the same grid, but without employing the sponge layer term. For this purpose, a test case of computational aeroacoustics, the single airfoil gust response problem, has been addressed in several configurations. As a direct consequence of our investigation, we present a well documented and highly validated reference solution for the far-field acoustic intensity, a result that is not well established in the literature. Lastly, the proof of the accuracy of an algorithm for coupling sub-domains solved by the linear and non-liner Euler governing equations is given. This result is here exploited to adopt a linear-based sponge layer even in a non-linear computation.

  1. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Shi Joon; Im, Chung Gie; Yeon, Kyung Mo; Hasn, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

  2. Cardiac sodium channelopathies

    NARCIS (Netherlands)

    Amin, A.S.; Asghari-Roodsari, A.; Tan, H.L.


    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward depolarizing current (I-Na) during phase 0 of the cardiac action potential. The importance of I-Na for normal cardiac electrical activity is reflected by the high incidence of

  3. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    DEFF Research Database (Denmark)

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig


    -hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition...... of myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence...... intervention was successful in 68% versus 36% (PECG is a suboptimal diagnostic tool to predict STEMI...

  4. Cardiac cameras. (United States)

    Travin, Mark I


    Cardiac imaging with radiotracers plays an important role in patient evaluation, and the development of suitable imaging instruments has been crucial. While initially performed with the rectilinear scanner that slowly transmitted, in a row-by-row fashion, cardiac count distributions onto various printing media, the Anger scintillation camera allowed electronic determination of tracer energies and of the distribution of radioactive counts in 2D space. Increased sophistication of cardiac cameras and development of powerful computers to analyze, display, and quantify data has been essential to making radionuclide cardiac imaging a key component of the cardiac work-up. Newer processing algorithms and solid state cameras, fundamentally different from the Anger camera, show promise to provide higher counting efficiency and resolution, leading to better image quality, more patient comfort and potentially lower radiation exposure. While the focus has been on myocardial perfusion imaging with single-photon emission computed tomography, increased use of positron emission tomography is broadening the field to include molecular imaging of the myocardium and of the coronary vasculature. Further advances may require integrating cardiac nuclear cameras with other imaging devices, ie, hybrid imaging cameras. The goal is to image the heart and its physiological processes as accurately as possible, to prevent and cure disease processes.

  5. Patients without myocardial accumulation of {sup 123}I-metaiodobenzylguanidine. Does it always reflect cardiac adrenergic dysfunction?

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Honda, Minoru; Hohjoh, Osamu [Sumitomo Hospital, Osaka (Japan)


    Since December 1992 to March 1994, we have performed myocardial imaging with {sup 123}I-metaiodobenzylguanidine ({sup 123}I-MIBG) in 110 patients to examine myocardial sympathetic integrity. Among them 11 patients (10%) showed no accumulation of {sup 123}I-MIBG in the heart. So we have examined the mechanisms of no myocardial {sup 123}I-MIBG accumulation. {sup 123}I-MIBG imaging was obtained at 20 min and 3 h after intravenous injection of {sup 123}I-MIBG (148 MBq) at rest. In addition to routine tomography, anterior planar imaging of the heart and the whole body imaging were performed. Eleven patients without myocardial {sup 123}I-MIBG accumulation consisted of 5 patients with orthostatic hypotension (including 3 patients with diabetic neuropathy). four patients with hypertrophic cardiomyopathy (HCM), one patient with hypertension and one normal subject. In patients with orthostatic hypotension, standing test showed cardiac sympathetic dysfunction. In addition to no myocardial {sup 123}I-MIBG accumulation, accumulation of {sup 123}I-MIBG in the salivary glands was not found in all them. These indicated that in patients with orthostatic hypotension, generalized sympathetic dysfunction caused no myocardial {sup 123}I-MIBG accumulation. But in other 6 patients there was no evidence which suggested the cardiac sympathetic nerve dysfunction. Age, sex, serum norepinephrine level, myocardial perfusion and the medication were not different between the patients with and without myocardial {sup 123}I-MIBG accumulation. So the mechanism of no myocardial {sup 123}I-MIBG accumulation was not clear in these patients. But it was noteworthy that in patients with HCM, no myocardial {sup 123}I-MIBG accumulation appeared in 17% (4/24), and the frequency of no myocardial {sup 123}I-MIBG accumulation in HCM was significantly (p<0.05) higher than in other disease entities when patients with orthostatic hypotension were excluded. (author).

  6. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

    LENUS (Irish Health Repository)

    Phelan, Dermot


    In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g\\/m(2), p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

  7. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

    Directory of Open Access Journals (Sweden)

    Dermot Phelan

    Full Text Available In asymptomatic subjects B-type natriuretic peptide (BNP is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS and peripheral serum from patients with low (n = 14 and high BNP (n = 27. Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001. CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008, CITP (r = 0.35, p = 0.03 and PIIINP (r = 0.35, p = 0.001, and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002, IL-6 (r = 0.35, p = 0.04, and IL-8 (r = 0.54, p<0.001. The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007, TNF-α (3.2±0.5 versus 3.7±1.1, p = 003, IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02 and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04, and greater left ventricular mass index (97±20 versus 118±26 g/m(2, p = 0.03 and left atrial volume index (18±2 versus 21±4, p = 0.008. Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

  8. CLARREO Cornerstone of the Earth Observing System: Measuring Decadal Change Through Accurate Emitted Infrared and Reflected Solar Spectra and Radio Occultation (United States)

    Sandford, Stephen P.


    The Climate Absolute Radiance and Refractivity Observatory (CLARREO) is one of four Tier 1 missions recommended by the recent NRC Decadal Survey report on Earth Science and Applications from Space (NRC, 2007). The CLARREO mission addresses the need to provide accurate, broadly acknowledged climate records that are used to enable validated long-term climate projections that become the foundation for informed decisions on mitigation and adaptation policies that address the effects of climate change on society. The CLARREO mission accomplishes this critical objective through rigorous SI traceable decadal change observations that are sensitive to many of the key uncertainties in climate radiative forcings, responses, and feedbacks that in turn drive uncertainty in current climate model projections. These same uncertainties also lead to uncertainty in attribution of climate change to anthropogenic forcing. For the first time CLARREO will make highly accurate, global, SI-traceable decadal change observations sensitive to the most critical, but least understood, climate forcings, responses, and feedbacks. The CLARREO breakthrough is to achieve the required levels of accuracy and traceability to SI standards for a set of observations sensitive to a wide range of key decadal change variables. The required accuracy levels are determined so that climate trend signals can be detected against a background of naturally occurring variability. Climate system natural variability therefore determines what level of accuracy is overkill, and what level is critical to obtain. In this sense, the CLARREO mission requirements are considered optimal from a science value perspective. The accuracy for decadal change traceability to SI standards includes uncertainties associated with instrument calibration, satellite orbit sampling, and analysis methods. Unlike most space missions, the CLARREO requirements are driven not by the instantaneous accuracy of the measurements, but by accuracy in

  9. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)


    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  10. Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    S. de Hoogd (Sjoerd); S.J.G.M. Ahlers (Sabine); E.H.P.A. van Dongen (Eric); D. Tibboel (Dick); A. Dahan (Albert); C.A.J. Knibbe (Catherijne)


    textabstractBackground: Chronic thoracic pain after cardiac surgery is prevalent (11 to 56%) and may affect patients' physical and mental health status. Despite its favorable pharmacokinetic and pharmacodynamic properties, high doses of remifentanil administered during surgery are reported to cause

  11. Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

    LENUS (Irish Health Repository)

    O'Donnell, David H


    OBJECTIVE: This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION: Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

  12. [Basic standards for a department of cardiac surgery. Quality requirements for the care of cardiac patients in connection with operations on the heart, the heart vessels and thoracic organ transplantation]. (United States)

    Beckmann, Andreas; Beyersdorf, F; Diegeler, A; Mohr, F W; Welz, A; Rein, J-G; Cremer, J


    Current evolutions and substantial amendments of the German health care system in combination with distinguished progress in cardiac surgery over the past years require both a reflection of principles in patient-centered care and an update of basic standard requirements for a department of cardiac surgery in Germany. In due consideration of the data from the voluntary registry of the German Society for Thoracic and Cardiovascular Surgery, this article accurately defines core requirements for a cardiac surgical department (cardiac surgery on-site), subdivided into facilities, staff and processes. If based on these standards, one may anticipate that cardiac surgical care is performed under appropriate conditions leading to an intrinsic benefit for patients.

  13. Cardiac arrest (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  14. Structural and functional screening in human induced-pluripotent stem cell-derived cardiomyocytes accurately identifies cardiotoxicity of multiple drug types

    Energy Technology Data Exchange (ETDEWEB)

    Doherty, Kimberly R., E-mail:; Talbert, Dominique R.; Trusk, Patricia B.; Moran, Diarmuid M.; Shell, Scott A.; Bacus, Sarah


    Safety pharmacology studies that evaluate new drug entities for potential cardiac liability remain a critical component of drug development. Current studies have shown that in vitro tests utilizing human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CM) may be beneficial for preclinical risk evaluation. We recently demonstrated that an in vitro multi-parameter test panel assessing overall cardiac health and function could accurately reflect the associated clinical cardiotoxicity of 4 FDA-approved targeted oncology agents using hiPS-CM. The present studies expand upon this initial observation to assess whether this in vitro screen could detect cardiotoxicity across multiple drug classes with known clinical cardiac risks. Thus, 24 drugs were examined for their effect on both structural (viability, reactive oxygen species generation, lipid formation, troponin secretion) and functional (beating activity) endpoints in hiPS-CM. Using this screen, the cardiac-safe drugs showed no effects on any of the tests in our panel. However, 16 of 18 compounds with known clinical cardiac risk showed drug-induced changes in hiPS-CM by at least one method. Moreover, when taking into account the Cmax values, these 16 compounds could be further classified depending on whether the effects were structural, functional, or both. Overall, the most sensitive test assessed cardiac beating using the xCELLigence platform (88.9%) while the structural endpoints provided additional insight into the mechanism of cardiotoxicity for several drugs. These studies show that a multi-parameter approach examining both cardiac cell health and function in hiPS-CM provides a comprehensive and robust assessment that can aid in the determination of potential cardiac liability. - Highlights: • 24 drugs were tested for cardiac liability using an in vitro multi-parameter screen. • Changes in beating activity were the most sensitive in predicting cardiac risk. • Structural effects add in

  15. Cardiac Sarcoidosis. (United States)

    Birnie, David; Ha, Andrew C T; Gula, Lorne J; Chakrabarti, Santabhanu; Beanlands, Rob S B; Nery, Pablo


    Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.

  16. Towards robust specularity detection and inpainting in cardiac images (United States)

    Alsaleh, Samar M.; Aviles, Angelica I.; Sobrevilla, Pilar; Casals, Alicia; Hahn, James


    Computer-assisted cardiac surgeries had major advances throughout the years and are gaining more popularity over conventional cardiac procedures as they offer many benefits to both patients and surgeons. One obvious advantage is that they enable surgeons to perform delicate tasks on the heart while it is still beating, avoiding the risks associated with cardiac arrest. Consequently, the surgical system needs to accurately compensate the physiological motion of the heart which is a very challenging task in medical robotics since there exist different sources of disturbances. One of which is the bright light reflections, known as specular highlights, that appear on the glossy surface of the heart and partially occlude the field of view. This work is focused on developing a robust approach that accurately detects and removes those highlights to reduce their disturbance to the surgeon and the motion compensation algorithm. As a first step, we exploit both color attributes and Fuzzy edge detector to identify specular regions in each acquired image frame. These two techniques together work as restricted thresholding and are able to accurately identify specular regions. Then, in order to eliminate the specularity artifact and give the surgeon a better perception of the heart, the second part of our solution is dedicated to correct the detected regions using inpainting to propagate and smooth the results. Our experimental results, which we carry out in realistic datasets, reveal how efficient and precise the proposed solution is, as well as demonstrate its robustness and real-time performance.

  17. Cardiac transplantation in Friedreich ataxia. (United States)

    Yoon, Grace; Soman, Teesta; Wilson, Judith; George, Kristen; Mital, Seema; Dipchand, Anne I; McCabe, Jane; Logan, William; Kantor, Paul


    In this article, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurological disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac transplantation.

  18. Cardiac Transplantation in Friedreich Ataxia


    Yoon, Grace; Soman, Teesta; Wilson, Judith; George, Kristen; Mital, Seema; Dipchand, Anne I; McCabe, Jane; Logan, William; Kantor, Paul


    In this paper, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurologic disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac ...

  19. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.


    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  20. Cardiac Rehabilitation (United States)

    ... your risk of future heart problems, and to improve your health and quality of life. Cardiac rehabilitation programs increase ... exercise routine at home or at a local gym. You may also continue to ... health concerns. Education about nutrition, lifestyle and weight loss ...

  1. Cardiac Calcification

    Directory of Open Access Journals (Sweden)

    Morteza Joorabian


    Full Text Available There is a spectrum of different types of cardiac"ncalcifications with the importance and significance"nof each type of cardiac calcification, especially"ncoronary artery calcification. Radiologic detection of"ncalcifications within the heart is quite common. The"namount of coronary artery calcification correlates"nwith the severity of coronary artery disease (CAD."nCalcification of the aortic or mitral valve may indicate"nhemodynamically significant valvular stenosis."nMyocardial calcification is a sign of prior infarction,"nwhile pericardial calcification is strongly associated"nwith constrictive pericarditis. A spectrum of different"ntypes of cardiac calcifications (linear, annular,"ncurvilinear,... could be seen in chest radiography and"nother imaging modalities. So a carful inspection for"ndetection and reorganization of these calcifications"nshould be necessary. Numerous modalities exist for"nidentifying coronary calcification, including plain"nradiography, fluoroscopy, intravascular ultrasound,"nMRI, echocardiography, and conventional, helical and"nelectron-beam CT (EBCT. Coronary calcifications"ndetected on EBCT or helical CT can be quantifie,"nand a total calcification score (Cardiac Calcification"nScoring may be calculated. In an asymptomatic"npopulation and/or patients with concomitant risk"nfactors like diabetes mellitus, determination of the"npresence of coronary calcifications identifies the"npatients at risk for future myocardial infarction and"ncoronary artery disease. In patients without coronary"ncalcifications, future cardiovascular events could"nbe excluded. Therefore, detecting and recognizing"ncalcification related to the heart on chest radiography"nand other imaging modalities such as fluoroscopy, CT"nand echocardiography may have important clinical"nimplications.

  2. Reflecting reflection in supervision

    DEFF Research Database (Denmark)

    Lystbæk, Christian Tang

    Reflection has moved from the margins to the mainstream in supervision. Notions of reflection have become well established since the late 1980s. These notions have provided useful framing devices to help conceptualize some important processes in guidance and counseling. However, some applications...

  3. Cardiac Sarcoidosis (United States)

    ... as well as chemicals that control inflammation (called cytokines) have also been linked to sarcoidosis. How can ... accurate in only 63% cases. What is the Treatment? Controversy exists as to the best treatment for ...

  4. Cardiac sympathetic imaging with mIBG in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Mortensen, Christian; Bendtsen, Flemming


    Autonomic and cardiac dysfunction is frequent in cirrhosis and includes increased sympathetic nervous activity, impaired heart rate variability (HRV), and baroreflex sensitivity (BRS). Quantified (123)I-metaiodobenzylguanidine (mIBG) scintigraphy reflects cardiac noradrenaline uptake, and in pati...

  5. Speaking Fluently And Accurately

    Institute of Scientific and Technical Information of China (English)



    Even after many years of study,students make frequent mistakes in English. In addition, many students still need a long time to think of what they want to say. For some reason, in spite of all the studying, students are still not quite fluent.When I teach, I use one technique that helps students not only speak more accurately, but also more fluently. That technique is dictations.

  6. Cardiac MRI in Athletes

    NARCIS (Netherlands)

    Luijkx, T.


    Cardiac magnetic resonance imaging (CMR) is often used in athletes to image cardiac anatomy and function and is increasingly requested in the context of screening for pathology that can cause sudden cardiac death (SCD). In this thesis, patterns of cardiac adaptation to sports are investigated with C

  7. Reflective Teaching (United States)

    Farrell, Thomas S. C.


    Thomas Farrell's "Reflective Teaching" outlines four principles that take teachers from just doing reflection to making it a way of being. Using the four principles, Reflective Practice Is Evidence Based, Reflective Practice Involves Dialogue, Reflective Practice Links Beliefs and Practices, and Reflective Practice Is a Way of Life,…

  8. Modelflow underestimates cardiac output in heat-stressed individuals

    DEFF Research Database (Denmark)

    Shibasaki, Manabu; Wilson, Thad E; Bundgaard-Nielsen, Morten


    An estimation of cardiac output can be obtained from arterial pressure waveforms using the Modelflow method. However, whether the assumptions associated with Modelflow calculations are accurate during whole body heating is unknown. This project tested the hypothesis that cardiac output obtained v...

  9. Cardiac output measurement : evaluation of methods in ICU patients

    NARCIS (Netherlands)

    Wilde, Robert Bernard Pieter de


    Accurate clinical assessment of the circulatory status is particular desirable in critically ill patients in the intensive care unit (ICU) and patients undergoing cardiac, thoracic, or vascular interventions. As the patient’s haemodynamic status may change rapidly, continuous monitoring of cardiac o

  10. Cardiac MRI and CT features of inheritable and congenital conditions associated with sudden cardiac death

    Energy Technology Data Exchange (ETDEWEB)

    Sparrow, Patrick; Merchant, Naeem; Provost, Yves; Doyle, Deirdre; Nguyen, Elsie; Paul, Narinder [University Health Network and Mount Sinai Hospital, Division of Cardiothoracic Imaging, Department of Medical Imaging, Toronto, Ontario (Canada)


    Cardiac MRI (CMR) and electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) are increasingly important tools in the identification and assessment of cardiac-related disease processes, including those associated with sudden cardiac death (SCD). While the commonest cause of SCD is coronary artery disease (CAD), in patients under 35 years inheritable cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy are important aetiologies. CMR in particular offers both accurate delineation of the morphological abnormalities associated with these and other conditions and the possibility for risk stratification for development of ventricular arrhythmias with demonstration of macroscopic scar by delayed enhancement imaging with intravenous gadolinium. (orig.)

  11. Cardiac tamponade (image) (United States)

    Cardiac tamponade is a condition involving compression of the heart caused by blood or fluid accumulation in the space ... they cannot adequately fill or pump blood. Cardiac tamponade is an emergency condition that requires hospitalization.

  12. What Is Cardiac Rehabilitation? (United States)

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  13. Effects of Aesthetic Chills on a Cardiac Signature of Emotionality.

    Directory of Open Access Journals (Sweden)

    Maria Sumpf

    Full Text Available Previous studies have shown that a cardiac signature of emotionality (referred to as EK, which can be computed from the standard 12 lead electrocardiogram, ECG, predicts inter-individual differences in the tendency to experience and express positive emotion. Here, we investigated whether EK values can be transiently modulated during stimulation with participant-selected music pieces and film scenes that elicit strongly positive emotion.The phenomenon of aesthetic chills, as indicated by measurable piloerection on the forearm, was used to accurately locate moments of peak emotional responses during stimulation. From 58 healthy participants, continuous EK values, heart rate, and respiratory frequency were recorded during stimulation with film scenes and music pieces, and were related to the aesthetic chills. EK values, as well as heart rate, increased significantly during moments of peak positive emotion accompanied by piloerection.These results are the first to provide evidence for an influence of momentary psychological state on a cardiac signature of emotional personality (as reflected in EK values. The possibility to modulate ECG amplitude signatures via stimulation with emotionally significant music pieces and film scenes opens up new perspectives for the use of emotional peak experiences in the therapy of disorders characterized by flattened emotionality, such as depression or schizoid personality disorder.

  14. Effects of Aesthetic Chills on a Cardiac Signature of Emotionality (United States)

    Sumpf, Maria; Jentschke, Sebastian; Koelsch, Stefan


    Background Previous studies have shown that a cardiac signature of emotionality (referred to as EK, which can be computed from the standard 12 lead electrocardiogram, ECG), predicts inter-individual differences in the tendency to experience and express positive emotion. Here, we investigated whether EK values can be transiently modulated during stimulation with participant-selected music pieces and film scenes that elicit strongly positive emotion. Methodology/Principal Findings The phenomenon of aesthetic chills, as indicated by measurable piloerection on the forearm, was used to accurately locate moments of peak emotional responses during stimulation. From 58 healthy participants, continuous EK values, heart rate, and respiratory frequency were recorded during stimulation with film scenes and music pieces, and were related to the aesthetic chills. EK values, as well as heart rate, increased significantly during moments of peak positive emotion accompanied by piloerection. Conclusions/Significance These results are the first to provide evidence for an influence of momentary psychological state on a cardiac signature of emotional personality (as reflected in EK values). The possibility to modulate ECG amplitude signatures via stimulation with emotionally significant music pieces and film scenes opens up new perspectives for the use of emotional peak experiences in the therapy of disorders characterized by flattened emotionality, such as depression or schizoid personality disorder. PMID:26083383

  15. Cardiac troponin testing in idiopathic inflammatory myopathies and systemic sclerosis-spectrum disorders: biomarkers to distinguish between primary cardiac involvement and low-grade skeletal muscle disease activity. (United States)

    Hughes, Michael; Lilleker, James B; Herrick, Ariane L; Chinoy, Hector


    Primary cardiac involvement, an under-recognised manifestation of the idiopathic inflammatory myopathies (IIM) and systemic sclerosis (SSc)-spectrum disorders, is associated with significant mortality. Within these two conditions, traditional skeletal muscle enzyme testing may not effectively distinguish between skeletal and cardiac muscle involvement, especially in patients with subclinical cardiac disease. Accurate biomarkers are thus required to screen for cardiac disease, to better inform both therapeutic decision-making and treatment response. The widespread uptake of cardiac troponin testing has revolutionised the management of acute coronary syndromes. While cardiac troponin I (cTnI) appears specific to the myocardium, cardiac troponin T (cTnT) is also expressed by skeletal muscle, including regenerating skeletal muscle tissue. There is increasing interest about the role of cardiac troponins as a putative biomarker of primary cardiac involvement in IIM and SSc-spectrum disorders. Herewith we discuss subclinical cardiac disease in IIM and SSc-spectrum disorders, the respective roles of cTnI and cTnT testing, and the re-expression of cTnT within regenerating skeletal muscle tissue. There remains wide variation in access to cardiac troponin testing nationally and internationally. We propose two pragmatic clinical pathways using cardiac troponins, preferably measuring concomitant cTnT followed by confirmatory (cardiac) cTnI to screen patients for subclinical cardiac disease and/or low-grade skeletal muscle disease activity, and also an agenda for future research.

  16. Mechanisms of cardiac pain. (United States)

    Foreman, Robert D; Garrett, Kennon M; Blair, Robert W


    Angina pectoris is cardiac pain that typically is manifested as referred pain to the chest and upper left arm. Atypical pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred cardiac pain. Spinal cardiac afferent fibers mediate typical anginal pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal cardiac afferent fibers likely mediate atypical anginal pain and contribute to cardiac ischemia without accompanying pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate cardiac nociception. Sensory input from other visceral organs can mimic cardiac pain due to convergence of this input with cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish cardiac pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with cardiac pain.

  17. A review: trichloroethylene metabolites: potential cardiac teratogens. (United States)

    Johnson, P D; Dawson, B V; Goldberg, S J


    This review is a a series of the authors' studies designed to test the hypothesis that administration of trichloroethylene (TCE), dichloroethylene (DCE), their metabolites, and related compounds are responsible for fetal cardiac teratogenesis when given to pregnant rats during organogenesis. Identification of teratogenic compounds will allow more accurate assessment of environmental contaminants and public health risks. Epidemiologic studies and previous teratogenic studies using chick embryos and fetal rats have reported an increased number of congenital cardiac defects when exposed to TCE or DCE during fetal development. Metabolites of TCE and DCE studied in the drinking-water exposure study include trichloroacetic acid TCAA), monochloroacetic acid, trichloroethanol, carboxymethylcysteine, trichloroacetaldehyde, dichloroacetaldehyde, and dichlorovinyl cysteine. Varying doses of each were given in drinking water to pregnant rats during the period of fetal heart development. Rats receiving 2730 ppm TCAA in drinking water were the only metabolite group demonstrating a significant increase in the number of cardiac defects in fetuses on a per-litter basis (p = 0.0004 Wilcoxon test and p =0.0015 exact permutation test). Maternal and fetal variables showed no statistically significant differences between treated and untreated groups. When treated with TCAA the increased cardiac defects, as compared to controls, do not preclude the involvement of other metabolites as cardiac teratogens, but indicates TCAA as a specific cardiac teratogen. Further studies of drinking-water exposure and potential mechanisms of action on the developing heart are proceeding.

  18. Reflective Writing

    DEFF Research Database (Denmark)

    Ahrenkiel Jørgensen, Andriette


    Høeg etetera. The dialogues work as a tool of reflection in terms of providing opportunity to examine his own beliefs, to explore the possible reasons for engaging in a particular activity. On the basis of Sven-Ingvar Andersson’s book a teaching program at the Aarhus School of Architecture provides...... a contribution to the discussions about the role of reflection in design work and in learning situations at large. By engaging with the dialogic reflection, which is one of the four essential types of reflection, (the three others being descriptive writing, descriptive reflection and critical reflection...

  19. Cardiac Imaging System (United States)


    Although not available to all patients with narrowed arteries, balloon angioplasty has expanded dramatically since its introduction with an estimated further growth to 562,000 procedures in the U.S. alone by 1992. Growth has fueled demand for higher quality imaging systems that allow the cardiologist to be more accurate and increase the chances of a successful procedure. A major advance is the Digital Cardiac Imaging (DCI) System designed by Philips Medical Systems International, Best, The Netherlands and marketed in the U.S. by Philips Medical Systems North America Company. The key benefit is significantly improved real-time imaging and the ability to employ image enhancement techniques to bring out added details. Using a cordless control unit, the cardiologist can manipulate images to make immediate assessment, compare live x-ray and roadmap images by placing them side-by-side on monitor screens, or compare pre-procedure and post procedure conditions. The Philips DCI improves the cardiologist's precision by expanding the information available to him.

  20. Predictors for severe cardiac complications after hematopoietic stem cell transplantation. (United States)

    Sakata-Yanagimoto, M; Kanda, Y; Nakagawa, M; Asano-Mori, Y; Kandabashi, K; Izutsu, K; Imai, Y; Hangaishi, A; Kurokawa, M; Tsujino, S; Ogawa, S; Chiba, S; Motokura, T; Hirai, H


    The value of pre-transplant factors for predicting the development of cardiac complications after transplantation has been inconsistent among studies. We analyzed the impact of pre-transplant factors on the incidence of severe cardiac complications in 164 hematopoietic stem cell transplant recipients. We identified eight patients (4.8%) who experienced grade III or IV cardiac complications according to the Bearman criteria. Seven died of cardiac causes a median of 3 days after the onset of cardiac complications. On univariate analysis, both the cumulative dose of anthracyclines and the use of anthracyclines within 60 days before transplantation affected the incidence of severe cardiac complications (P=0.0091 and 0.011). The dissociation of heart rate and body temperature, which reflects "relative tachycardia", was also associated with a higher incidence of cardiac complications (P=0.024). None of the variables obtained by electrocardiography or echocardiography were useful for predicting cardiac complications after transplantation, although the statistical power might not be sufficient to detect the usefulness of ejection fraction. On a multivariate analysis, the cumulative dose of anthracyclines was the only independent significant risk factor for severe cardiac complications. We conclude that the cumulative dose of anthracyclines is the most potent predictor of cardiac complications and the administration of anthracyclines should be avoided within two months before transplantation.

  1. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan


    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  2. Reflected Glory (United States)


    The nebula Messier 78 takes centre stage in this image taken with the Wide Field Imager on the MPG/ESO 2.2-metre telescope at the La Silla Observatory in Chile, while the stars powering the bright display take a backseat. The brilliant starlight ricochets off dust particles in the nebula, illuminating it with scattered blue light. Igor Chekalin was the overall winner of ESO's Hidden Treasures 2010 astrophotography competition with his image of this stunning object. Messier 78 is a fine example of a reflection nebula. The ultraviolet radiation from the stars that illuminate it is not intense enough to ionise the gas to make it glow - its dust particles simply reflect the starlight that falls on them. Despite this, Messier 78 can easily be observed with a small telescope, being one of the brightest reflection nebulae in the sky. It lies about 1350 light-years away in the constellation of Orion (The Hunter) and can be found northeast of the easternmost star of Orion's belt. This new image of Messier 78 from the MPG/ESO 2.2-metre telescope at the La Silla Observatory is based on data selected by Igor Chekalin in his winning entry to the Hidden Treasures competition [1]. The pale blue tint seen in the nebula in this picture is an accurate representation of its dominant colour. Blue hues are commonly seen in reflection nebulae because of the way the starlight is scattered by the tiny dust particles that they contain: the shorter wavelength of blue light is scattered more efficiently than the longer wavelength red light. This image contains many other striking features apart from the glowing nebula. A thick band of obscuring dust stretches across the image from the upper left to the lower right, blocking the light from background stars. In the bottom right corner, many curious pink structures are also visible, which are created by jets of material being ejected from stars that have recently formed and are still buried deep in dust clouds. Two bright stars, HD 38563A and

  3. Marketing cardiac CT programs. (United States)

    Scott, Jason


    There are two components of cardiac CT discussed in this article: coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA).The distinctive advantages of each CT examination are outlined. In order to ensure a successful cardiac CT program, it is imperative that imaging facilities market their cardiac CT practices effectively in order to gain a competitive advantage in this valuable market share. If patients receive quality care by competent individuals, they are more likely to recommend the facility's cardiac CT program. Satisfied patients will also be more willing to come back for any further testing.

  4. Cardiac expression of microsomal triglyceride transfer protein is increased in obesity and serves to attenuate cardiac triglyceride accumulation.

    Directory of Open Access Journals (Sweden)

    Emil D Bartels

    Full Text Available Obesity causes lipid accumulation in the heart and may lead to lipotoxic heart disease. Traditionally, the size of the cardiac triglyceride pool is thought to reflect the balance between uptake and beta-oxidation of fatty acids. However, triglycerides can also be exported from cardiomyocytes via secretion of apolipoproteinB-containing (apoB lipoproteins. Lipoprotein formation depends on expression of microsomal triglyceride transfer protein (MTP; the mouse expresses two isoforms of MTP, A and B. Since many aspects of the link between obesity-induced cardiac disease and cardiac lipid metabolism remain unknown, we investigated how cardiac lipoprotein synthesis affects cardiac expression of triglyceride metabolism-controlling genes, insulin sensitivity, and function in obese mice. Heart-specific ablation of MTP-A in mice using Cre-loxP technology impaired upregulation of MTP expression in response to increased fatty acid availability during fasting and fat feeding. This resulted in cardiac triglyceride accumulation but unaffected cardiac insulin-stimulated glucose uptake. Long-term fat-feeding of male C57Bl/6 mice increased cardiac triglycerides, induced cardiac expression of triglyceride metabolism-controlling genes and attenuated heart function. Abolishing cardiac triglyceride accumulation in fat-fed mice by overexpression of an apoB transgene in the heart prevented the induction of triglyceride metabolism-controlling genes and improved heart function. The results suggest that in obesity, the physiological increase of cardiac MTP expression serves to attenuate cardiac triglyceride accumulation albeit without major effects on cardiac insulin sensitivity. Nevertheless, the data suggest that genetically increased lipoprotein secretion prevents development of obesity-induced lipotoxic heart disease.

  5. Blunt cardiac rupture in patient with liver laceration

    Institute of Scientific and Technical Information of China (English)

    王文林; 曾伟生; 蒋仁超


    The early diagnosis of cardiac rupture is one of the key factors for a successful outcome. However, the accurate diagnosis is often difficult in the early stage of injury, especially when some obvious severe wounds are found in other regions of the body,1,2 for they are easy to disguise the symptom of the heart. We report a case with cardiac rupture and liver trauma caused by traffic accident.

  6. Approaching system equilibrium with accurate or not accurate feedback information in a two-route system (United States)

    Zhao, Xiao-mei; Xie, Dong-fan; Li, Qi


    With the development of intelligent transport system, advanced information feedback strategies have been developed to reduce traffic congestion and enhance the capacity. However, previous strategies provide accurate information to travelers and our simulation results show that accurate information brings negative effects, especially in delay case. Because travelers prefer to the best condition route with accurate information, and delayed information cannot reflect current traffic condition but past. Then travelers make wrong routing decisions, causing the decrease of the capacity and the increase of oscillations and the system deviating from the equilibrium. To avoid the negative effect, bounded rationality is taken into account by introducing a boundedly rational threshold BR. When difference between two routes is less than the BR, routes have equal probability to be chosen. The bounded rationality is helpful to improve the efficiency in terms of capacity, oscillation and the gap deviating from the system equilibrium.

  7. Cardiac Procedures and Surgeries (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Procedures and Surgeries Updated:Sep 16,2016 If you've had ... degree of coronary artery disease (CAD) you have. Cardiac Procedures and Surgeries Angioplasty Also known as Percutaneous Coronary Interventions [PCI], ...

  8. [Advances in cardiac pacing]. (United States)

    de Carranza, María-José Sancho-Tello; Fidalgo-Andrés, María Luisa; Ferrer, José Martínez; Mateas, Francisco Ruiz


    This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.

  9. A review: trichloroethylene metabolites: potential cardiac teratogens.


    Johnson, P. D.; Dawson, B V; Goldberg, S J


    This review is a a series of the authors' studies designed to test the hypothesis that administration of trichloroethylene (TCE), dichloroethylene (DCE), their metabolites, and related compounds are responsible for fetal cardiac teratogenesis when given to pregnant rats during organogenesis. Identification of teratogenic compounds will allow more accurate assessment of environmental contaminants and public health risks. Epidemiologic studies and previous teratogenic studies using chick embryo...

  10. Learning rules from multisource data for cardiac monitoring

    CERN Document Server

    Cordier, Marie-Odile; Quiniou, René


    This paper formalises the concept of learning symbolic rules from multisource data in a cardiac monitoring context. Our sources, electrocardiograms and arterial blood pressure measures, describe cardiac behaviours from different viewpoints. To learn interpretable rules, we use an Inductive Logic Programming (ILP) method. We develop an original strategy to cope with the dimensionality issues caused by using this ILP technique on a rich multisource language. The results show that our method greatly improves the feasibility and the efficiency of the process while staying accurate. They also confirm the benefits of using multiple sources to improve the diagnosis of cardiac arrhythmias.

  11. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc


    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  12. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone


    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  13. Quantifying Reflection

    DEFF Research Database (Denmark)

    Alcock, Gordon Lindsay


    . It contrasts the students’ self-assessment in a range of ‘product’ skills such as Revit, Structural Design, Mathematics of construction, Technical Installations; as well as ‘process’ competencies such as ‘Working in a team’, Sharing knowledge, Maintaining a portfolio and Reflecting ON learning and FOR learning......´ These are all based on Blooms taxonomy and levels of competence and form a major part of individual student and group learning portfolios. Key Words :Project-Based learning, Reflective Portfolios, Self assessment, Defining learning gains, Developing learning strategies , Reflections on and for learning...

  14. Reflection ciphers

    DEFF Research Database (Denmark)

    Boura, Christina; Canteaut, Anne; Knudsen, Lars Ramkilde;


    study the necessary properties for this coupling permutation. Special care has to be taken of some related-key distinguishers since, in the context of reflection ciphers, they may provide attacks in the single-key setting.We then derive some criteria for constructing secure reflection ciphers...... and analyze the security properties of different families of coupling permutations. Finally, we concentrate on the case of reflection block ciphers and, as an illustration, we provide concrete examples of key schedules corresponding to several coupling permutations, which lead to new variants of the block...

  15. Cardiac tumors: echo assessment. (United States)

    Mankad, Rekha; Herrmann, Joerg


    Cardiac tumors are exceedingly rare (0.001-0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  16. Accurate and Fast Iris Segmentation

    Directory of Open Access Journals (Sweden)

    G. AnnaPoorani,


    Full Text Available A novel iris segmentation approach for noisy iris is proposed in this paper. The proposed approach comprises of specular reflection removal, pupil localization, iris localization and eyelid localization. Reflection map computation is devised to get the reflection ROI of eye image using adaptive threshold technique. Bilinear interpolation is used to fill these reflection points in the eye image. Variant of edge-based segmentation technique is adopted to detect the pupil boundary from the eye image. Gradient based heuristic approach is devised to detect the iris boundary from theeye image. Eyelid localization is designed to detect the eyelids using the edge detection and curve fitting. Feature sequence combined into spatial domain segments the iris texture patterns properly. Empirical results show that the proposed approach is effective and suitable to deal with the noisy eye image for iris segmentation.

  17. The effect of classification of arrhythmic sudden cardiac death on the efficacy of cardiac resynchronization therapy in the CARE-HF study

    DEFF Research Database (Denmark)

    Uretsky, B.; Cleland, J.G.F.; Freemantle, N.


    Topic(s): The definition of arrhythmic sudden cardiac death (SCD) differs widely among studies, which will affect the frequency with which it is ascribed as the cause of death. Cardiac resynchronization therapy (CRT) was reported to reduce SCD in the CARE-HF study. This could reflect a real effec...

  18. Molecular Basis of Cardiac Myxomas

    Directory of Open Access Journals (Sweden)

    Pooja Singhal


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

  19. A computerised dichromatic earpiece densitometer for the measurement of cardiac output. (United States)

    Robinson, P S; Crowther, A; Jenkins, B S; Webb-Peploe, M M; Coltart, D J


    This study assesses a precalibrated dichromatic earpiece densitometer and microprocessor for the measurement of cardiac output by indocyanine green dye dilution. The measured cardiac output is compared with values of cardiac output simultaneously determined using a cuvette densitometer. The microprocessor computation of cardiac output agreed very closely with the cardiac output determined by manual calculation from the same dye dilution curves (standard deviation +/- 1.47%). The reproducibility of the earpiece densitometer (standard deviation +/- 5.2%) was virtually identical to that of the cuvette densitometer (+/- 5.3%). In a comparison of earpiece and cuvette densitometers for 60 measurements of cardiac output following pulmonary arterial injection of dye and for 50 measurements following femoral venous injection of dye, correlation coefficients were 0.83 and 0.78 and the standard deviations of the differences of simultaneous measurements were 7.2% and 8.3% respectively. The instrument offers an accurate reproducible and relatively noninvasive technique for measuring cardiac output.

  20. Cardiac Tumors; Tumeurs cardiaques

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, J.P.; Fernandez, P. [Centre Hospitalier Universitaire Bichat Claude Bernard, Service d' Imagerie, 76 - Rouen (France); Mousseaux, E. [Hopital Europeen Georges Pompidou (HEGP), Service de Radiologie Cardio Vasculaire et Interventionnelle, 75 - Paris (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, 75 - Rouen (France); Crochet, D. [Centre Hospitalier Universitaire, Hopital Laennec, Centre Hemodynamique, Radiologie Thoracique et Vasculaire, 44 - Nantes (France)


    Metastases are the most frequent tumors of the heart even though they seldom are recognized. Most primary cardiac tumors are benign. The main role of imaging is to differentiate a cardiac tumor from thrombus and rare pseudo-tumors: tuberculoma, hydatid cyst. Echocardiography is the fist line imaging technique to detect cardiac tumors, but CT and MRl arc useful for further characterization and differential diagnosis. Myxoma of the left atrium is the most frequent benign cardiac tumor. It usually is pedunculated and sometimes calcified. Sarcoma is the most frequent primary malignant tumor and usually presents as a sessile infiltrative tumor. Lymphoma and metastases are usually recognized by the presence of known tumor elsewhere of by characteristic direct contiguous involvement. Diagnosing primary and secondary pericardial tumors often is difficult. Imaging is valuable for diagnosis, characterization, pre-surgical evaluation and follow-up. (author)

  1. Socially differentiated cardiac rehabilitation

    DEFF Research Database (Denmark)

    Meillier, Lucette Kirsten; Nielsen, Kirsten Melgaard; Larsen, Finn Breinholt;


    to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements......%. Patients were equally distributed to the SRP and the ERP. No inequality was found in attendance and adherence among referred patients. Conclusions: It seems possible to overcome unequal referral, attendance, and adherence in cardiac rehabilitation by organisation of systematic screening and social......Aim: The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality...

  2. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Cardiac imaging in adults

    Energy Technology Data Exchange (ETDEWEB)

    Jaffe, C.C.


    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  4. Port Access Cardiac Surgery. (United States)

    Viganó, Mario; Minzioni, Gaetano; Spreafico, Patrizio; Rinaldi, Mauro; Pasquino, Stefano; Ceriana, Piero; Locatelli, Alessandro


    The port-access technique for cardiac surgery was recently developed at Stanford University in California as a less invasive method to perform some cardiac operations. The port-access system has been described in detail elsewhere. It is based on femoral arterial and venous access for cardiopulmonary bypass (CPB) and on the adoption of a specially designed triple-lumen catheter described originally by Peters, and subsequently modified and developed in the definitive configuration called the endoaortic clamp.

  5. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon


    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  6. Post cardiac injury syndrome

    DEFF Research Database (Denmark)

    Nielsen, S L; Nielsen, F E


    The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery, i...... on the coronary vessels, with cardiac tamponade and chronic pericardial exudate. In the lighter cases, PCIS may be treated with NSAID and, in the more severe cases, with systemic glucocorticoid which has a prompt effect....

  7. Autonomic cardiac innervation


    Hasan, Wohaib


    Autonomic cardiac neurons have a common origin in the neural crest but undergo distinct developmental differentiation as they mature toward their adult phenotype. Progenitor cells respond to repulsive cues during migration, followed by differentiation cues from paracrine sources that promote neurochemistry and differentiation. When autonomic axons start to innervate cardiac tissue, neurotrophic factors from vascular tissue are essential for maintenance of neurons before they reach their targe...

  8. Infected cardiac hydatid cyst


    Ceviz, M; Becit, N; Kocak, H.


    A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.

Keywords: cardiac hydatid cyst; infected cardiac hydatid cyst

  9. Cardiac applications of optogenetics. (United States)

    Ambrosi, Christina M; Klimas, Aleksandra; Yu, Jinzhu; Entcheva, Emilia


    In complex multicellular systems, such as the brain or the heart, the ability to selectively perturb and observe the response of individual components at the cellular level and with millisecond resolution in time, is essential for mechanistic understanding of function. Optogenetics uses genetic encoding of light sensitivity (by the expression of microbial opsins) to provide such capabilities for manipulation, recording, and control by light with cell specificity and high spatiotemporal resolution. As an optical approach, it is inherently scalable for remote and parallel interrogation of biological function at the tissue level; with implantable miniaturized devices, the technique is uniquely suitable for in vivo tracking of function, as illustrated by numerous applications in the brain. Its expansion into the cardiac area has been slow. Here, using examples from published research and original data, we focus on optogenetics applications to cardiac electrophysiology, specifically dealing with the ability to manipulate membrane voltage by light with implications for cardiac pacing, cardioversion, cell communication, and arrhythmia research, in general. We discuss gene and cell delivery methods of inscribing light sensitivity in cardiac tissue, functionality of the light-sensitive ion channels within different types of cardiac cells, utility in probing electrical coupling between different cell types, approaches and design solutions to all-optical electrophysiology by the combination of optogenetic sensors and actuators, and specific challenges in moving towards in vivo cardiac optogenetics.

  10. Systems and methods for remote long standoff biometric identification using microwave cardiac signals (United States)

    McGrath, William R. (Inventor); Talukder, Ashit (Inventor)


    Systems and methods for remote, long standoff biometric identification using microwave cardiac signals are provided. In one embodiment, the invention relates to a method for remote biometric identification using microwave cardiac signals, the method including generating and directing first microwave energy in a direction of a person, receiving microwave energy reflected from the person, the reflected microwave energy indicative of cardiac characteristics of the person, segmenting a signal indicative of the reflected microwave energy into a waveform including a plurality of heart beats, identifying patterns in the microwave heart beats waveform, and identifying the person based on the identified patterns and a stored microwave heart beats waveform.

  11. Reflective optics

    CERN Document Server

    Korsch, Dietrich


    This is the first book dedicated exclusively to all-reflective imaging systems. It is a teaching tool as well as a practical design tool for anyone who specializes in optics, particularly for those interested in telescopes, infrared, and grazing-incidence systems. The first part of the book describes a unified geometric optical theory of all-reflective imaging systems (from near-normal to grazing incidence) developed from basic principles. The second part discusses correction methods and a multitude of closed-form solutions of well-corrected systems, supplemented with many conventional and unc

  12. Measuring temporal resolution of cardiac CT reconstructions (United States)

    Matthews, David; Heuscher, Dominic


    Multi-slice CT today is capable of imaging the heart with excellent temporal resolution. Algorithms have been developed to perform reconstructions combining data from multiple cardiac cycles. This paper presents a simulation phantom that enables a direct measurement of the actual temporal resolution achieved by these algorithms. This is not only useful for assessing the temporal resolution but also for validating the algorithms themselves. A simulation phantom was developed that consists of a 20 cm. diameter water phantom containing an array of cylinders whose intensities are pulsed for various durations ranging from 10 msec. to 250 msec. The intensity varied between the background value of water (0 HU) and 800 HU. By measuring the nominal attenuation value at the center of each cylinder, a curve can be derived representing the response over the given temporal range. A temporal resolution representing the FWHM value is determined based on the half-max value of this curve. Reconstructions were performed using a multi-cycle cardiac algorithm described previously in the literature. The measured FWHM values agree quite well to the temporal resolution predicted by the cardiac algorithm itself. Even the variation along the longitudinal axis can be accounted for by the predicted values. A simulated phantom can be used to accurately assess the temporal resolution of cardiac reconstruction algorithms. Excellent agreement was achieved between the predicted and measured temporal resolution values for the multi-cycle algorithm used in this study.

  13. Speckle Tracking Based Strain Analysis Is Sensitive for Early Detection of Pathological Cardiac Hypertrophy. (United States)

    An, Xiangbo; Wang, Jingjing; Li, Hao; Lu, Zhizhen; Bai, Yan; Xiao, Han; Zhang, Youyi; Song, Yao


    Cardiac hypertrophy is a key pathological process of many cardiac diseases. However, early detection of cardiac hypertrophy is difficult by the currently used non-invasive method and new approaches are in urgent need for efficient diagnosis of cardiac malfunction. Here we report that speckle tracking-based strain analysis is more sensitive than conventional echocardiography for early detection of pathological cardiac hypertrophy in the isoproterenol (ISO) mouse model. Pathological hypertrophy was induced by a single subcutaneous injection of ISO. Physiological cardiac hypertrophy was established by daily treadmill exercise for six weeks. Strain analysis, including radial strain (RS), radial strain rate (RSR) and longitudinal strain (LS), showed marked decrease as early as 3 days after ISO injection. Moreover, unlike the regional changes in cardiac infarction, strain analysis revealed global cardiac dysfunction that affects the entire heart in ISO-induced hypertrophy. In contrast, conventional echocardiography, only detected altered E/E', an index reflecting cardiac diastolic function, at 7 days after ISO injection. No change was detected on fractional shortening (FS), E/A and E'/A' at 3 days or 7 days after ISO injection. Interestingly, strain analysis revealed cardiac dysfunction only in ISO-induced pathological hypertrophy but not the physiological hypertrophy induced by exercise. Taken together, our study indicates that strain analysis offers a more sensitive approach for early detection of cardiac dysfunction than conventional echocardiography. Moreover, multiple strain readouts distinguish pathological cardiac hypertrophy from physiological hypertrophy.

  14. Reflective equilibrium

    NARCIS (Netherlands)

    van der Burg, W.; van Willigenburg, T.


    The basic idea of reflective equilibrium, as a method for theory construction and decision making in ethics, is that we should bring together a broad variety of moral and non-moral beliefs and, through a process of critical scrutiny and mutual adjustment, combine these into one coherent belief syste

  15. Comparison of PIV with 4D-Flow in a physiological accurate flow phantom (United States)

    Sansom, Kurt; Balu, Niranjan; Liu, Haining; Aliseda, Alberto; Yuan, Chun; Canton, Maria De Gador


    Validation of 4D MRI flow sequences with planar particle image velocimetry (PIV) is performed in a physiologically-accurate flow phantom. A patient-specific phantom of a carotid artery is connected to a pulsatile flow loop to simulate the 3D unsteady flow in the cardiovascular anatomy. Cardiac-cycle synchronized MRI provides time-resolved 3D blood velocity measurements in clinical tool that is promising but lacks a robust validation framework. PIV at three different Reynolds numbers (540, 680, and 815, chosen based on +/- 20 % of the average velocity from the patient-specific CCA waveform) and four different Womersley numbers (3.30, 3.68, 4.03, and 4.35, chosen to reflect a physiological range of heart rates) are compared to 4D-MRI measurements. An accuracy assessment of raw velocity measurements and a comparison of estimated and measureable flow parameters such as wall shear stress, fluctuating velocity rms, and Lagrangian particle residence time, will be presented, with justification for their biomechanics relevance to the pathophysiology of arterial disease: atherosclerosis and intimal hyperplasia. Lastly, the framework is applied to a new 4D-Flow MRI sequence and post processing techniques to provide a quantitative assessment with the benchmarked data. Department of Education GAANN Fellowship.

  16. Chest pain of cardiac and noncardiac origin. (United States)

    Lenfant, Claude


    causes, gastroesophageal disorders are by far the most prevalent, especially gastroesophageal reflux disease. Fortunately, this disease can be diagnosed and treated effectively by proton-pump inhibitors. The other types of non-gastroesophageal reflux disease-related noncardiac chest pain are more difficult to diagnose and treat. In conclusion, the cause of chest pain must be accurately diagnosed; and treatment must be pursued according to the cause, especially if the cause is of cardiac origin.

  17. [Psychosomatic aspects of cardiac arrhythmias]. (United States)

    Siepmann, Martin; Kirch, Wilhelm


    Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

  18. Exercise-induced cardiac fatigue in low handicap polo horses

    Directory of Open Access Journals (Sweden)

    CAO Bello


    Full Text Available Physical exercise leads to several changes in the cardiovascular system of horses and may induce abnormalities that are not observed at rest. Little is known about the cardiac effects of intense physical exercise performed by horses in polo competitions. This study aimed at identifying if exercise-induced cardiac fatigue is observed in healthy polo ponies. We examined 25 equine athletes before and after a training match. The results demonstrated post-exercise electrocardiographic alteration such as cardiac arrhythmia, QTc prolongation, abnormal T waves and ST-segment elevation. The post-exercise echocardiogram showed interventricular septum and left ventricle free wall thickness reduction, systolic volume decreased and ejection fraction decreased. These results suggest that polo causes exercise-induced cardiac fatigue. It was not possible to establish accurately the etiology of this abnormality, nor its long-term consequences.

  19. A fast and accurate method for echocardiography strain rate imaging (United States)

    Tavakoli, Vahid; Sahba, Nima; Hajebi, Nima; Nambakhsh, Mohammad Saleh


    Recently Strain and strain rate imaging have proved their superiority with respect to classical motion estimation methods in myocardial evaluation as a novel technique for quantitative analysis of myocardial function. Here in this paper, we propose a novel strain rate imaging algorithm using a new optical flow technique which is more rapid and accurate than the previous correlation-based methods. The new method presumes a spatiotemporal constancy of intensity and Magnitude of the image. Moreover the method makes use of the spline moment in a multiresolution approach. Moreover cardiac central point is obtained using a combination of center of mass and endocardial tracking. It is proved that the proposed method helps overcome the intensity variations of ultrasound texture while preserving the ability of motion estimation technique for different motions and orientations. Evaluation is performed on simulated, phantom (a contractile rubber balloon) and real sequences and proves that this technique is more accurate and faster than the previous methods.

  20. Cardiac radiology: centenary review. (United States)

    de Roos, Albert; Higgins, Charles B


    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  1. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa


    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  2. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O;


    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  3. Toothache of cardiac origin. (United States)

    Kreiner, M; Okeson, J P


    Pain referred to the orofacial structures can sometimes be a diagnostic challenge for the clinician. In some instances, a patient may complain of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. Cardiac pain most commonly radiates to the left arm, shoulder, neck, and face. In rare instances, angina pectoris may present as dental pain. When this occurs, an improper diagnosis frequently leads to unnecessary dental treatment or, more significantly, a delay of proper treatment. This delay may result in the patient experiencing an acute myocardial infarction. It is the dentist's responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain. This article reviews the literature concerning referred pain of cardiac origin and presents a case report of toothache of cardiac origin.

  4. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients

    NARCIS (Netherlands)

    Beek, M.H. van; Oude Voshaar, R.C.; Deelen, F.M. van; Balkom, A.J. van; Pop, G.A.; Speckens, A.E.


    OBJECTIVE: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the D


    NARCIS (Netherlands)

    van Beek, M. H. C. T.; Voshaar, R. C. Oude; van Deelen, F. M.; van Balkom, A. J. L. M.; Pop, G.; Speckens, A. E. M.


    Objective: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the D

  6. Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy


    Lambiase, P. D.; Rinaldi, A.; J. Hauck; Mobb, M; Elliott, D; Mohammad, S; Gill, J. S.; Bucknall, C A


    Background: Up to 30% of patients with heart failure do not respond to cardiac resynchronisation therapy (CRT). This may reflect placement of the coronary sinus lead in regions of slow conduction despite optimal positioning on current criteria.

  7. Evaluation of respiratory and cardiac motion correction schemes in dual gated PET/CT cardiac imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lamare, F., E-mail:; Fernandez, P. [Univ. Bordeaux, INCIA, UMR 5287, F-33400 Talence (France); CNRS, INCIA, UMR 5287, F-33400 Talence (France); Service de Médecine Nucléaire, Hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux (France); Le Maitre, A.; Visvikis, D. [INSERM, UMR1101, LaTIM, Université de Bretagne Occidentale, 29609 Brest (France); Dawood, M.; Schäfers, K. P. [European Institute for Molecular Imaging, University of Münster, Mendelstr. 11, 48149 Münster (Germany); Rimoldi, O. E. [Vita-Salute University and Scientific Institute San Raffaele, Milan, Italy and CNR Istituto di Bioimmagini e Fisiologia Molecolare, Milan (Italy)


    observed in the performance of the two motion models considered. Superior image SNR and contrast were seen using the affine respiratory motion model in combination with the diastole cardiac bin in comparison to the use of the whole cardiac cycle. In contrast, when simultaneously correcting for cardiac beating and respiration, the elastic respiratory motion model outperformed the affine model. In this context, four cardiac bins associated with eight respiratory amplitude bins seemed to be adequate. Conclusions: Considering the compensation of respiratory motion effects only, both affine and elastic based approaches led to an accurate resizing and positioning of the myocardium. The use of the diastolic phase combined with an affine model based respiratory motion correction may therefore be a simple approach leading to significant quality improvements in cardiac PET imaging. However, the best performance was obtained with the combined correction for both cardiac and respiratory movements considering all the dual-gated bins independently through the use of an elastic model based motion compensation.

  8. Efficient and accurate fragmentation methods. (United States)

    Pruitt, Spencer R; Bertoni, Colleen; Brorsen, Kurt R; Gordon, Mark S


    Conspectus Three novel fragmentation methods that are available in the electronic structure program GAMESS (general atomic and molecular electronic structure system) are discussed in this Account. The fragment molecular orbital (FMO) method can be combined with any electronic structure method to perform accurate calculations on large molecular species with no reliance on capping atoms or empirical parameters. The FMO method is highly scalable and can take advantage of massively parallel computer systems. For example, the method has been shown to scale nearly linearly on up to 131 000 processor cores for calculations on large water clusters. There have been many applications of the FMO method to large molecular clusters, to biomolecules (e.g., proteins), and to materials that are used as heterogeneous catalysts. The effective fragment potential (EFP) method is a model potential approach that is fully derived from first principles and has no empirically fitted parameters. Consequently, an EFP can be generated for any molecule by a simple preparatory GAMESS calculation. The EFP method provides accurate descriptions of all types of intermolecular interactions, including Coulombic interactions, polarization/induction, exchange repulsion, dispersion, and charge transfer. The EFP method has been applied successfully to the study of liquid water, π-stacking in substituted benzenes and in DNA base pairs, solvent effects on positive and negative ions, electronic spectra and dynamics, non-adiabatic phenomena in electronic excited states, and nonlinear excited state properties. The effective fragment molecular orbital (EFMO) method is a merger of the FMO and EFP methods, in which interfragment interactions are described by the EFP potential, rather than the less accurate electrostatic potential. The use of EFP in this manner facilitates the use of a smaller value for the distance cut-off (Rcut). Rcut determines the distance at which EFP interactions replace fully quantum

  9. Accurate determination of antenna directivity

    DEFF Research Database (Denmark)

    Dich, Mikael


    The derivation of a formula for accurate estimation of the total radiated power from a transmitting antenna for which the radiated power density is known in a finite number of points on the far-field sphere is presented. The main application of the formula is determination of directivity from power......-pattern measurements. The derivation is based on the theory of spherical wave expansion of electromagnetic fields, which also establishes a simple criterion for the required number of samples of the power density. An array antenna consisting of Hertzian dipoles is used to test the accuracy and rate of convergence...

  10. Perioperative management of cardiac disease. (United States)

    Aresti, N A; Malik, A A; Ihsan, K M; Aftab, S M E; Khan, W S


    Pre-existing cardiac disease contributes significantly to morbidity and mortality amongst patients undergoing non cardiac surgery. Patients with pre-existing cardiac disease or with risk factors for it, have as much as a 3.9% risk of suffering a major perioperative cardiac event (Lee et al 1999, Devereaux 2005). Furthermore, the incidence of perioperative myocardial infarction (MI) is increased 10 to 50 fold in patients with previous coronary events (Jassal 2008).

  11. Inspiring Reflections

    DEFF Research Database (Denmark)

    Muchie, Mammo


    A numberof Chris Freeman's colleagues were asked to reflect on what they thought describes his life and work in a few words. Some of the colleagues replied including former SPRU students that were taught or supervised by Chris Freeman. Their views on what they thought were Chris Freeman's defining...... life is not free from fluctuations, cycles, disruptions, crises and destructions both human and ecological. Innovation research ought to position itself to address environmental, financial and economic crises. The third is innovation research for development by addressing not only poverty erdaication...

  12. Data analysis in cardiac arrhythmias. (United States)

    Rodrigo, Miguel; Pedrón-Torecilla, Jorge; Hernández, Ismael; Liberos, Alejandro; Climent, Andreu M; Guillem, María S


    Cardiac arrhythmias are an increasingly present in developed countries and represent a major health and economic burden. The occurrence of cardiac arrhythmias is closely linked to the electrical function of the heart. Consequently, the analysis of the electrical signal generated by the heart tissue, either recorded invasively or noninvasively, provides valuable information for the study of cardiac arrhythmias. In this chapter, novel cardiac signal analysis techniques that allow the study and diagnosis of cardiac arrhythmias are described, with emphasis on cardiac mapping which allows for spatiotemporal analysis of cardiac signals.Cardiac mapping can serve as a diagnostic tool by recording cardiac signals either in close contact to the heart tissue or noninvasively from the body surface, and allows the identification of cardiac sites responsible of the development or maintenance of arrhythmias. Cardiac mapping can also be used for research in cardiac arrhythmias in order to understand their mechanisms. For this purpose, both synthetic signals generated by computer simulations and animal experimental models allow for more controlled physiological conditions and complete access to the organ.

  13. Biosynthesis of cardiac natriuretic peptides

    DEFF Research Database (Denmark)

    Goetze, Jens Peter


    Cardiac-derived peptide hormones were identified more than 25 years ago. An astonishing amount of clinical studies have established cardiac natriuretic peptides and their molecular precursors as useful markers of heart disease. In contrast to the clinical applications, the biogenesis of cardiac...

  14. Cardiac troponins and high-sensitivity cardiac troponin assays. (United States)

    Conrad, Michael J; Jarolim, Petr


    Measurement of circulating cardiac troponins I and T has become integral to the diagnosis of myocardial infarction. This article discusses the structure and function of the troponin complex and the release of cardiac troponin molecules from the injured cardiomyocyte into the circulation. An overview of current cardiac troponin assays and their classification according to sensitivity is presented. The diagnostic criteria, role, and usefulness of cardiac troponin for myocardial infarction are discussed. In addition, several examples are given of the usefulness of high-sensitivity cardiac troponin assays for short-term and long-term prediction of adverse events.

  15. Cardiac potassium channel subtypes

    DEFF Research Database (Denmark)

    Schmitt, Nicole; Grunnet, Morten; Olesen, Søren-Peter


    About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K(+) channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K(+) channels...

  16. Cardiac Risk Assessment (United States)

    ... Risk Assessment Related tests: Lipid Profile , VLDL Cholesterol , hs-CRP , Lp(a) Overview | Common Questions | Related Pages What ... cardiac risk include: High-sensitivity C-reactive protein (hs-CRP) : Studies have shown that measuring CRP with a ...

  17. The cardiac malpositions. (United States)

    Perloff, Joseph K


    Dextrocardia was known in the 17th century and was 1 of the first congenital malformations of the heart to be recognized. Fifty years elapsed before Matthew Baillie published his account of complete transposition in a human of the thoracic and abdominal viscera to the opposite side from what is natural. In 1858, Thomas Peacock stated that "the heart may be congenitally misplaced in various ways, occupying either an unusual position within the thorax, or being situated external to that cavity." In 1915, Maude Abbott described ectopia cordis, and Richard Paltauf's remarkable illustrations distinguished the various types of dextrocardia. In 1928, the first useful classification of the cardiac malpositions was proposed, and in 1966, Elliott et al's radiologic classification set the stage for clinical recognition. The first section of this review deals with the 3 basic cardiac malpositions in the presence of bilateral asymmetry. The second section deals with cardiac malpositions in the presence of bilateral left-sidedness or right-sidedness. Previous publications on cardiac malpositions are replete with an arcane vocabulary that confounds rather than clarifies. Even if the terms themselves are understood, inherent complexity weighs against clarity. This review was designed as a guided tour of an unfamiliar subject.

  18. Hepato-cardiac disorders

    Institute of Scientific and Technical Information of China (English)

    Yasser; Mahrous; Fouad; Reem; Yehia


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

  19. Accurate Modeling of Advanced Reflectarrays

    DEFF Research Database (Denmark)

    Zhou, Min

    Analysis and optimization methods for the design of advanced printed re ectarrays have been investigated, and the study is focused on developing an accurate and efficient simulation tool. For the analysis, a good compromise between accuracy and efficiency can be obtained using the spectral domain...... to the POT. The GDOT can optimize for the size as well as the orientation and position of arbitrarily shaped array elements. Both co- and cross-polar radiation can be optimized for multiple frequencies, dual polarization, and several feed illuminations. Several contoured beam reflectarrays have been designed...... using the GDOT to demonstrate its capabilities. To verify the accuracy of the GDOT, two offset contoured beam reflectarrays that radiate a high-gain beam on a European coverage have been designed and manufactured, and subsequently measured at the DTU-ESA Spherical Near-Field Antenna Test Facility...

  20. The Accurate Particle Tracer Code

    CERN Document Server

    Wang, Yulei; Qin, Hong; Yu, Zhi


    The Accurate Particle Tracer (APT) code is designed for large-scale particle simulations on dynamical systems. Based on a large variety of advanced geometric algorithms, APT possesses long-term numerical accuracy and stability, which are critical for solving multi-scale and non-linear problems. Under the well-designed integrated and modularized framework, APT serves as a universal platform for researchers from different fields, such as plasma physics, accelerator physics, space science, fusion energy research, computational mathematics, software engineering, and high-performance computation. The APT code consists of seven main modules, including the I/O module, the initialization module, the particle pusher module, the parallelization module, the field configuration module, the external force-field module, and the extendible module. The I/O module, supported by Lua and Hdf5 projects, provides a user-friendly interface for both numerical simulation and data analysis. A series of new geometric numerical methods...

  1. Accurate ab initio spin densities

    CERN Document Server

    Boguslawski, Katharina; Legeza, Örs; Reiher, Markus


    We present an approach for the calculation of spin density distributions for molecules that require very large active spaces for a qualitatively correct description of their electronic structure. Our approach is based on the density-matrix renormalization group (DMRG) algorithm to calculate the spin density matrix elements as basic quantity for the spatially resolved spin density distribution. The spin density matrix elements are directly determined from the second-quantized elementary operators optimized by the DMRG algorithm. As an analytic convergence criterion for the spin density distribution, we employ our recently developed sampling-reconstruction scheme [J. Chem. Phys. 2011, 134, 224101] to build an accurate complete-active-space configuration-interaction (CASCI) wave function from the optimized matrix product states. The spin density matrix elements can then also be determined as an expectation value employing the reconstructed wave function expansion. Furthermore, the explicit reconstruction of a CA...

  2. Accurate thickness measurement of graphene. (United States)

    Shearer, Cameron J; Slattery, Ashley D; Stapleton, Andrew J; Shapter, Joseph G; Gibson, Christopher T


    Graphene has emerged as a material with a vast variety of applications. The electronic, optical and mechanical properties of graphene are strongly influenced by the number of layers present in a sample. As a result, the dimensional characterization of graphene films is crucial, especially with the continued development of new synthesis methods and applications. A number of techniques exist to determine the thickness of graphene films including optical contrast, Raman scattering and scanning probe microscopy techniques. Atomic force microscopy (AFM), in particular, is used extensively since it provides three-dimensional images that enable the measurement of the lateral dimensions of graphene films as well as the thickness, and by extension the number of layers present. However, in the literature AFM has proven to be inaccurate with a wide range of measured values for single layer graphene thickness reported (between 0.4 and 1.7 nm). This discrepancy has been attributed to tip-surface interactions, image feedback settings and surface chemistry. In this work, we use standard and carbon nanotube modified AFM probes and a relatively new AFM imaging mode known as PeakForce tapping mode to establish a protocol that will allow users to accurately determine the thickness of graphene films. In particular, the error in measuring the first layer is reduced from 0.1-1.3 nm to 0.1-0.3 nm. Furthermore, in the process we establish that the graphene-substrate adsorbate layer and imaging force, in particular the pressure the tip exerts on the surface, are crucial components in the accurate measurement of graphene using AFM. These findings can be applied to other 2D materials.

  3. Accurate thickness measurement of graphene (United States)

    Shearer, Cameron J.; Slattery, Ashley D.; Stapleton, Andrew J.; Shapter, Joseph G.; Gibson, Christopher T.


    Graphene has emerged as a material with a vast variety of applications. The electronic, optical and mechanical properties of graphene are strongly influenced by the number of layers present in a sample. As a result, the dimensional characterization of graphene films is crucial, especially with the continued development of new synthesis methods and applications. A number of techniques exist to determine the thickness of graphene films including optical contrast, Raman scattering and scanning probe microscopy techniques. Atomic force microscopy (AFM), in particular, is used extensively since it provides three-dimensional images that enable the measurement of the lateral dimensions of graphene films as well as the thickness, and by extension the number of layers present. However, in the literature AFM has proven to be inaccurate with a wide range of measured values for single layer graphene thickness reported (between 0.4 and 1.7 nm). This discrepancy has been attributed to tip-surface interactions, image feedback settings and surface chemistry. In this work, we use standard and carbon nanotube modified AFM probes and a relatively new AFM imaging mode known as PeakForce tapping mode to establish a protocol that will allow users to accurately determine the thickness of graphene films. In particular, the error in measuring the first layer is reduced from 0.1-1.3 nm to 0.1-0.3 nm. Furthermore, in the process we establish that the graphene-substrate adsorbate layer and imaging force, in particular the pressure the tip exerts on the surface, are crucial components in the accurate measurement of graphene using AFM. These findings can be applied to other 2D materials.

  4. On Reflection

    DEFF Research Database (Denmark)

    Blasco, Maribel


    This article explores how the concept of reflexivity is used in intercultural education. Reflexivity is often presented as a key learning goal in acquiring intercultural competence (ICC). Yet, reflexivity can be defined in different ways, and take different forms across time and space, depending...... in designing learning objectives in intercultural education and in devising ways to attain them. Greater attention is also needed in intercultural education to the ways in which selfhood, and hence also reflexivity and constructions of difference, differ across space and time....... on the concepts of selfhood that prevail and how notions of difference are constructed. First, I discuss how the dominant usages of reflexivity in intercultural education reflect and reproduce a Cartesian view of the self that shapes how ICC is conceptualized and taught. I discuss three assumptions that this view...

  5. Preoperative cardiac computed tomography for demonstration of congenital cardiac septal defect in adults

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Hye-Joung; Yang, Dong Hyun; Kang, Joon-Won; Lim, Tae-Hwan [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of); Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan [University of Ulsan College of Medicine, Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of); Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won [University of Ulsan College of Medicine, Department of Cardiothoracic surgery, Cardiac Imaging Center, Asan Medical Center, Seoul (Korea, Republic of)


    We aimed to evaluate the role of preoperative cardiac computed tomography (CT) for adults with congenital cardiac septal defect (CSD). Sixty-five consecutive patients who underwent preoperative CT and surgery for CSD were included. The diagnostic accuracy of CT and the concordance rate of the subtype classification of CSD were evaluated using surgical findings as the reference standard. Sixty-five patients without CSD who underwent cardiac valve surgery were used as a control group. An incremental value of CT over echocardiography was described retrospectively. Sensitivity and specificity of CT for diagnosis of CSD were 95 % and 100 %, respectively. The concordance rate of subtype classification was 91 % in CT and 92 % in echocardiography. The maximum size of the defect measured by CT correlated well with surgical measurement (r = 0.82), and the limit of agreement was -0.9 ± 7.42 mm. In comparison with echocardiography, CT was able to detect combined abnormalities in three cases, and exclusively provided correct subtype classification or clarified suspected abnormal findings found on echocardiography in seven cases. Cardiac CT can accurately demonstrates CSD in preoperative adult patients. CT may have an incremental role in preoperative planning, particularly in those with more complex anatomy. (orig.)

  6. Mapping cardiac surface mechanics with structured light imaging. (United States)

    Laughner, Jacob I; Zhang, Song; Li, Hao; Shao, Connie C; Efimov, Igor R


    Cardiovascular disease often manifests as a combination of pathological electrical and structural heart remodeling. The relationship between mechanics and electrophysiology is crucial to our understanding of mechanisms of cardiac arrhythmias and the treatment of cardiac disease. While several technologies exist for describing whole heart electrophysiology, studies of cardiac mechanics are often limited to rhythmic patterns or small sections of tissue. Here, we present a comprehensive system based on ultrafast three-dimensional (3-D) structured light imaging to map surface dynamics of whole heart cardiac motion. Additionally, we introduce a novel nonrigid motion-tracking algorithm based on an isometry-maximizing optimization framework that forms correspondences between consecutive 3-D frames without the use of any fiducial markers. By combining our 3-D imaging system with nonrigid surface registration, we are able to measure cardiac surface mechanics at unprecedented spatial and temporal resolution. In conclusion, we demonstrate accurate cardiac deformation at over 200,000 surface points of a rabbit heart recorded at 200 frames/s and validate our results on highly contrasting heart motions during normal sinus rhythm, ventricular pacing, and ventricular fibrillation.

  7. Magnetic Resonance Imaging Evaluation of Cardiac Masses

    Energy Technology Data Exchange (ETDEWEB)

    Braggion-Santos, Maria Fernanda, E-mail: [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Hospital Universitário - Universidade de Heidelberg, Heidelberg (Germany); Koenigkam-Santos, Marcel [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Hospital Universitário - Universidade de Heidelberg, Heidelberg (Germany); Teixeira, Sara Reis [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Volpe, Gustavo Jardim [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Divisão de Cardiologia - Universidade Johns Hopkins, Baltimore (United States); Trad, Henrique Simão [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Schmidt, André [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)


    Cardiac tumors are extremely rare; however, when there is clinical suspicion, proper diagnostic evaluation is necessary to plan the most appropriate treatment. In this context, cardiovascular magnetic resonance imaging (CMRI) plays an important role, allowing a comprehensive characterization of such lesions. To review cases referred to a CMRI Department for investigation of cardiac and paracardiac masses. To describe the positive case series with a brief review of the literature for each type of lesion and the role of cardiovascular magnetic resonance imaging in evaluation. Between August 2008 and December 2011, all cases referred for CMRI with suspicion of tumor involving the heart were reviewed. Cases with positive histopathological diagnosis, clinical evolution or therapeutic response compatible with the clinical suspicion and imaging findings were selected. Among the 13 cases included in our study, eight (62%) had histopathological confirmation. We describe five benign tumors (myxomas, rhabdomyoma and fibromas), five malignancies (sarcoma, lymphoma, Richter syndrome involving the heart and metastatic disease) and three non-neoplastic lesions (pericardial cyst, intracardiac thrombus and infectious vegetation). CMRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, contributing to a more accurate diagnosis in a noninvasive manner and assisting in treatment planning, allowing safe clinical follow-up with good reproducibility.

  8. Future of cardiac computed tomography

    Institute of Scientific and Technical Information of China (English)

    Carlo N De Cecco; U Joseph Schoepf


    Coronary computed tomography angiography(CCTA)has become an integral tool in the noninvasive diagnostic workup of patients with suspected coronary artery disease in both elective and emergency settings. Today, it represents a mature technique providing accurate, non-invasive morphological assessment of the coronary arteries and atherosclerotic plaque burden. Iterative reconstruction algorithms, low kV imaging, and single-heart beat acquisitions hold promise to further reduce dose requirements and improve the safety and robustness of the technique in several circumstances including imaging of heavily calcified vessels, patients with morbid obesity or irregular heart rates, and assessment in the emergency setting. However, it has become clear over recent years that cardiac radiologists need to take further steps towards the development and integration of functional imaging with morphological CCTA assessment to truly provide a comprehensive evaluation of the heart. Computed tomography myocardial perfusion imaging, including both dynamic and static dual-energy approaches, has demonstrated the ability to directly assess and quantify myocardial ischemia with simultaneous CCTA acquisition with a reasonable contrast medium volume and radiation dose delivered to the patient. In order to promote CCTA in the clinical and research environments, radiologists should prepare to embrace the change from morphological to functional imaging, furnishing all the necessary resources and information to referring clinicians.

  9. A More Accurate Fourier Transform

    CERN Document Server

    Courtney, Elya


    Fourier transform methods are used to analyze functions and data sets to provide frequencies, amplitudes, and phases of underlying oscillatory components. Fast Fourier transform (FFT) methods offer speed advantages over evaluation of explicit integrals (EI) that define Fourier transforms. This paper compares frequency, amplitude, and phase accuracy of the two methods for well resolved peaks over a wide array of data sets including cosine series with and without random noise and a variety of physical data sets, including atmospheric $\\mathrm{CO_2}$ concentrations, tides, temperatures, sound waveforms, and atomic spectra. The FFT uses MIT's FFTW3 library. The EI method uses the rectangle method to compute the areas under the curve via complex math. Results support the hypothesis that EI methods are more accurate than FFT methods. Errors range from 5 to 10 times higher when determining peak frequency by FFT, 1.4 to 60 times higher for peak amplitude, and 6 to 10 times higher for phase under a peak. The ability t...

  10. Automated detection of cardiac phase from intracoronary ultrasound image sequences. (United States)

    Sun, Zheng; Dong, Yi; Li, Mengchan


    Intracoronary ultrasound (ICUS) is a widely used interventional imaging modality in clinical diagnosis and treatment of cardiac vessel diseases. Due to cyclic cardiac motion and pulsatile blood flow within the lumen, there exist changes of coronary arterial dimensions and relative motion between the imaging catheter and the lumen during continuous pullback of the catheter. The action subsequently causes cyclic changes to the image intensity of the acquired image sequence. Information on cardiac phases is implied in a non-gated ICUS image sequence. A 1-D phase signal reflecting cardiac cycles was extracted according to cyclical changes in local gray-levels in ICUS images. The local extrema of the signal were then detected to retrieve cardiac phases and to retrospectively gate the image sequence. Results of clinically acquired in vivo image data showed that the average inter-frame dissimilarity of lower than 0.1 was achievable with our technique. In terms of computational efficiency and complexity, the proposed method was shown to be competitive when compared with the current methods. The average frame processing time was lower than 30 ms. We effectively reduced the effect of image noises, useless textures, and non-vessel region on the phase signal detection by discarding signal components caused by non-cardiac factors.

  11. Neuromuscular blockade in cardiac surgery: An update for clinicians

    Directory of Open Access Journals (Sweden)

    Hemmerling Thomas


    Full Text Available There have been great advancements in cardiac surgery over the last two decades; the widespread use of off-pump aortocoronary bypass surgery, minimally invasive cardiac surgery, and robotic surgery have also changed the face of cardiac anaesthesia. The concept of "Fast-track anaesthesia" demands the use of nondepolarising neuromuscular blocking drugs with short duration of action, combining the ability to provide (if necessary sufficiently profound neuromuscular blockade during surgery and immediate re-establishment of normal neuromuscular transmission at the end of surgery. Postoperative residual muscle paralysis is one of the major hurdles for immediate or early extubation after cardiac surgery. Nondepolarising neuromuscular blocking drugs for cardiac surgery should therefore be easy to titrate, of rapid onset and short duration of action with a pathway of elimination independent from hepatic or renal dysfunction, and should equally not affect haemodynamic stability. The difference between repetitive bolus application and continuous infusion is outlined in this review, with the pharmacodynamic and pharmacokinetic characteristics of vecuronium, pancuronium, rocuronium, and cisatracurium. Kinemyography and acceleromyography are the most important currently used neuromuscular monitoring methods. Whereas monitoring at the adductor pollicis muscle is appropriate at the end of surgery, monitoring of the corrugator supercilii muscle better reflects neuromuscular blockade at more central, profound muscles, such as the diaphragm, larynx, or thoraco-abdominal muscles. In conclusion, cisatracurium or rocuronium is recommended for neuromuscular blockade in modern cardiac surgery.

  12. Cardiac nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Gerson, M.C.


    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  13. Sudden Cardiac Death

    Directory of Open Access Journals (Sweden)

    Yipsy María Gutiérrez Báez


    Full Text Available Since the second half of the twentieth century, dying suddenly due to heart-related problems has become the main health issue in all countries where infectious diseases are not prevalent. Sudden death from cardiac causes is an important global health problem. Major databases were searched for the leading causes of sudden cardiac death. It has been demonstrated that there is a group of hereditary diseases with structural alterations or without apparent organic cause that explains many cases of sudden death in young people, whether related or not to physical exertion. Certain population groups are at higher risk for this disease. They are relatively easy to identify and can be the target of primary prevention measures.

  14. Cardiac arrhythmias in pregnancy. (United States)

    Knotts, Robert J; Garan, Hasan


    As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias.

  15. Cardiac surgery 2015 reviewed. (United States)

    Doenst, Torsten; Strüning, Constanze; Moschovas, Alexandros; Gonzalez-Lopez, David; Essa, Yasin; Kirov, Hristo; Diab, Mahmoud; Faerber, Gloria


    For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.

  16. Cardiac hybrid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); University Hospital Zurich, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)


    Hybrid cardiac single photon emission computed tomography (SPECT)/CT imaging allows combined assessment of anatomical and functional aspects of cardiac disease. In coronary artery disease (CAD), hybrid SPECT/CT imaging allows detection of coronary artery stenosis and myocardial perfusion abnormalities. The clinical value of hybrid imaging has been documented in several subsets of patients. In selected groups of patients, hybrid imaging improves the diagnostic accuracy to detect CAD compared to the single imaging techniques. Additionally, this approach facilitates functional interrogation of coronary stenoses and guidance with regard to revascularization procedures. Moreover, the anatomical information obtained from CT coronary angiography or coronary artery calcium scores (CACS) adds prognostic information over perfusion data from SPECT. The use of cardiac hybrid imaging has been favoured by the dissemination of dedicated hybrid systems and the release of dedicated image fusion software, which allow simple patient throughput for hybrid SPECT/CT studies. Further technological improvements such as more efficient detector technology to allow for low-radiation protocols, ultra-fast image acquisition and improved low-noise image reconstruction algorithms will be instrumental to further promote hybrid SPECT/CT in research and clinical practice. (orig.)

  17. Cardiac tissue engineering

    Directory of Open Access Journals (Sweden)



    Full Text Available We hypothesized that clinically sized (1-5 mm thick,compact cardiac constructs containing physiologically high density of viable cells (~108 cells/cm3 can be engineered in vitro by using biomimetic culture systems capable of providing oxygen transport and electrical stimulation, designed to mimic those in native heart. This hypothesis was tested by culturing rat heart cells on polymer scaffolds, either with perfusion of culture medium (physiologic interstitial velocity, supplementation of perfluorocarbons, or with electrical stimulation (continuous application of biphasic pulses, 2 ms, 5 V, 1 Hz. Tissue constructs cultured without perfusion or electrical stimulation served as controls. Medium perfusion and addition of perfluorocarbons resulted in compact, thick constructs containing physiologic density of viable, electromechanically coupled cells, in contrast to control constructs which had only a ~100 mm thick peripheral region with functionally connected cells. Electrical stimulation of cultured constructs resulted in markedly improved contractile properties, increased amounts of cardiac proteins, and remarkably well developed ultrastructure (similar to that of native heart as compared to non-stimulated controls. We discuss here the state of the art of cardiac tissue engineering, in light of the biomimetic approach that reproduces in vitro some of the conditions present during normal tissue development.

  18. Psychosocial aspects in cardiac rehabilitation

    DEFF Research Database (Denmark)

    Pogosova, N. V.; Saner, H.; Pedersen, S. S.


    A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health- related quality ......, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.......A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health- related quality...... questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention...

  19. Psychosocial aspects in cardiac rehabilitation

    DEFF Research Database (Denmark)

    Pogosova, Nana; Saner, Hugo; Pedersen, Susanne S.


    A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality o......, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.......A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality...... questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention...

  20. Reflecting on a room of one reflectance. (United States)

    Ruppertsberg, Alexa I; Bloj, Marina


    We present a numerical analysis of rendered pairs of rooms, in which the spectral power distribution of the illuminant in one room matched the surface reflectance function in the other room, and vice versa. We ask whether distinction between the rooms is possible and on what cues this discrimination is based. Using accurately rendered three-dimensional (3D) scenes, we found that room pairs can be distinguished based on indirect illumination, as suggested by A. L. Gilchrist and A. Jacobsen (1984). In a simulated color constancy scenario, we show that indirect illumination plays a pivotal role as areas of indirect illumination undergo a smaller appearance change than areas of direct illumination. Our study confirms that indirect illumination can play a critical role in surface color recovery and shows how computer rendering programs, which model the light-object interaction according to the laws of physics, are valuable tools that can be used to analyze and explore what image information is available to the visual system from 3D scenes.

  1. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.


    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  2. Indeterminacy of Spatiotemporal Cardiac Alternans

    CERN Document Server

    Zhao, Xiaopeng


    Cardiac alternans, a beat-to-beat alternation in action potential duration (at the cellular level) or in ECG morphology (at the whole heart level), is a marker of ventricular fibrillation, a fatal heart rhythm that kills hundreds of thousands of people in the US each year. Investigating cardiac alternans may lead to a better understanding of the mechanisms of cardiac arrhythmias and eventually better algorithms for the prediction and prevention of such dreadful diseases. In paced cardiac tissue, alternans develops under increasingly shorter pacing period. Existing experimental and theoretical studies adopt the assumption that alternans in homogeneous cardiac tissue is exclusively determined by the pacing period. In contrast, we find that, when calcium-driven alternans develops in cardiac fibers, it may take different spatiotemporal patterns depending on the pacing history. Because there coexist multiple alternans solutions for a given pacing period, the alternans pattern on a fiber becomes unpredictable. Usin...

  3. Evaluation of cardiac tumors with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Luna, Antonio [Clinica Las Nieves, MR Unit, Jaen (Spain); Ribes, Ramon [Reina Sofia Hospital, MR Unit, Radiology Department, Cordoba (Spain); Caro, Pilar [MR Unit, Dadisa, Cadiz (Spain); Vida, Jose [San Juan De Dios Hospital, MR Unit, Resalta, Cordoba (Spain); Erasmus, Jeremy J. [University of Texas, Department of Radiology, Houston, TX (United States)


    Primary cardiac neoplasms are rare, and are more commonly benign than malignant. However, metastases are by far the most common cardiac neoplasms. MRI allows evaluation of myocardial infiltration, pericardial involvement and/or extracardiac extension. MRI overcomes the usual limitations of echocardiography and assesses more accurately changes in cardiac function. Specific tumoral characterization is only possible in cases of myxoma, lipoma, fibroma and hemangioma. Suggestive features of malignancy are right side location, extracardiac extension, inhomogeneity in signal intensity of the tumor and pericardial effusion. The use of intravenous contrast material improves tumor characterization and depiction of tumor borders. MRI also allows differentiation of tumor from other nontumoral masses such as intracavitary tumors or fibromuscular elements of the posterior wall of the right atrium. (orig.)

  4. Ultrasensitive, label-free detection of cardiac biomarkers with optical SIS sensor. (United States)

    Diware, Mangesh S; Cho, Hyun Mo; Chegal, Won; Cho, Yong Jai; Kim, Dong Soo; O, Sang Won; Kim, Kyeong-Suk; Paek, Se-Hwan


    Acute myocardial infarction (MI) is the leading cause of high mortality and morbidity rate worldwide, early and accurate diagnosis can increase the chances of survival. In this work, we report a simple, ultrasensitive, label-free, and high-throughput solution immersed silicon (SIS) immunosensor based on non-reflection condition (NRC) for p-polarized wave for early diagnosis of MI. SIS sensor chips are just a thin dielectric polymer layer on the silicon surface, which can be functionalized for specific application. At NRC, SIS sensors are extremely sensitive to the growing thickness of a bio-layer on the sensor surface while independent of refractive index change of the surrounding medium. Therefore, SIS signal is free from thermal noise, unlike surface plasmon resonance based sensor. Also, there is no need of reference signal which facilitates fast and accurate interaction measurement. Here, SIS technology is applied to tackle two issues in MI diagnosis: high sensitivity with the direct assay and the ability to measure in human serum. Myoglobin, creatine kinase-MB, and cardiac troponin I (cTnI) proteins were used as the MI biomarkers. We were able to measure over a broad concentration range with the detection limit of 5 and 10pg/ml for cTnI in PBS and blood serum, respectively. The response time is about 5min. This novel technique is a suitable candidate for cost effective point-of-care application.

  5. Case Report: Penetrating Cardiac Injury

    Directory of Open Access Journals (Sweden)

    Adem Grbolar


    Full Text Available Summary: Penetrating cardiac injurys caused by gunshots and penetrating tools have high mortality rates. The way of injury, how the cardiac area is effected and the presence of cardiac tamponadecauses mortality in different rates. However the better treatment quality of hospitals, increasingoperative techniques, and internel care unit quality has not been change during the years. Searching the literature, we want to present a 42 years old male patient whowas injured by knife and had a 1 cm skin wound on chest with cardiac tamponade. After sternotomy a 7 cm laseration was observed in heart. Cardioraphy was performed.

  6. Cardiac surgery for Kartagener syndrome. (United States)

    Tkebuchava, T; von Segesser, L K; Niederhäuser, U; Bauersfeld, U; Turina, M


    Two patients (one girl, one boy) with Kartagener syndrome (situs inversus, bronchiectasis, sinusitis), despite pulmonary problems and associated congenital cardiac anomalies, were operated on at the ages of 4 years and 7 years, respectively. They had had previous palliative treatment at the age of 3 months and 1.3 years, respectively. Both postoperative periods after total correction were without significant complications. Long-term follow-up was available for 9 and 19 years, respectively, with no manifestations of heart insufficiency. Both patients are physically active, and neither requires cardiac medication. Patients with Kartagener syndrome and associated congenital cardiac anomalies can successfully undergo multiple cardiac operations with good long-term outcome.

  7. 38 CFR 4.46 - Accurate measurement. (United States)


    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  8. Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus

    NARCIS (Netherlands)

    Burger, Nicole B.; Haak, Monique C.; Kok, Evelien; de Groot, Christianne J M; Shou, Weinian; Scambler, Peter J.; Lee, Youngsook; Cho, Eunjin; Christoffels, Vincent M.; Bekker, Mireille N.


    Background In human fetuses with cardiac defects and increased nuchal translucency, abnormal ductus venosus flow velocity waveforms are observed. It is unknown whether abnormal ductus venosus flow velocity waveforms in fetuses with increased nuchal translucency are a reflection of altered cardiac fu

  9. Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

    Institute of Scientific and Technical Information of China (English)

    Hung Ming-Yow; Li Ju-Chi; Hao Wen-Rui; Wu Cheng-Hsueh; Hung Ming-Jui


    Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

  10. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B. [Papworth Hospital, Cambridge (United Kingdom); Screaton, Nicholas J. [Papworth Hospital, Cambridge (United Kingdom); Papworth Hospital NHS Trust, Diagnostic Centre, Department of Radiology, Papworth Everard, Cambridgeshire (United Kingdom)


    The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. (orig.)

  11. How flatbed scanners upset accurate film dosimetry. (United States)

    van Battum, L J; Huizenga, H; Verdaasdonk, R M; Heukelom, S


    Film is an excellent dosimeter for verification of dose distributions due to its high spatial resolution. Irradiated film can be digitized with low-cost, transmission, flatbed scanners. However, a disadvantage is their lateral scan effect (LSE): a scanner readout change over its lateral scan axis. Although anisotropic light scattering was presented as the origin of the LSE, this paper presents an alternative cause. Hereto, LSE for two flatbed scanners (Epson 1680 Expression Pro and Epson 10000XL), and Gafchromic film (EBT, EBT2, EBT3) was investigated, focused on three effects: cross talk, optical path length and polarization. Cross talk was examined using triangular sheets of various optical densities. The optical path length effect was studied using absorptive and reflective neutral density filters with well-defined optical characteristics (OD range 0.2-2.0). Linear polarizer sheets were used to investigate light polarization on the CCD signal in absence and presence of (un)irradiated Gafchromic film. Film dose values ranged between 0.2 to 9 Gy, i.e. an optical density range between 0.25 to 1.1. Measurements were performed in the scanner's transmission mode, with red-green-blue channels. LSE was found to depend on scanner construction and film type. Its magnitude depends on dose: for 9 Gy increasing up to 14% at maximum lateral position. Cross talk was only significant in high contrast regions, up to 2% for very small fields. The optical path length effect introduced by film on the scanner causes 3% for pixels in the extreme lateral position. Light polarization due to film and the scanner's optical mirror system is the main contributor, different in magnitude for the red, green and blue channel. We concluded that any Gafchromic EBT type film scanned with a flatbed scanner will face these optical effects. Accurate dosimetry requires correction of LSE, therefore, determination of the LSE per color channel and dose delivered to the film.

  12. Echocardiographic Evaluation of Cardiac Function in Ischemic Rats: Value of M-Mode Echocardiography


    Darbandi Azar, Amir; Tavakoli, Fatemeh; Moladoust, Hassan; Zare, Asghar; Sadeghpour, Anita


    Background: Echocardiography is a well-established diagnostic tool for a safe, reproducible and accurate evaluation of cardiac anatomy, hemodynamics and function in clinical practice. Objectives: We sought to demonstrate the efficacy and feasibility of M-mode echocardiography to evaluate cardiac structure and function in normal and MI-induced adult rats. Materials and Methods: All animal procedures were approved by the ethics committee of Tehran University of Medical Sciences and the investig...

  13. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld


    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  14. The Danish Cardiac Rehabilitation Database

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne


    AIM OF DATABASE: The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). STUDY POPULATION: Hospitalized patients with CHD with stenosis on coronary angiography treated with percutane...

  15. Biosynthesis of cardiac natriuretic peptides

    DEFF Research Database (Denmark)

    Goetze, Jens Peter


    . An inefficient post-translational prohormone maturation will also affect the biology of the cardiac natriuretic peptide system. This review aims at summarizing the myocardial synthesis of natriuretic peptides focusing on B-type natriuretic peptide, where new data has disclosed cardiac myocytes as highly...

  16. [Cardiac myxoma with cerebral metastases]. (United States)

    Bazin, A; Peruzzi, P; Baudrillard, J C; Pluot, M; Rousseaux, P


    A 56 year old woman developed multiple metastases in the cerebrum and cerebellum, four years after cardiac intervention on a left atrial myxoma. The absence of stroke is noteworthy. Multiple high density lesions with contrast enhancement were seen by CT scan, suggesting metastatic neoplasms. Histological examination confirmed the diagnosis of metastases of cardiac myxoma. Only four cases were recorded in the literature.

  17. Health Instruction Packages: Cardiac Anatomy. (United States)

    Phillips, Gwen; And Others

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

  18. Pneumothorax in cardiac pacing

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;


    AIM: To identify risk factors for pneumothorax treated with a chest tube after cardiac pacing device implantation in a population-based cohort.METHODS AND RESULTS: A nationwide cohort study was performed based on data on 28 860 patients from the Danish Pacemaker Register, which included all Danish...... patients who received their first pacemaker (PM) or cardiac resynchronization device from 1997 to 2008. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for the association between risk factors and pneumothorax treated with a chest tube. The median...... age was 77 years (25th and 75th percentile: 69-84) and 55% were male (n = 15 785). A total of 190 patients (0.66%) were treated for pneumothorax, which was more often in women [aOR 1.9 (1.4-2.6)], and in patients with age >80 years [aOR 1.4 (1.0-1.9)], a prior history of chronic obstructive pulmonary...

  19. Leadership in cardiac surgery. (United States)

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos


    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance.

  20. Nuclear cardiac imaging for the diagnosis and management of heart failure: what can be learned from recent guidelines? (United States)

    Vervloet, Delphine M; DE Sutter, Johan


    The aim of this review is to provide the clinical cardiologist and nuclear medicine specialist a brief overview of the currently accepted clinical use of cardiac nuclear imaging for the diagnosis and management of patients with heart failure based on recent (2012-2015) European Society of Cardiology (ESC) guidelines. We used the most recent ESC guidelines on heart failure, management of stable coronary artery disease, cardiac pacing, myocardial revascularisation, non-cardiac surgery and ventricular arrhythmias and sudden death. Nowadays cardiac nuclear imaging is useful in almost every step in heart failure from diagnostics to treatment. In first diagnosis of heart failure radionuclide imaging can provide information on ventricular function and volumes and nuclear imaging techniques provide accurate and reproducible left ventricular function assessment. In work out of the aetiology of the heart failure CMR, SPECT and PET imaging can demonstrate presence of inducible ischemia and myocardial viability. For prognostic information MIBG might be promising in the future. In treatment planning cardiac nuclear imaging is important to evaluate new angina and to assess accurate left ventricular ejection fraction before cardiac resynchronization therapy. Imaging stress testing is useful in the preoperative evaluation for non-cardiac surgery of heart failure patients. There is until now no recommended place for cardiac nuclear imaging in the follow-up of heart failure patients or prior to the initiation of cardiac rehabilitation.

  1. Cardiac MR Elastography: Comparison with left ventricular pressure measurement

    Directory of Open Access Journals (Sweden)

    Samani Abbas


    Full Text Available Abstract Purpose of study To compare magnetic resonance elastography (MRE with ventricular pressure changes in an animal model. Methods Three pigs of different cardiac physiology (weight, 25 to 53 kg; heart rate, 61 to 93 bpm; left ventricular [LV] end-diastolic volume, 35 to 70 ml were subjected to invasive LV pressure measurement by catheter and noninvasive cardiac MRE. Cardiac MRE was performed in a short-axis view of the heart and applying a 48.3-Hz shear-wave stimulus. Relative changes in LV-shear wave amplitudes during the cardiac cycle were analyzed. Correlation coefficients between wave amplitudes and LV pressure as well as between wave amplitudes and LV diameter were determined. Results A relationship between MRE and LV pressure was observed in all three animals (R2 ≥ 0.76. No correlation was observed between MRE and LV diameter (R2 ≤ 0.15. Instead, shear wave amplitudes decreased 102 ± 58 ms earlier than LV diameters at systole and amplitudes increased 175 ± 40 ms before LV dilatation at diastole. Amplitude ratios between diastole and systole ranged from 2.0 to 2.8, corresponding to LV pressure differences of 60 to 73 mmHg. Conclusion Externally induced shear waves provide information reflecting intraventricular pressure changes which, if substantiated in further experiments, has potential to make cardiac MRE a unique noninvasive imaging modality for measuring pressure-volume function of the heart.

  2. Automatic basal slice detection for cardiac analysis (United States)

    Paknezhad, Mahsa; Marchesseau, Stephanie; Brown, Michael S.


    Identification of the basal slice in cardiac imaging is a key step to measuring the ejection fraction (EF) of the left ventricle (LV). Despite research on cardiac segmentation, basal slice identification is routinely performed manually. Manual identification, however, has been shown to have high inter-observer variability, with a variation of the EF by up to 8%. Therefore, an automatic way of identifying the basal slice is still required. Prior published methods operate by automatically tracking the mitral valve points from the long-axis view of the LV. These approaches assumed that the basal slice is the first short-axis slice below the mitral valve. However, guidelines published in 2013 by the society for cardiovascular magnetic resonance indicate that the basal slice is the uppermost short-axis slice with more than 50% myocardium surrounding the blood cavity. Consequently, these existing methods are at times identifying the incorrect short-axis slice. Correct identification of the basal slice under these guidelines is challenging due to the poor image quality and blood movement during image acquisition. This paper proposes an automatic tool that focuses on the two-chamber slice to find the basal slice. To this end, an active shape model is trained to automatically segment the two-chamber view for 51 samples using the leave-one-out strategy. The basal slice was detected using temporal binary profiles created for each short-axis slice from the segmented two-chamber slice. From the 51 successfully tested samples, 92% and 84% of detection results were accurate at the end-systolic and the end-diastolic phases of the cardiac cycle, respectively.

  3. Abundance, distribution, mobility and oligomeric state of M2 muscarinic acetylcholine receptors in live cardiac muscle


    Nenasheva, Tatiana A.; Neary, Marianne; Gregory I. Mashanov; Birdsall, Nigel J.M.; Breckenridge, Ross A.; Molloy, Justin E.


    M2 muscarinic acetylcholine receptors modulate cardiac rhythm via regulation of the inward potassium current. To increase our understanding of M2 receptor physiology we used Total Internal Reflection Fluorescence Microscopy to visualize individual receptors at the plasma membrane of transformed CHOM2 cells, a cardiac cell line (HL-1), primary cardiomyocytes and tissue slices from pre- and post-natal mice. Receptor expression levels between individual cells in dissociated cardiomyocytes and he...

  4. Physics of Cardiac Arrhythmogenesis (United States)

    Karma, Alain


    A normal heartbeat is orchestrated by the stable propagation of an excitation wave that produces an orderly contraction. In contrast, wave turbulence in the ventricles, clinically known as ventricular fibrillation (VF), stops the heart from pumping and is lethal without prompt defibrillation. I review experimental, computational, and theoretical studies that have shed light on complex dynamical phenomena linked to the initiation, maintenance, and control of wave turbulence. I first discuss advances made to understand the precursor state to a reentrant arrhythmia where the refractory period of cardiac tissue becomes spatiotemporally disordered; this is known as an arrhythmogenic tissue substrate. I describe observed patterns of transmembrane voltage and intracellular calcium signaling that can contribute to this substrate, and symmetry breaking instabilities to explain their formation. I then survey mechanisms of wave turbulence and discuss novel methods that exploit electrical pacing stimuli to control precursor patterns and low-energy pulsed electric fields to control turbulence.

  5. Platelets and cardiac arrhythmia

    Directory of Open Access Journals (Sweden)

    Jonas S De Jong


    Full Text Available Sudden cardiac death remains one of the most prevalent modes of death in industrialized countries, and myocardial ischemia due to thrombotic coronary occlusion is its primary cause. The role of platelets in the occurrence of SCD extends beyond coronary flow impairment by clot formation. Here we review the substances released by platelets during clot formation and their arrhythmic properties. Platelet products are released from three types of platelet granules: dense core granules, alpha-granules, and platelet lysosomes. The physiologic properties of dense granule products are of special interest as a potential source of arrhythmic substances. They are released readily upon activation and contain high concentrations of serotonin, histamine, purines, pyrimidines, and ions such as calcium and magnesium. Potential arrhythmic mechanisms of these substances, e.g. serotonin and high energy phosphates, include induction of coronary constriction, calcium overloading, and induction of delayed after-depolarizations. Alpha-granules produce thromboxanes and other arachidonic acid products with many potential arrhythmic effects mediated by interference with cardiac sodium, calcium and potassium channels. Alpha-granules also contain hundreds of proteins that could potentially serve as ligands to receptors on cardiomyocytes. Lysosomal products probably do not have an important arrhythmic effect. Platelet products and ischemia can induce coronary permeability, thereby enhancing interaction with surrounding cardiomyocytes. Antiplatelet therapy is known to improve survival after myocardial infarction. Although an important part of this effect results from prevention of coronary clot formation, there is evidence to suggest that antiplatelet therapy also induces anti-arrhythmic effects during ischemia by preventing the release of platelet activation products.

  6. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf


    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  7. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore


    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  8. Fetal cardiac rhabdomyoma: case report

    Directory of Open Access Journals (Sweden)

    Seyed Mostafa Ghavami


    Full Text Available Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported. Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm, originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis. Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.

  9. Reflectance spectra of subarctic lichens (United States)

    Petzold, Donald E.; Goward, Samuel N.


    Lichens constitute a major portion of the ground cover of high latitude environments, but little has been reported concerning their in situ solar spectral reflectance properties. Knowledge of these properties is important for the interpretation of remotely sensed observations from high latitude regions, as well as in studies of high latitude ecology and energy balance climatology. The spectral reflectance of common boreal vascular plants is similar to that of vascular plants of the midlatitudes. The dominant lichens, in contrast, display variable reflectance patterns in visible wavelengths. The relative reflectance peak at 0.55 microns, common to green vegetation, is absent or indistinct in spectra of pervasive boreal forest and tundra lichens, despite the presence of chlorophyll in the inner algal cells. Lichens of the dominant genus, Cladina, display strong absorption of ultraviolet energy and short-wavelength blue light relative to their absorption in other visible wavelengths. Since the Cladinae dominate both the surface vegetation in open woodlands of the boreal forest and the low arctic tundra, their unusual spectral reflectance patterns will enable accurate monitoring of the boreal forest-tundra ecotone and detection of its vigor and movement in the future.

  10. Accurate measurement of the helical twisting power of chiral dopants (United States)

    Kosa, Tamas; Bodnar, Volodymyr; Taheri, Bahman; Palffy-Muhoray, Peter


    We propose a method for the accurate determination of the helical twisting power (HTP) of chiral dopants. In the usual Cano-wedge method, the wedge angle is determined from the far-field separation of laser beams reflected from the windows of the test cell. Here we propose to use an optical fiber based spectrometer to accurately measure the cell thickness. Knowing the cell thickness at the positions of the disclination lines allows determination of the HTP. We show that this extension of the Cano-wedge method greatly increases the accuracy with which the HTP is determined. We show the usefulness of this method by determining the HTP of ZLI811 in a variety of hosts with negative dielectric anisotropy.

  11. Epigenetic regulation in cardiac fibrosis

    Institute of Scientific and Technical Information of China (English)

    Li-Ming; Yu; Yong; Xu


    Cardiac fibrosis represents an adoptive response in the heart exposed to various stress cues. While resolution of the fibrogenic response heralds normalization of heart function, persistent fibrogenesis is usually associated with progressive loss of heart function and eventually heart failure. Cardiac fibrosis is regulated by a myriad of factors that converge on the transcription of genes encoding extracellular matrix proteins, a process the epigenetic machinery plays a pivotal role. In this minireview, we summarize recent advances regarding the epigenetic regulation of cardiac fibrosis focusing on the role of histone and DNA modifications and non-coding RNAs.

  12. Cardiac Involvement in Ankylosing Spondylitis (United States)

    Ozkan, Yasemin


    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  13. Acupuncture therapy related cardiac injury. (United States)

    Li, Xue-feng; Wang, Xian


    Cardiac injury is the most serious adverse event in acupuncture therapy. The causes include needling chest points near the heart, the cardiac enlargement and pericardial effusion that will enlarge the projected area on the body surface and make the proper depth of needling shorter, and the incorrect needling method of the points. Therefore, acupuncture practitioners must be familiar with the points of the heart projected area on the chest and the correct needling methods in order to reduce the risk of acupuncture therapy related cardiac injury.

  14. Normal cardiac function in mice with supraphysiological cardiac creatine levels. (United States)

    Santacruz, Lucia; Hernandez, Alejandro; Nienaber, Jeffrey; Mishra, Rajashree; Pinilla, Miguel; Burchette, James; Mao, Lan; Rockman, Howard A; Jacobs, Danny O


    Creatine and phosphocreatine levels are decreased in heart failure, and reductions in myocellular phosphocreatine levels predict the severity of the disease and portend adverse outcomes. Previous studies of transgenic mouse models with increased creatine content higher than two times baseline showed the development of heart failure and shortened lifespan. Given phosphocreatine's role in buffering ATP content, we tested the hypothesis whether elevated cardiac creatine content would alter cardiac function under normal physiological conditions. Here, we report the creation of transgenic mice that overexpress the human creatine transporter (CrT) in cardiac muscle under the control of the α-myosin heavy chain promoter. Cardiac transgene expression was quantified by qRT-PCR, and human CrT protein expression was documented on Western blots and immunohistochemistry using a specific anti-CrT antibody. High-energy phosphate metabolites and cardiac function were measured in transgenic animals and compared with age-matched, wild-type controls. Adult transgenic animals showed increases of 5.7- and 4.7-fold in the content of creatine and free ADP, respectively. Phosphocreatine and ATP levels were two times as high in young transgenic animals but declined to control levels by the time the animals reached 8 wk of age. Transgenic mice appeared to be healthy and had normal life spans. Cardiac morphometry, conscious echocardiography, and pressure-volume loop studies demonstrated mild hypertrophy but normal function. Based on our characterization of the human CrT protein expression, creatine and phosphocreatine content, and cardiac morphometry and function, these transgenic mice provide an in vivo model for examining the therapeutic value of elevated creatine content for cardiac pathologies.

  15. Use of cardiac biomarkers in neonatology. (United States)

    Vijlbrief, Daniel C; Benders, Manon J N L; Kemperman, Hans; van Bel, Frank; de Vries, Willem B


    Cardiac biomarkers are used to identify cardiac disease in term and preterm infants. This review discusses the roles of natriuretic peptides and cardiac troponins. Natriuretic peptide levels are elevated during atrial strain (atrial natriuretic peptide (ANP)) or ventricular strain (B-type natriuretic peptide (BNP)). These markers correspond well with cardiac function and can be used to identify cardiac disease. Cardiac troponins are used to assess cardiomyocyte compromise. Affected cardiomyocytes release troponin into the bloodstream, resulting in elevated levels of cardiac troponin. Cardiac biomarkers are being increasingly incorporated into clinical trials as indicators of myocardial strain. Furthermore, cardiac biomarkers can possibly be used to guide therapy and improve outcome. Natriuretic peptides and cardiac troponins are potential tools in the diagnosis and treatment of neonatal disease that is complicated by circulatory compromise. However, clear reference ranges need to be set and validation needs to be carried out in a population of interest.

  16. Cardiac ion channels in health and disease. (United States)

    Amin, Ahmad S; Tan, Hanno L; Wilde, Arthur A M


    Cardiac electrical activity depends on the coordinated propagation of excitatory stimuli through the heart and, as a consequence, the generation of action potentials in individual cardiomyocytes. Action potential formation results from the opening and closing (gating) of ion channels that are expressed within the sarcolemma of cardiomyocytes. Ion channels possess distinct genetic, molecular, pharmacologic, and gating properties and exhibit dissimilar expression levels within different cardiac regions. By gating, ion channels permit ion currents across the sarcolemma, thereby creating the different phases of the action potential (e.g., resting phase, depolarization, repolarization). The importance of ion channels in maintaining normal heart rhythm is reflected by the increased incidence of arrhythmias in inherited diseases that are linked to mutations in genes encoding ion channels or their accessory proteins and in acquired diseases that are associated with changes in ion channel expression levels or gating properties. This review discusses ion channels that contribute to action potential formation in healthy hearts and their role in inherited and acquired diseases.

  17. Coupling of cardiac and locomotor rhythms. (United States)

    Kirby, R L; Nugent, S T; Marlow, R W; MacLeod, D A; Marble, A E


    The pressure within exercising skeletal muscle rises and falls rhythmically during normal human locomotion, the peak pressure reaching levels that intermittently impede blood flow to the exercising muscle. Speculating that a reciprocal relationship between the timing of peak intramuscular and pulsatile arterial pressures should optimize blood flow through muscle and minimize cardiac load, we tested the hypothesis that heart rate becomes entrained with walking and running cadence at some locomotion speeds, by means of electrocardiography and an accelerometer to provide signals reflecting heart rate and cadence, respectively. In 18 of 25 subjects, 1:1 coupling of heart and step rates was present at one or more speeds on a motorized treadmill, generally at moderate to high exercise intensities. To determine how exercise specific this phenomenon is, and to refute the competing hypothesis that coupling is due to vertical accelerations of the heart during locomotion, we had 12 other subjects cycle on an electronically braked bicycle ergometer. Coupling was found between heart rate and pedaling frequency in 10 of them. Cardiac-locomotor coupling appears to be a normal physiological phenomenon, and its identification provides a fresh perspective from which to study endurance.

  18. Recent developments in cardiac pacing. (United States)

    Rodak, D J


    Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.

  19. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson


    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  20. Cardiac manifestations in systemic sclerosis

    Institute of Scientific and Technical Information of China (English)

    Sevdalina; Lambova


    Primary cardiac involvement, which develops as a direct consequence of systemic sclerosis(SSc), may manifest as myocardial damage, fibrosis of the conduction system, pericardial and, less frequently, as valvular disease. In addition, cardiac complications in SSc may develop as a secondary phenomenon due to pulmonary arterial hypertension and kidney pathology. The prevalence of primary cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations, the presence of subclinical periods, the type of diagnostic tools applied, and the diversity of patient populations. When clinically manifested, cardiac involvement is thought to be an important prognostic factor. Profound microvascular disease is a pathognomonic feature of SSc, as both vasospasm and structural alterations are present. Such alterations are thought to predict macrovascular atherosclerosis over time. There are contradictory reports regarding the prevalence of atherosclerosis in SSc. According to some authors, the prevalence of atherosclerosis of the large epicardial coronary arteries is similar to that of the general population, in contrast with other rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the level of inflammation in SSc is inferior. Thus, the atherosclerotic process may not be as aggressive and not easily detectable in smaller studies. Echocardiography(especially tissue Doppler imaging), single-photon emission computed tomography, magnetic resonance imaging and cardiac computed tomography are sensitive techniques for earlier detection of both structural and functional scleroderma-related cardiac pathologies. Screening for subclinical cardiac involvement via modern, sensitive tools provides an opportunity for early diagnosis and treatment, which is of crucial importance for a positive outcome.

  1. Reflectable bases for affine reflection systems

    CERN Document Server

    Azam, Saeid; Yousofzadeh, Malihe


    The notion of a "root base" together with its geometry plays a crucial role in the theory of finite and affine Lie theory. However, it is known that such a notion does not exist for the recent generalizations of finite and affine root systems such as extended affine root systems and affine reflection systems. As an alternative, we introduce the notion of a "reflectable base", a minimal subset $\\Pi$ of roots such that the non-isotropic part of the root system can be recovered by reflecting roots of $\\Pi$ relative to the hyperplanes determined by $\\Pi$. We give a full characterization of reflectable bases for tame irreducible affine reflection systems of reduced types, excluding types $E_{6,7,8}$. As a byproduct of our results, we show that if the root system under consideration is locally finite then any reflectable base is an integral base.

  2. [Stem cells and cardiac regeneration]. (United States)

    Perez Millan, Maria Ines; Lorenti, Alicia


    Stem cells are defined by virtue of their functional attributes: absence of tissue specific differentitated markers, capable of proliferation, able to self-maintain the population, able to produce a large number of differentiated, functional progeny, able to regenerate the tissue after injury. Cell therapy is an alternative for the treatment of several diseases, like cardiac diseases (cell cardiomyoplasty). A variety of stem cells could be used for cardiac repair: from cardiac and extracardiac sources. Each cell type has its own profile of advantages, limitations, and practicability issues in specific clinical settings. Differentiation of bone marrow stem cells to cardiomyocyte-like cells have been observed under different culture conditions. The presence of resident cardiac stem cell population capable of differentiation into cardiomyocyte or vascular lineage suggests that these cells could be used for cardiac tissue repair, and represent a great promise for clinical application. Stem cells mobilization by cytokines may also offer a strategy for cardiac regeneration. The use of stem cells (embryonic and adult) may hold the key to replacing cells lost in many devastating diseases. This potential benefit is a major focus for stem cell research.

  3. Cardiac Regeneration and Stem Cells. (United States)

    Zhang, Yiqiang; Mignone, John; MacLellan, W Robb


    After decades of believing the heart loses the ability to regenerate soon after birth, numerous studies are now reporting that the adult heart may indeed be capable of regeneration, although the magnitude of new cardiac myocyte formation varies greatly. While this debate has energized the field of cardiac regeneration and led to a dramatic increase in our understanding of cardiac growth and repair, it has left much confusion in the field as to the prospects of regenerating the heart. Studies applying modern techniques of genetic lineage tracing and carbon-14 dating have begun to establish limits on the amount of endogenous regeneration after cardiac injury, but the underlying cellular mechanisms of this regeneration remained unclear. These same studies have also revealed an astonishing capacity for cardiac repair early in life that is largely lost with adult differentiation and maturation. Regardless, this renewed focus on cardiac regeneration as a therapeutic goal holds great promise as a novel strategy to address the leading cause of death in the developed world.

  4. Cardiac imaging. A multimodality approach

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    Thelen, Manfred [Johannes Gutenberg University Hospital, Mainz (Germany); Erbel, Raimund [University Hospital Essen (Germany). Dept. of Cardiology; Kreitner, Karl-Friedrich [Johannes Gutenberg University Hospital, Mainz (Germany). Clinic and Polyclinic for Diagnostic and Interventional Radiology; Barkhausen, Joerg (eds.) [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Radiology and Nuclear Medicine


    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  5. Cardiac Biomarkers and Cycling Race

    Directory of Open Access Journals (Sweden)

    Caroline Le Goff, Jean-François Kaux, Sébastien Goffaux, Etienne Cavalier


    Full Text Available In cycling as in other types of strenuous exercise, there exists a risk of sudden death. It is important both to understand its causes and to see if the behavior of certain biomarkers might highlight athletes at risk. Many reports describe changes in biomarkers after strenuous exercise (Nie et al., 2011, but interpreting these changes, and notably distinguishing normal physiological responses from pathological changes, is not easy. Here we have focused on the kinetics of different cardiac biomarkers: creatin kinase (CK, creating kinase midbrain (CK-MB, myoglobin (MYO, highly sensitive troponin T (hs-TnT and N-terminal brain natriuretic peptide (NT-proBNP. The population studied was a group of young trained cyclists participating in a 177-km cycling race. The group of individuals was selected for maximal homogeneity. Their annual training volume was between 10,000 and 16,000 kilometers. The rhythm of races is comparable and averages 35 km/h, depending on the race’s difficulty. The cardiac frequency was recorded via a heart rate monitor. Three blood tests were taken. The first blood test, T0, was taken approximately 2 hours before the start of the race and was intended to gather values which would act as references for the following tests. The second blood test, T1, was realized within 5 minutes of their arrival. The third and final blood test, T3, was taken 3 hours following their arrival. The CK, CK-MB, MYO, hs-TnT and NT-proBNP were measured on the Roche Diagnostic modular E (Manhein, Germany. For the statistical analysis, an ANOVA and post hoc test of Scheffé were calculated with the Statistica Software version 9.1. We noticed an important significant variation in the cardiac frequency between T0 and T1 (p < 0.0001, T0 and T3 (p < 0.0001, and T1 and T3 (p < 0.01. Table 1 shows the results obtained for the different biomarkers. CK and CK-MB showed significant variation between T0-T1 and T0-T3 (p < 0.0001. Myoglobin increased significantly

  6. Recurrent late cardiac tamponade following cardiac surgery : a deceiving and potentially lethal complication

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Meuzelaar, Jacobus J.


    Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagno

  7. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    DEFF Research Database (Denmark)

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina;


    causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P ...AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...... the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known...

  8. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.


    Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...... a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0...

  9. [Calpains and cardiac diseases]. (United States)

    Perrin, C; Vergely, C; Rochette, L


    Calpains are a large family of cytosolic cysteine proteases composed of at least fourteen distinct isoforms. The family can be divided into two groups on the basis of distribution: ubiquitous and tissue-specific. Our current knowledge about calpains properties apply mainly to the ubiquitous isozymes, micro- and milli-calpain (classic calpains). These forms are activated after autolysis. Translocation and subsequent interactions with phospholipids of these enzymes increase their activity. Calpains are able to cleave a subset of substrates, as enzymes, structural and signalling proteins. Cardiac pathologies, such as heart failure, atrial fibrillation or clinical states particularly ischemia reperfusion, are associated with an increase of cytosolic calcium and in this regards, calpain activation has been evoked as one of the mediators leading to myocardial damage. Calpain activities have been shown to be increased in hearts experimentally subjected to ischemia reperfusion or during hypertrophy, but also in atrial tissue harvested from patients suffering from atrial fibrillations. These activities have been related to an increase of the proteolysis of different myocardial components, particularly, troponins, which are major regulators of the contraction of cardiomyocytes. Moreover, recent works have demonstrated that calpains are involved in the development of myocardial cell death by necrosis or apoptosis.

  10. Determining cardiac fiber orientation using FSL and registered ultrasound/DTI volumes (United States)

    Dormer, James; Qin, Xulei; Shen, Ming; Wang, Silun; Zhang, Xiaodong; Jiang, Rong; Wagner, Mary B.; Fei, Baowei


    Accurate extraction of cardiac fiber orientation from diffusion tensor imaging is important for determining heart structure and function. However, the acquisition of magnetic resonance (MR) diffusion tensor images is costly and time consuming. By comparison, cardiac ultrasound imaging is rapid and relatively inexpensive, but it lacks the capability to directly measure fiber orientations. In order to create a detailed heart model from ultrasound data, a three-dimensional (3D) diffusion tensor imaging (DTI) with known fiber orientations can be registered to an ultrasound volume through a geometric mask. After registration, the cardiac orientations from the template DTI can be mapped to the heart using a deformable transformation field. This process depends heavily on accurate fiber orientation extraction from the DTI. In this study, we use the FMRIB Software Library (FSL) to determine cardiac fiber orientations in diffusion weighted images. For the registration between ultrasound and MRI volumes, we achieved an average Dice similarity coefficient (DSC) of 81.6+/-2.1%. For the estimation of fiber orientations from the proposed method, we achieved an acute angle error (AAE) of 22.7+/-3.1° as compared to the direct measurements from DTI. This work provides a new approach to generate cardiac fiber orientation that may be used for many cardiac applications.

  11. End-expiration Respiratory Gating for a High Resolution Stationary Cardiac SPECT system (United States)

    Chan, Chung; Harris, Mark; Le, Max; Biondi, James; Grobshtein, Yariv; Liu, Yi-Hwa; Sinusas, Albert J.; Liu, Chi


    Respiratory and cardiac motions can degrade myocardial perfusion SPECT (MPS) image quality and reduce defect detection and quantitative accuracy. In this study, we developed a dual-respiratory and cardiac gating system for a high resolution fully stationary cardiac SPECT scanner in order to improve the image quality and defect detection. Respiratory motion was monitored using a compressive sensor pillow connected to a dual respiratory-cardiac gating box, which sends cardiac triggers only during end-expiration phases to the single cardiac trigger input on the SPECT scanners. The listmode data were rebinned retrospectively into end-expiration frames for respiratory motion reduction or 8 cardiac gates only during end-expiration phases to compensate for both respiratory and cardiac motions. The proposed method was first validated on a motion phantom in the presence and absence of multiple perfusion defects, and then applied on 11 patient studies with and without perfusion defects. In the normal phantom studies, the end-expiration gated SPECT (EXG-SPECT) reduced respiratory motion blur and increased myocardium to blood pool contrast by 51.2% as compared to the ungated images. The proposed method also yielded an average of 11.2% increase in myocardium to defect contrast as compared to the ungated images in the phantom studies with perfusion defects. In the patient studies, EXG-SPECT significantly improved the myocardium to blood pool contrast (pdefect, EXG-SPECT improved the defect contrast and definition. The dual respiratory-cardiac gating further reduced the blurring effect, increased the myocardium to blood pool contrast significantly by 36% (pdefect characteristics and visualization of fine structures at the expense of increased noise on the patient with defect. The results showed that the proposed methods can effectively reduce motion blur in the images caused by both respiratory and cardiac motions, which may lead to more accurate defect detection and

  12. End-expiration respiratory gating for a high-resolution stationary cardiac SPECT system (United States)

    Chan, Chung; Harris, Mark; Le, Max; Biondi, James; Grobshtein, Yariv; Liu, Yi-Hwa; Sinusas, Albert J.; Liu, Chi


    Respiratory and cardiac motions can degrade myocardial perfusion SPECT (MPS) image quality and reduce defect detection and quantitative accuracy. In this study, we developed a dual respiratory and cardiac gating system for a high-resolution fully stationary cardiac SPECT scanner in order to improve the image quality and defect detection. Respiratory motion was monitored using a compressive sensor pillow connected to a dual respiratory-cardiac gating box, which sends cardiac triggers only during end-expiration phases to the single cardiac trigger input on the SPECT scanners. The listmode data were rebinned retrospectively into end-expiration frames for respiratory motion reduction or eight cardiac gates only during end-expiration phases to compensate for both respiratory and cardiac motions. The proposed method was first validated on a motion phantom in the presence and absence of multiple perfusion defects, and then applied on 11 patient studies with and without perfusion defects. In the normal phantom studies, the end-expiration gated SPECT (EXG-SPECT) reduced respiratory motion blur and increased myocardium to blood pool contrast by 51.2% as compared to the ungated images. The proposed method also yielded an average of 11.2% increase in myocardium to defect contrast as compared to the ungated images in the phantom studies with perfusion defects. In the patient studies, EXG-SPECT significantly improved the myocardium to blood pool contrast (p defect, EXG-SPECT improved the defect contrast and definition. The dual respiratory-cardiac gating further reduced the blurring effect, increased the myocardium to blood pool contrast significantly by 36% (p defect characteristics and visualization of fine structures at the expense of increased noise on the patient with defect. The results showed that the proposed methods can effectively reduce motion blur in the images caused by both respiratory and cardiac motions, which may lead to more accurate defect detection and

  13. Laboratory Building for Accurate Determination of Plutonium

    Institute of Scientific and Technical Information of China (English)


    <正>The accurate determination of plutonium is one of the most important assay techniques of nuclear fuel, also the key of the chemical measurement transfer and the base of the nuclear material balance. An

  14. Understanding the Code: keeping accurate records. (United States)

    Griffith, Richard


    In his continuing series looking at the legal and professional implications of the Nursing and Midwifery Council's revised Code of Conduct, Richard Griffith discusses the elements of accurate record keeping under Standard 10 of the Code. This article considers the importance of accurate record keeping for the safety of patients and protection of district nurses. The legal implications of records are explained along with how district nurses should write records to ensure these legal requirements are met.

  15. Improving reflectance estimation by BRDF-consistent region clustering

    Institute of Scientific and Technical Information of China (English)


    Previous studies in reflectance estimation generally require prior segmentation of an image into regions of uniform reflectance. Due to the measurement noise and limited sampling of the BRDF (bi-directional reflectance function) directions, such estimated results of reflectance are not accurate. In this paper, we propose a novel method for reducing uncertainty in reflectance estimates by merging image regions which have consistent reflectance observations. Each image region acts as a reflectance subspace, so merging of the image regions can result in subspace reduction. We propose a Bayesian segmentation framework to decrease the reflectance uncertainty by using novel merging criteria. Finally, a maximum likelihood reflectance estimation is made for each resulting image region. Experimental results verify the feasibility and superiority of this reflectance-oriented region merging method.

  16. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)


    Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

  17. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)


    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  18. Cardiac Fibroma in a Neonate Presenting With Dyspnea and Tachycardia: A Very Rare Case Tachycardia

    Directory of Open Access Journals (Sweden)

    Anvari Shahriar


    Full Text Available Introduction: Cardiac tumors can be divided to primary and secondary and to benign and malignant tumors. One of the benign tumors of the heart is cardiac fibroma. More than 80% of this tumor occurs in children; however its occurrence in neonates is very rare. Fewer than 100 cases have been reported. Case Presentation: Our patient is a 10 day’s girl neonate with severe dyspnea, mild cyanosis, tachycardia (heart rate = 170- 180/min and obstruction of right ventricle (RV outlet with very large tumor. Conclusion: Cardiac tumors in neonate population must be considered in the diagnosis of arrhythmias, cardiac insufficiency, valvular disease, cardiomegaly or presence of murmurs. Early diagnosis before birth should be appropriate and accurate imaging devices must be used in detecting these tumors.

  19. Accurate estimation of the boundaries of a structured light pattern. (United States)

    Lee, Sukhan; Bui, Lam Quang


    Depth recovery based on structured light using stripe patterns, especially for a region-based codec, demands accurate estimation of the true boundary of a light pattern captured on a camera image. This is because the accuracy of the estimated boundary has a direct impact on the accuracy of the depth recovery. However, recovering the true boundary of a light pattern is considered difficult due to the deformation incurred primarily by the texture-induced variation of the light reflectance at surface locales. Especially for heavily textured surfaces, the deformation of pattern boundaries becomes rather severe. We present here a novel (to the best of our knowledge) method to estimate the true boundaries of a light pattern that are severely deformed due to the heavy textures involved. First, a general formula that models the deformation of the projected light pattern at the imaging end is presented, taking into account not only the light reflectance variation but also the blurring along the optical passages. The local reflectance indices are then estimated by applying the model to two specially chosen reference projections, all-bright and all-dark. The estimated reflectance indices are to transform the edge-deformed, captured pattern signal into the edge-corrected, canonical pattern signal. A canonical pattern implies the virtual pattern that would have resulted if there were neither the reflectance variation nor the blurring in imaging optics. Finally, we estimate the boundaries of a light pattern by intersecting the canonical form of a light pattern with that of its inverse pattern. The experimental results show that the proposed method results in significant improvements in the accuracy of the estimated boundaries under various adverse conditions.

  20. Dying from cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Powari Manish


    Full Text Available Abstract Background To determine the causes of cardiac tamponade (CT, focussing especially on haemopericardium (HP, as a terminal mode of death, within a 430,000 rural English population. Methods Our hospital mortuary register and, all postmortem reports between 1995 and 2004 inclusive, were interrogated for patients dying of CT or HP. The causes of CT/HP and selected morphological characteristics were then determined. Results 14,368 postmortems were performed in this period: of these, 461 patients died of CT. Three cases were due to non-haemorrhagic pericardial effusion. HP accounted for the remaining 458 cases of which, five were post-traumatic, 311 followed rupture of an acute myocardial infarction (RAMI, 138 after intra-pericardial rupture of dissecting ascending aortic aneurysms (RD3A and four were due to miscellaneous causes. HP was more commonly due to RAMI. Men tended to die from RAMI or RD3A earlier than women. RAMI or RD3A were commoner in men Two thirds of RAMI were associated with coronary artery thrombosis. Anterior free wall rupture was commonest overall, and in women, but posterior free wall rupture was commoner in men. The volume of intrapericardial blood in RAMI (mean = 440 ml and RD3A (mean = 498 ml varied between 150 and 1000 ml: intrapericardial blood volume was greater in men than in women dying from either RAMI or RD3A. Conclusion At postmortem, CT is most often related to HP, attributable to either RAMI or intrapericardial RD3A. Post-traumatic and other causes of CT are infrequent.

  1. Cardiac output monitoring

    Directory of Open Access Journals (Sweden)

    Mathews Lailu


    Full Text Available Minimally invasive and non-invasive methods of estimation of cardiac output (CO were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC and direct Fick method used for the measurement of stroke volume (SV. The important minimally invasive techniques available are: oesophageal Doppler monitoring (ODM, the derivative Fick method (using partial carbon dioxide (CO 2 breathing, transpulmonary thermodilution, lithium indicator dilution, pulse contour and pulse power analysis. Impedance cardiography is probably the only non-invasive technique in true sense. It provides information about haemodynamic status without the risk, cost and skill associated with the other invasive or minimally invasive techniques. It is important to understand what is really being measured and what assumptions and calculations have been incorporated with respect to a monitoring device. Understanding the basic principles of the above techniques as well as their advantages and limitations may be useful. In addition, the clinical validation of new techniques is necessary to convince that these new tools provide reliable measurements. In this review the physics behind the working of ODM, partial CO 2 breathing, transpulmonary thermodilution and lithium dilution techniques are dealt with. The physical and the physiological aspects underlying the pulse contour and pulse power analyses, various pulse contour techniques, their development, advantages and limitations are also covered. The principle of thoracic bioimpedance along with computation of CO from changes in thoracic impedance is explained. The purpose of the review is to help us minimize the dogmatic nature of practice favouring one technique or the other.

  2. Patch in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alireza Alizadeh Ghavidel


    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  3. Surgical experience with cardiac tumours at the General Hospital, Kuala Lumpur. (United States)

    Awang, Y; Sallehuddin, A


    Fifteen patients underwent surgery for cardiac tumours in General Hospital Kuala Lumpur between October 1984 and June 1989. Twelve of the patients had cardiac myxomas and underwent excision under cardiopulmonary bypass. Two patients had sarcoma, of which one was excised. The other was inoperable. Another patient had a metastalic malignant melanoma which was inoperable. Of the patients 10 were female and five male. Their ages ranged from 16 to 60 years. All were symptomatic and the commonest mode of presentation was exertional dyspnoea and palpitations. Two presented with cerebral embolisation. The three patients with malignant tumours had constitutional symptoms at the time of surgery. All patients had echocardiography pre-operatively to confirm the diagnosis of cardiac tumour. Only one patient underwent preoperative cardiac catheterisation and angiography. The surgical approach in all patients was through a median sternotomy and all except one were operated under cardiopulmonary bypass. There was no intraoperative embolisation. There was one perioperative death. Fourteen patients were followed up for periods ranging from one to 44 months. Three patients with malignant cardiac tumours died. One had recurrence of myxoma 21 months after the initial surgery. We conclude that excision of cardiac myxomas carry a very small risk following which patients have good prognosis. Malignant tumours carry a bad prognosis. From our experience, we conclude that echocardiography is an extremely accurate tool in the diagnosis of cardiac tumours.

  4. Estimation of cardiac function by thallium-201 myocardial scintigraphy in mitral regurgitation

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Mitsunori (Ehime Univ., Shigenobu (Japan). School of Medicine)


    To estimate whether thallium-201 myocardioal scintigraphy is a valid method to evaluate cardiac condition in mitral regurgitation, thallium myocardial scintigraphy was performed in 24 patients with mitral regurgitation. The extent score was calculated as the index of thallium-201 myocardial scintigraphy. The extent score was high (28.7[+-]5.5%) and was significantly correlated with severity of mitral regurgitant flow volume. There were correlations among extent score and fractional shortening (r=-0.78, p<0.01), left ventricular end-systolic dimension (r=0.79, p<0.01) and end-systolic wall stress (r=0.68, p<0.01). Extent scores significantly decreased after the mitral valve replacement. The decrease in extent scores associated with mitral valve replacement was greater in patients with a smaller preoperative extent score and smaller in patients with a greater preoperative extent score. In conclusion, extent score obtained by thallium-201 myocardial scintigraphy accurately reflects the myocardial damages associated with mitral regurgitation, and it may be useful for predicting the postoperative prognosis. (author).

  5. Accurate LAI retrieval method based on PROBA/CHRIS data

    Directory of Open Access Journals (Sweden)

    W. Fan


    Full Text Available Leaf area index (LAI is one of the key structural variables in terrestrial vegetation ecosystems. Remote sensing offers a chance to derive LAI in regional scales accurately. Variations of background, atmospheric conditions and the anisotropy of canopy reflectance are three factors that can strongly restrain the accuracy of retrieved LAI. Based on the hybrid canopy reflectance model, a new hyperspectral directional second derivative method (DSD is proposed in this paper. This method can estimate LAI accurately through analyzing the canopy anisotropy. The effect of the background can also be effectively removed. So the inversion precision and the dynamic range can be improved remarkably, which has been proved by numerical simulations. As the derivative method is very sensitive to the random noise, we put forward an innovative filtering approach, by which the data can be de-noised in spectral and spatial dimensions synchronously. It shows that the filtering method can remove the random noise effectively; therefore, the method can be performed to the remotely sensed hyperspectral image. The study region is situated in Zhangye, Gansu Province, China; the hyperspectral and multi-angular image of the study region has been acquired from Compact High-Resolution Imaging Spectrometer/Project for On-Board Autonomy (CHRIS/PROBA, on 4 and 14 June 2008. After the pre-processing procedures, the DSD method was applied, and the retrieve LAI was validated by the ground truth of 11 sites. It shows that by applying innovative filtering method, the new LAI inversion method is accurate and effective.

  6. DCP-collected absolute target reflectance signatures assist accurate interpretation of ERTS-1 imagery (United States)

    Weber, F. P.


    Data collection platforms (DCP's) are being used at a Black Hills, South Dakota, test site (MMC 226A) to record radiometric measurements needed to determine solar and atmospheric parameters that affect ERTS-1 multispectral scanner radiance measurements. A total of 72 channels of analog data transmitted from an unattended ground truth site via three DCP's at least six times a day. The system has operated with only minor problems since September, sending forth daily measurements of biophysical responses and atmospheric conditions. Comparisons of scene radiance data calculated from ERTS images with that measured on the ground show the image-measured values to be 35 percent higher for the green channel and 20 percent higher for the red channel for the same scene targets. Radiance values for channels 6 and 7 are nearly the same from the ground data and from the imagery.

  7. How accurately does output reflect the nature and design of transdisciplinary research programmes?

    NARCIS (Netherlands)

    Koier, Elizabeth; Horlings, E.


    Many of today’s societal problems are wicked problems that require a new, transdisciplinary approach in which knowledge of scientists and stakeholders from different disciplines is integrated. The evaluation of transdisciplinary science requires a multi-method approach. Bibliometric analysis is cons

  8. Patient safety measures in burn care: do National reporting systems accurately reflect quality of burn care? (United States)

    Mandell, Samuel P; Robinson, Ellen F; Cooper, Claudette L; Klein, Matthew B; Gibran, Nicole S


    Recently, much attention has been placed on quality of care metrics and patient safety. Groups such as the University Health-System Consortium (UHC) collect and review patient safety data, monitor healthcare facilities, and often report data using mortality and complication rates as outcomes. The purpose of this study was to analyze the UHC database to determine if it differentiates quality of care across burn centers. We reviewed UHC clinical database (CDB) fields and available data from 2006 to 2008 for the burn product line. Based on the September 2008 American Burn Association (ABA) list of verified burn centers, we categorized centers as American Burn Association-verified burn centers, self-identified burn centers, and other centers that are not burn units but admit some burn patients. We compared total burn admissions, risk pool, complication rates, and mortality rates. Overall mortality was compared between the UHC and National Burn Repository. The UHC CDB provides fields for number of admissions, % intensive care unit admission, risk pool, length of stay, complication profiles, and mortality index. The overall numbers of burn patients in the database for the study period included 17,740 patients admitted to verified burn centers (mean 631 admissions/burn center/yr or per 2 years), 10,834 for self-identified burn centers (mean 437 admissions/burn center/yr or per 2 years), and 1,487 for other centers (mean 11.5 admissions/burn center/yr or per 2 years). Reported complication rates for verified burn centers (21.6%), self-identified burn centers (21.3%), and others (20%) were similar. Mortality rates were highest for self-identified burn centers (3.06%), less for verified centers (2.88%), and lowest for other centers (0.74%). However, these outcomes data may be misleading, because the risk pool criteria do not include burn-specific risk factors, and the inability to adjust for injury severity prevents rigorous comparison across centers. Databases such as the UHC CDB provide a potential to benchmark quality of care. However, reporting quality data for trauma and burns requires stringent understanding of injury data collection. Although quality measures are important for improving patient safety and establishing benchmarks for complication and mortality rates, caution must be taken when applying them to specific product lines.

  9. On the Automated Segmentation of Epicardial and Mediastinal Cardiac Adipose Tissues Using Classification Algorithms. (United States)

    Rodrigues, Érick Oliveira; Cordeiro de Morais, Felipe Fernandes; Conci, Aura


    The quantification of fat depots on the surroundings of the heart is an accurate procedure for evaluating health risk factors correlated with several diseases. However, this type of evaluation is not widely employed in clinical practice due to the required human workload. This work proposes a novel technique for the automatic segmentation of cardiac fat pads. The technique is based on applying classification algorithms to the segmentation of cardiac CT images. Furthermore, we extensively evaluate the performance of several algorithms on this task and discuss which provided better predictive models. Experimental results have shown that the mean accuracy for the classification of epicardial and mediastinal fats has been 98.4% with a mean true positive rate of 96.2%. On average, the Dice similarity index, regarding the segmented patients and the ground truth, was equal to 96.8%. Therfore, our technique has achieved the most accurate results for the automatic segmentation of cardiac fats, to date.

  10. Analysis of 2-d ultrasound cardiac strain imaging using joint probability density functions. (United States)

    Ma, Chi; Varghese, Tomy


    Ultrasound frame rates play a key role for accurate cardiac deformation tracking. Insufficient frame rates lead to an increase in signal de-correlation artifacts resulting in erroneous displacement and strain estimation. Joint probability density distributions generated from estimated axial strain and its associated signal-to-noise ratio provide a useful approach to assess the minimum frame rate requirements. Previous reports have demonstrated that bi-modal distributions in the joint probability density indicate inaccurate strain estimation over a cardiac cycle. In this study, we utilize similar analysis to evaluate a 2-D multi-level displacement tracking and strain estimation algorithm for cardiac strain imaging. The effect of different frame rates, final kernel dimensions and a comparison of radio frequency and envelope based processing are evaluated using echo signals derived from a 3-D finite element cardiac model and five healthy volunteers. Cardiac simulation model analysis demonstrates that the minimum frame rates required to obtain accurate joint probability distributions for the signal-to-noise ratio and strain, for a final kernel dimension of 1 λ by 3 A-lines, was around 42 Hz for radio frequency signals. On the other hand, even a frame rate of 250 Hz with envelope signals did not replicate the ideal joint probability distribution. For the volunteer study, clinical data was acquired only at a 34 Hz frame rate, which appears to be sufficient for radio frequency analysis. We also show that an increase in the final kernel dimensions significantly affect the strain probability distribution and joint probability density function generated, with a smaller effect on the variation in the accumulated mean strain estimated over a cardiac cycle. Our results demonstrate that radio frequency frame rates currently achievable on clinical cardiac ultrasound systems are sufficient for accurate analysis of the strain probability distribution, when a multi-level 2-D

  11. EANM/ESC guidelines for radionuclide imaging of cardiac function

    DEFF Research Database (Denmark)

    Hesse, B.; Lindhardt, T.B.; Acampa, W.;


    radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes......Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium......, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "prevailing or general consensus...

  12. Nuclear imaging in cardiac amyloidosis

    Energy Technology Data Exchange (ETDEWEB)

    Glaudemans, A.W.J.M.; Slart, R.H.J.A.; Veltman, N.C.; Dierckx, R.A.J.O. [University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Hanzeplein 1, P.O. Box 30001, Groningen (Netherlands); Zeebregts, C.J. [University Medical Center Groningen, Department of Surgery (Division of Vascular Surgery), Groningen (Netherlands); Tio, R.A. [University Medical Center Groningen, Department of Cardiology, Groningen (Netherlands); Hazenberg, B.P.C. [University Medical Center Groningen, Department of Rheumatology and Clinical Immunology, Groningen (Netherlands)


    Amyloidosis is a disease characterized by depositions of amyloid in organs and tissues. It can be localized (in just one organ) or systemic. Cardiac amyloidosis is a debilitating disease and can lead to arrhythmias, deterioration of heart function and even sudden death. We reviewed PubMed/Medline, without time constraints, on the different nuclear imaging modalities that are used to visualize myocardial amyloid involvement. Several SPECT tracers have been used for this purpose. The results with these tracers in the evaluation of myocardial amyloidosis and their mechanisms of action are described. Most clinical evidence was found for the use of {sup 123}I-MIBG. Myocardial defects in MIBG activity seem to correlate well with impaired cardiac sympathetic nerve endings due to amyloid deposits. {sup 123}I-MIBG is an attractive option for objective evaluation of cardiac sympathetic level and may play an important role in the indirect measurement of the effect of amyloid myocardial infiltration. Other, less sensitive, options are {sup 99m}Tc-aprotinin for imaging amyloid deposits and perhaps {sup 99m}Tc-labelled phosphate derivatives, especially in the differential diagnosis of the aetiology of cardiac amyloidosis. PET tracers, despite the advantage of absolute quantification and higher resolution, are not yet well evaluated for the study of cardiac amyloidosis. Because of these advantages, there is still the need for further research in this field. (orig.)

  13. Cardiac Penetrating Injuries and Pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    CHEN Shifeng


    Objective To discuss the early diagnosis and treatment of cardiac penetrating injuries and pseudoaneurysm. Methods 18 cases of cardiac penetrating injuries, in which 2 cases were complicated with pseudoaneurysm, were diagnosed by emergency operation and color Doppler echocardiography between May 1973 and Dec. 2001 in our hospital. The basis for emergency operation is the injured path locating in cardiac dangerous zone, severe shock or pericardial tamponade. ResultsAmong 18 cases of this study, 17 cases underwent emergency operation. During the operation, 11 cases were found injured in right ventricle, 2 cases were found injured in right atrium, 1 case was found injured in pulmonary artery,4 cases were found injured in left ventricle, 2 cases were found complicated with pseudoaneurysm. 17cases underwent cardiac repair including 1 case of rupture of aneurysm. 1 case underwent elective aneurysm resection. In whole group, 15 cases survived(83.33% ), 3 cases died( 16.67%). The cause of death is mainly hemorrhagic shock. Conclusion Highly suspicious cardiac penetrating injuries or hemopericaridium should undergo direct operative exploration. Pseudoaneurysm should be resected early,which can prevent severe complications.

  14. Accurate monitoring of intravascular fluid volume: A novel application of intrathoracic impedance measures for the guidance of volume reduction therapy

    Directory of Open Access Journals (Sweden)

    Barbara A. Lara


    Conclusion: Impedance vectors derived from a multivector monitoring system reflect changes in intravascular plasma volume. Two of these vectors most closely track changes in plasma volume and may be used to more accurately guide and optimize volume reduction therapy.

  15. Exercise-induced cardiac remodeling. (United States)

    Weiner, Rory B; Baggish, Aaron L


    Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes.

  16. [Ectopia cordis and cardiac anomalies]. (United States)

    Cabrera, Alberto; Rodrigo, David; Luis, María Teresa; Pastor, Esteban; Galdeano, José Miguel; Esteban, Susana


    Ectopia cordis is a rare disease that occurs in 5.5 to 7.9 per million live births. Only 267 cases had been reported as of 2001, most (95%) associated with other cardiac anomalies. We studied the cardiac malformations associated in 6 patients with ectopia cordis. Depending on where the defect was located, the cases of ectopia were classified into four groups: cervical, thoracic, thoraco-abdominal, and abdominal. All 6 patients died before the third day of life, 4 during delivery. Three of the patients were included in the thoracic group, whereas the other 3 belonged to the thoraco-abdominal group. All the patients had associated ventricular septal defects, 3 double-outlet right ventricle (50%) and the rest (50%) tetralogy of Fallot-pulmonary atresia. Two patients with double-outlet right ventricle presented mitral-valve pathology, a parachute valve and an atresic mitral valve. None of these cardiac anomalies have been reported to date.

  17. Electrophysiological Cardiac Modeling: A Review. (United States)

    Beheshti, Mohammadali; Umapathy, Karthikeyan; Krishnan, Sridhar


    Cardiac electrophysiological modeling in conjunction with experimental and clinical findings has contributed to better understanding of electrophysiological phenomena in various species. As our knowledge on underlying electrical, mechanical, and chemical processes has improved over time, mathematical models of the cardiac electrophysiology have become more realistic and detailed. These models have provided a testbed for various hypotheses and conditions that may not be easy to implement experimentally. In addition to the limitations in experimentally validating various scenarios implemented by the models, one of the major obstacles for these models is computational complexity. However, the ever-increasing computational power of supercomputers facilitates the clinical application of cardiac electrophysiological models. The potential clinical applications include testing and predicting effects of pharmaceutical agents and performing patient-specific ablation and defibrillation. A review of studies involving these models and their major findings are provided.

  18. An update on insertable cardiac monitors

    DEFF Research Database (Denmark)

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W


    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring...

  19. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard;


    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  20. Accurate tracking control in LOM application

    Institute of Scientific and Technical Information of China (English)


    The fabrication of accurate prototype from CAD model directly in short time depends on the accurate tracking control and reference trajectory planning in (Laminated Object Manufacture) LOM application. An improvement on contour accuracy is acquired by the introduction of a tracking controller and a trajectory generation policy. A model of the X-Y positioning system of LOM machine is developed as the design basis of tracking controller. The ZPETC (Zero Phase Error Tracking Controller) is used to eliminate single axis following error, thus reduce the contour error. The simulation is developed on a Maltab model based on a retrofitted LOM machine and the satisfied result is acquired.

  1. Clinical advances on Cardiac Insuffiency

    Directory of Open Access Journals (Sweden)

    Angel Julio Romero Cabrera


    Full Text Available Cardiac insuffiency is a complex clinical syndrome which constitutes a common final path to get in by the majority of the cardiac diseases. Studies based on the communitarian surveys shows that from 30 to 40 % of the patients decease within the first year of the diagnosis. The rest of the patients (from 60 to 70 % die within the 5 years after being diagnosed. For this reason it has been called as the ¨cancer of cardiology¨. The objective of this article is to update the advances reached in the clinical and therapeutic aspects of this important syndrome.

  2. Reductionism and holism in coronary heart disease and cardiac nursing. (United States)

    Chummun, Harry

    Reductionism and holism are two contrasting philosophies which provide scientific knowledge of disease processes, health dynamics and care interventions. While reductionism focuses on specific and perhaps narrow concepts, it enhances our in-depth knowledge of key health issues. Holism focuses on understanding how all the significant factors affecting the particular health issue are involved, so a more informed decision can be made about health intervention. This article explores the contribution each makes to our understanding of coronary heart disease (CHD) and to the preparation of nurses working in cardiac nursing. It proposes that pre- and post-registration nursing curricula reflect both reductionist and holistic approaches and therefore cardiac nurses are suitably trained to manage reductionist as well as holistic care for clients with CHD.

  3. Elevated sensitivity to cardiac ischemia in proteinuric rats is independent of adverse cardiac remodeling

    NARCIS (Netherlands)

    Szymanski, Mariusz K.; Hillege, Hans L.; Danser, A. H. Jan; Garrelds, Ingrid M.; Schoemaker, Regien G.


    Objectives: Chronic renal dysfunction severely increases cardiovascular risk. Adverse cardiac remodeling is suggested to play a major role as predisposition for increased cardiac ischemic vulnerability. The aim of the present study was to examine the role of adverse cardiac remodeling in cardiac sen

  4. Sudden cardiac death and inherited channelopathy: the basic electrophysiology of the myocyte and myocardium in ion channel disease. (United States)

    Martin, Claire A; Matthews, Gareth D K; Huang, Christopher L-H


    Mutations involving cardiac ion channels result in abnormal action potential formation or propagation, leading to cardiac arrhythmias. Despite the large impact on society of sudden cardiac death resulting from such arrhythmias, understanding of the underlying cellular mechanism is poor and clinical risk stratification and treatment consequently limited. Basic research using molecular techniques, as well as animal models, has proved extremely useful in improving our knowledge of inherited arrhythmogenic syndromes. This offers the practitioner tools to accurately diagnose rare disorders and provides novel markers for risk assessment and a basis for new strategies of treatment.

  5. Evaluation of cardiac blood blow, metabolism and sympathetic nerve function in patients with cardiac failure using PET and SPECT. Prognostic diagnosis based on the analysis of aggravating factors of the disease

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Yoshio; Shimozu, Junko; Yasumura, Yoshio; Nagatani, Kenzo; Miyatake, Kunio [National Cardiovascular Center, Suita, Osaka (Japan)


    Focusing on the failure of energy metabolism, which is assumed to be attributed to the cardiac muscle disorder of a patient with cardiac failure, the characteristics and diagnostic significance of the metabolic disorders of cadiac muscles were investigated in those patients. The diagnostic efficacy of {beta}-methyl iodophenyl pentadecanoic acid (BMIPP) which is a imaging agent for lipid metabolism in the cardiac muscle was assessed in the clinical states of cardiac failure due to pulmonary hypertension. Even if there was a considerable increase in the mean pulmonary arterial pressure (mPAP), the initial accumulation of BMIPP linearly increased, similarly to the increase in the accumulation of MIBI, a blood flow agent. The initial accumulation of BMIPP was thought to reflect a thicken cardiac muscle and/or increased blood flow. Also, its washing-out rate was suggested to be usable as an clinical indicator to estimate the loading of ventricular pressure. (M.N.)

  6. Pregnancy as a cardiac stress model



    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women witho...

  7. Development of new anatomy reconstruction software to localize cardiac isochrones to the cardiac surface from the 12 lead ECG. (United States)

    van Dam, Peter M; Gordon, Jeffrey P; Laks, Michael M; Boyle, Noel G


    Non-invasive electrocardiographic imaging (ECGI) of the cardiac muscle can help the pre-procedure planning of the ablation of ventricular arrhythmias by reducing the time to localize the origin. Our non-invasive ECGI system, the cardiac isochrone positioning system (CIPS), requires non-intersecting meshes of the heart, lungs and torso. However, software to reconstruct the meshes of the heart, lungs and torso with the capability to check and prevent these intersections is currently lacking. Consequently the reconstruction of a patient specific model with realistic atrial and ventricular wall thickness and incorporating blood cavities, lungs and torso usually requires additional several days of manual work. Therefore new software was developed that checks and prevents any intersections, and thus enables the use of accurate reconstructed anatomical models within CIPS. In this preliminary study we investigated the accuracy of the created patient specific anatomical models from MRI or CT. During the manual segmentation of the MRI data the boundaries of the relevant tissues are determined. The resulting contour lines are used to automatically morph reference meshes of the heart, lungs or torso to match the boundaries of the morphed tissue. Five patients were included in the study; models of the heart, lungs and torso were reconstructed from standard cardiac MRI images. The accuracy was determined by computing the distance between the segmentation contours and the morphed meshes. The average accuracy of the reconstructed cardiac geometry was within 2mm with respect to the manual segmentation contours on the MRI images. Derived wall volumes and left ventricular wall thickness were within the range reported in literature. For each reconstructed heart model the anatomical heart axis was computed using the automatically determined anatomical landmarks of the left apex and the mitral valve. The accuracy of the reconstructed heart models was well within the accuracy of the used

  8. Imaging seismic reflections

    NARCIS (Netherlands)

    Op 't Root, Timotheus Johannes Petrus Maria


    The goal of reflection seismic imaging is making images of the Earth subsurface using surface measurements of reflected seismic waves. Besides the position and orientation of subsurface reflecting interfaces it is a challenge to recover the size or amplitude of the discontinuities. We investigate tw

  9. Knowledge-Level Reflection

    NARCIS (Netherlands)

    Harmelen, van F.A.H.; Wielinga, B.J.; Bredeweg, Bert; Schreiber, G.; Karbach, Werner; Reinders, Martin; Voss, A.; Akkermans, H.; Bartsch-Spoerl, Brigitte; Vinkhuyzen, Erik

    This paper presents an overview of the REFLECT project. It defines the notion of knowledge level reflection that has been central to the project, it compares this notion with existing approaches to reflection in related fields, and investigates some of the consequences of the concept of knowledge le

  10. Liberating Moral Reflection (United States)

    Horell, Harold D.


    The author argues that if we are to foster life-giving and liberating moral reflection, we must first liberate moral reflection from distortions; specifically, from the distorting effects of moral insensitivity, destructive moral relativism, and confusions resulting from a failure to understand the dynamics of moral reflection. The author proposes…

  11. Reflective Learning in Practice. (United States)

    Brockbank, Anne, Ed.; McGill, Ian, Ed.; Beech, Nic, Ed.

    This book contains 22 papers on reflective learning in practice. The following papers are included: "Our Purpose" (Ann Brockbank, Ian McGill, Nic Beech); "The Nature and Context of Learning" (Ann Brockbank, Ian McGill, Nic Beech); "Reflective Learning and Organizations" (Ann Brockbank, Ian McGill, Nic Beech); "Reflective Learning in Practice" (Ann…

  12. Bifid cardiac apex in a 25-year-old male with sudden cardiac death. (United States)

    Wu, Annie; Kay, Deborah; Fishbein, Michael C


    Although a bifid cardiac apex is common in certain marine animals, it is an uncommon finding in humans. When present, bifid cardiac apex is usually associated with other congenital heart anomalies. We present a case of bifid cardiac apex that was an incidental finding in a 25-year-old male with sudden cardiac death from combined drug toxicity. On gross examination, there was a bifid cardiac apex with a 2-cm long cleft. There were no other significant gross or microscopic abnormalities. This case represents the very rare occurrence of a bifid cardiac apex as an isolated cardiac anomaly.

  13. Cardiovascular Magnetic Resonance and prognosis in cardiac amyloidosis

    Directory of Open Access Journals (Sweden)

    Roughton Michael


    Full Text Available Abstract Background Cardiac involvement is common in amyloidosis and associated with a variably adverse outcome. We have previously shown that cardiovascular magnetic resonance (CMR can assess deposition of amyloid protein in the myocardial interstitium. In this study we assessed the prognostic value of late gadolinium enhancement (LGE and gadolinium kinetics in cardiac amyloidosis in a prospective longitudinal study. Materials and methods The pre-defined study end point was all-cause mortality. We prospectively followed a cohort of 29 patients with proven cardiac amyloidosis. All patients underwent biopsy, 2D-echocardiography and Doppler studies, 123I-SAP scintigraphy, serum NT pro BNP assay, and CMR with a T1 mapping method and late gadolinium enhancement (LGE. Results Patients with were followed for a median of 623 days (IQ range 221, 1436, during which 17 (58% patients died. The presence of myocardial LGE by itself was not a significant predictor of mortality. However, death was predicted by gadolinium kinetics, with the 2 minute post-gadolinium intramyocardial T1 difference between subepicardium and subendocardium predicting mortality with 85% accuracy at a threshold value of 23 ms (the lower the difference the worse the prognosis. Intramyocardial T1 gradient was a better predictor of survival than FLC response to chemotherapy (Kaplan Meier analysis P = 0.049 or diastolic function (Kaplan-Meier analysis P = 0.205. Conclusion In cardiac amyloidosis, CMR provides unique information relating to risk of mortality based on gadolinium kinetics which reflects the severity of the cardiac amyloid burden.

  14. Discovery and progress of direct cardiac reprogramming. (United States)

    Kojima, Hidenori; Ieda, Masaki


    Cardiac disease remains a major cause of death worldwide. Direct cardiac reprogramming has emerged as a promising approach for cardiac regenerative therapy. After the discovery of MyoD, a master regulator for skeletal muscle, other single cardiac reprogramming factors (master regulators) have been sought. Discovery of cardiac reprogramming factors was inspired by the finding that multiple, but not single, transcription factors were needed to generate induced pluripotent stem cells (iPSCs) from fibroblasts. We first reported a combination of cardiac-specific transcription factors, Gata4, Mef2c, and Tbx5 (GMT), that could convert mouse fibroblasts into cardiomyocyte-like cells, which were designated as induced cardiomyocyte-like cells (iCMs). Following our first report of cardiac reprogramming, many researchers, including ourselves, demonstrated an improvement in cardiac reprogramming efficiency, in vivo direct cardiac reprogramming for heart regeneration, and cardiac reprogramming in human cells. However, cardiac reprogramming in human cells and adult fibroblasts remains inefficient, and further efforts are needed. We believe that future research elucidating epigenetic barriers and molecular mechanisms of direct cardiac reprogramming will improve the reprogramming efficiency, and that this new technology has great potential for clinical applications.

  15. Multimodality imaging to guide cardiac interventional procedures

    NARCIS (Netherlands)

    Tops, Laurens Franciscus


    In recent years, a number of new cardiac interventional procedures have been introduced. Catheter ablation procedures for atrial fibrillation (AF) have been refined and are now considered a good treatment option in patients with drug-refractory AF. In cardiac pacing, cardiac resynchronization therap

  16. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)


    textabstractCardiac hypertrophy is the response of the heart to an increased workload. After myocardial infarction (MI) the surviving muscle tissue has to work harder to maintain cardiac output. This sustained increase in workload leads to cardiac hypertrophy. Despite its apparent appropriateness, c

  17. Cardiac manifestations of myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Vissing, John; Witting, Nanna;


    To estimate the degree of cardiac involvement regarding left ventricular ejection fraction, conduction abnormalities, arrhythmia, risk of sudden cardiac death (SCD) and the associations between cardiac involvement and cytosine-thymine-guanine (CTG)-repeat, neuromuscular involvement, age and gende...... in patients with myotonic dystrophy type 1 (MD1)....

  18. Cardiac anatomy and physiology: a review. (United States)

    Gavaghan, M


    This article reviews the normal anatomy and physiology of the heart. Understanding the normal anatomic and physiologic relationships described in this article will help perioperative nurses care for patients who are undergoing cardiac procedures. Such knowledge also assists nurses in educating patients about cardiac procedures and about activities that can prevent, reverse, or improve cardiac illness.

  19. Accurate Switched-Voltage voltage averaging circuit


    金光, 一幸; 松本, 寛樹


    Abstract ###This paper proposes an accurate Switched-Voltage (SV) voltage averaging circuit. It is presented ###to compensated for NMOS missmatch error at MOS differential type voltage averaging circuit. ###The proposed circuit consists of a voltage averaging and a SV sample/hold (S/H) circuit. It can ###operate using nonoverlapping three phase clocks. Performance of this circuit is verified by PSpice ###simulations.

  20. Accurate overlaying for mobile augmented reality

    NARCIS (Netherlands)

    Pasman, W; van der Schaaf, A; Lagendijk, RL; Jansen, F.W.


    Mobile augmented reality requires accurate alignment of virtual information with objects visible in the real world. We describe a system for mobile communications to be developed to meet these strict alignment criteria using a combination of computer vision. inertial tracking and low-latency renderi

  1. Reflection Positive Doubles

    CERN Document Server

    Jaffe, Arthur


    Here we introduce reflection positive doubles, a general framework for reflection positivity, covering a wide variety of systems in statistical physics and quantum field theory. These systems may be bosonic, fermionic, or parafermionic in nature. Within the framework of reflection positive doubles, we give necessary and sufficient conditions for reflection positivity. We use a reflection-invariant cone to implement our construction. Our characterization allows for a direct interpretation in terms of coupling constants, making it easy to check in concrete situations. We illustrate our methods with numerous examples.

  2. Molecular therapies for cardiac arrhythmias

    NARCIS (Netherlands)

    Boink, G.J.J.


    Despite the ongoing advances in pharmacology, devices and surgical approaches to treat heart rhythm disturbances, arrhythmias are still a significant cause of death and morbidity. With the introduction of gene and cell therapy, new avenues have arrived for the local modulation of cardiac disease. Th

  3. The cardiac patient in Ramadan. (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan


    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.

  4. Pseudothrombocytopenia in cardiac surgical practice. (United States)

    Nair, Sukumaran K; Shah, Roma; Petko, Matus; Keogh, Bruce E


    Pseudothrombocytopenia is observed occasionally in post-cardiac surgical patients. It is commonly due to EDTA-mediated immunological mechanisms, which lead to agglutination of functionally intact platelets. This condition is harmless and does not warrant platelet transfusion. We describe an instance of pseudothrombocytopenia in our practice and discuss its clinical relevance.

  5. Thoracocentesis in cardiac surgery patients. (United States)

    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders


    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

  6. Reninoma presenting as cardiac syncope

    Directory of Open Access Journals (Sweden)

    Tak Shahid


    Full Text Available Reninoma, a renin-secreting tumor of the juxta-glomerular cells of the kidney, is a rare but surgically treatable cause of secondary hypertension in children. We report a case of reninoma presenting as cardiac syncope with long QTc on electrocardiogram due to hypokalemia.

  7. Cardiac leiomyosarcoma, a case report

    DEFF Research Database (Denmark)

    Andersen, Rikke; Kristensen, Bjarne W; Gill, Sabine


    In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal chocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological...

  8. Cardiac connexins and impulse propagation

    NARCIS (Netherlands)

    J.A. Jansen; T.A.B. van Veen; J.M.T. de Bakker; H.V.M. van Rijen


    Gap junctions form the intercellular pathway for cell-to-cell transmission of the cardiac impulse from its site of origin, the sinoatrial node, along the atria, the atrioventricular conduction system to the ventricular myocardium. The component parts of gap junctions are proteins called connexins (C

  9. [Acute cardiac failure in pheochromocytoma.

    DEFF Research Database (Denmark)

    Jønler, Morten; Munk, Kim


    Pheochromocytoma (P) is an endocrine catecholamine-secreting tumor. Classical symptoms like hypertension, attacks of sweating, palpitations, headache and palor are related to catecholamine discharge. We provide a case of P in a 71 year-old man presenting with acute cardiac failure, severe reduction...

  10. Cardiac resynchronization therapy in China

    Institute of Scientific and Technical Information of China (English)

    Wei HUA


    @@ Congestive heart failure (HF) is a major and growing public health problem. The therapeutic approach includes non-pharmacological measures, pharmacological therapy,mechanical devices, and surgery. Despite the benefits of optimal pharmacologic therapy, the prognosis is still not ideal. At this time, cardiac resynchronization therapy (CRT)has gained wide acceptance as an alternative treatment for HF patients with conduction delay.1

  11. Cardiac abnormalities after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bilt, I.A.C. van der


    Aneurysmal subarachnoid hemorrhage(aSAH) is a devastating neurological disease. During the course of the aSAH several neurological and medical complications may occur. Cardiac abnormalities after aSAH are observed often and resemble stress cardiomyopathy or Tako-tsubo cardiomyopathy(Broken Heart Syn

  12. Response to cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Schiffer, Angélique A; Widdershoven, Jos W


    Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders...

  13. Genetic counseling and cardiac care in predictively tested hypertrophic cardiomyopathy mutation carriers: The patients' perspective

    NARCIS (Netherlands)

    Christiaans, Imke; Van Langen, Irene M.; Birnie, Erwin; Bonsel, Gouke J.; Wilde, Arthur A. M.; Smets, Ellen M. A.


    Hypertrophic cardiomyopathy (HCM) is a common hereditary heart disease associated with sudden cardiac death. Predictive genetic counseling and testing are performed using adapted Huntington guidelines, that is, psychosocial care and time for reflection are not obligatory and the test result can be d

  14. Wave Reflection Coefficient Spectrum

    Institute of Scientific and Technical Information of China (English)

    俞聿修; 邵利民; 柳淑学


    The wave reflection coefficient frequency spectrum and directional spectrum for concrete face slope breakwaters and rubble mound breakwaters are investigated through physical model tests in the present study. The reflection coefficients of oblique irregular waves are analyzed by the Modified Two-Point Method (MTPM) proposed by the authors. The results show that the wave reflection coefficient decreases with increasing wave frequency and incident angle or decreasing structure slope. The reflection coefficient frequency spectrum and its variation with Iribarren number are given in this paper. The paper also suggests an empirical 3-dimensional reflection coefficient spectrum, i.e. reflection coefficient directional spectrum, which can be used to illustrate quantitatively the variation of reflection coefficient with the incident angle and the Iribarren number for oblique irregular waves.

  15. Molecular Modeling of Cardiac Troponin (United States)

    Manning, Edward P.

    The cardiac thin filament regulates interactions of actin and myosin, the force-generating elements of muscular contraction. Over the past several decades many details have been discovered regarding the structure and function of the cardiac thin filament and its components, including cardiac troponin (cTn). My hypothesis is that signal propagation occurs between distant ends of the cardiac troponin complex through calcium-dependent alterations in the dynamics of cTn and tropomyosin (Tm). I propose a model of the thin filament that encompasses known structures of cTn, Tm and actin to gain insight into cardiac troponin's allosteric regulation of thin filament dynamics. By performing molecular dynamics simulations of cTn in conjunction with overlapping Tm in two conditions, with and without calcium bound to site II of cardiac troponin C (cTnC), I found a combination of calcium-dependent changes in secondary structure and dynamics throughout the cTn-Tm complex. I then applied this model to investigate familial hypertrophic cardiomyopathy (FHC), a disease of the sarcomere that is one of the most commonly occurring genetic causes of heart disease. Approximately 15% of known FHC-related mutations are found in cardiac troponin T (cTnT), most of which are in or flank the alpha-helical N-tail domain TNT1. TNT1 directly interacts with overlapping Tm coiled coils. Using this model I identified effects of TNT1 mutations that propagate to the cTn core where site II of cTnC, the regulatory site of calcium binding in the thin filament, is located. Specifically, I found that mutations in TNT1 alter the flexibility of TNT1 and that the flexibility of TNT1 is inversely proportional to the cooperativity of calcium activation of the thin filament. Further, I identified a pathway of propagation of structural and dynamic changes linking TNT1 to site II of cTnC. Mutation-induced changes at site II cTnC alter calcium coordination which corresponds to biophysical measurements of calcium

  16. Accurate finite difference methods for time-harmonic wave propagation (United States)

    Harari, Isaac; Turkel, Eli


    Finite difference methods for solving problems of time-harmonic acoustics are developed and analyzed. Multidimensional inhomogeneous problems with variable, possibly discontinuous, coefficients are considered, accounting for the effects of employing nonuniform grids. A weighted-average representation is less sensitive to transition in wave resolution (due to variable wave numbers or nonuniform grids) than the standard pointwise representation. Further enhancement in method performance is obtained by basing the stencils on generalizations of Pade approximation, or generalized definitions of the derivative, reducing spurious dispersion, anisotropy and reflection, and by improving the representation of source terms. The resulting schemes have fourth-order accurate local truncation error on uniform grids and third order in the nonuniform case. Guidelines for discretization pertaining to grid orientation and resolution are presented.

  17. Can cardiac surgery cause hypopituitarism? (United States)

    Francis, Flverly; Burger, Ines; Poll, Eva Maria; Reineke, Andrea; Strasburger, Christian J; Dohmen, Guido; Gilsbach, Joachim M; Kreitschmann-Andermahr, Ilonka


    Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3-12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.

  18. Cardiac energetics: sense and nonsense. (United States)

    Gibbs, Colin L


    1. The background to current ideas in cardiac energetics is outlined and, in the genomic era, the need is stressed for detailed knowledge of mouse heart mechanics and energetics. 2. The mouse heart is clearly different to the rat in terms of its excitation-contraction (EC) coupling and the common assumption that heart rate difference between mice and humans will account for the eightfold difference in myocardial oxygen consumption is wrong, because the energy per beat of the mouse heart is approximately one-third that of the human heart. 3. In vivo evidence suggests that there may well be an eightfold species difference in the non-beating metabolism of mice and human hearts. It is speculated that the magnitude of basal metabolism in the heart is regulatable and that, in the absence of perfusion, it falls to approximately one-quarter of its in vivo rate and that in clinical conditions, such as hibernation, it probably decreases; its magnitude may be controlled by the endothelium. 4. The active energy balance sheet is briefly discussed and it is suggested that the activation heat accounts for 20-25% of the active energy per beat and cross-bridge turnover accounts for the balance. It is argued that force, not shortening, is the major determinant of cardiac energy usage. 5. The outcome of recent cardiac modelling with variants of the Huxley and Hill/Eisenberg models is described. It has been necessary to invoke 'loose coupling' to replicate the low cardiac energy flux measured at low afterloads (medium to high velocities of shortening). 6. Lastly, some of the unexplained or 'nonsense' energetic data are outlined and eight unsolved problems in cardiac energetics are discussed.

  19. Cavity ring-down technique for measurement of reflectivity of high reflectivity mirrors with high accuracy

    Indian Academy of Sciences (India)

    G Sridhar; Sandeep K Agarwalla; Sunita Singh; L M Gantayet


    A simple, accurate and reliable method for measuring the reflectivity of laser-grade mirrors ( > 99.5 %) based on cavity ring-down (CRD) technique has been success-fully demonstrated in our laboratory using a pulsed Nd:YAG laser. A fast photomultiplier tube with an oscilloscope was used to detect and analyse the CRD signal. The cavity decay times were measured for three cavities formed by a combination of three mirror pairs. The absolute reflectivities 1, 2, 3 were determined to be 99.94%, 99.63%, 99.52% at normal incidence. The reflectivity of mirrors is measured to an accuracy of 0.01%.

  20. Cardiac Troponin I: A Valuable Biomarker Indicating the Cardiac Involvement in Fabry Disease.

    Directory of Open Access Journals (Sweden)

    Christian Tanislav

    Full Text Available Assessment of the clinical severity of Fabry disease (FD, an X-linked, rare, progressive disorder based on a genetic defect in alpha-galactosidase is challenging, especially regarding cardiac involvement. The aim of the study was to evaluate the diagnostic value of cardiac troponin I (cTnI in discriminating FD patients with cardiac involvement in a large FD patient cohort.cTnI levels were measured with a contemporary sensitive assay in plasma samples taken routinely from FD patients. The assay was calibrated to measure cTnI levels ≥0.01 ng/ml. Elevated cTnI values (cut-off ≥0.04 ng/ml were correlated with clinical data.cTnI was assessed in 62 FD patients (median age: 47 years, males: 36%. Elevated cTnI levels were detected in 23 (37% patients. Patients with a cTnI elevation were older (median 55 years versus 36 years, p<0.001. Elevated cTnI levels were associated with the presence of a LVH (16/23 versus 1/39; OR 65.81, CI: 6.747-641.859; p<0.001. In almost all patients with a left ventricular hypertrophy (LVH elevated cTnI levels were detected (16/17, 94%. Absolute cTnI levels in patients with LVH were higher than in those without (median 0.23 ng/ml versus 0.02 ng/ml; p<0.001. A cTnI level <0.04ng/ml had a high negative predictive value regarding the presence of a LVH (38/39, 97%. In a control group of non-FD patients (n = 17 with LVH (due to hypertension none showed cTnI levels ≥0.01 ng/ml.Elevated cTnI levels are common in FD patients, reflecting cardiac involvement. FD patients might benefit from a continuous cTnI monitoring.

  1. Cardiac Troponin I: A Valuable Biomarker Indicating the Cardiac Involvement in Fabry Disease (United States)

    Giese, Anne Kathrin; Eichler, Sabrina; Sieweke, Nicole; Speth, Maria; Bauer, Timm; Hamm, Christian


    Objectives Assessment of the clinical severity of Fabry disease (FD), an X-linked, rare, progressive disorder based on a genetic defect in alpha-galactosidase is challenging, especially regarding cardiac involvement. The aim of the study was to evaluate the diagnostic value of cardiac troponin I (cTnI) in discriminating FD patients with cardiac involvement in a large FD patient cohort. Methods cTnI levels were measured with a contemporary sensitive assay in plasma samples taken routinely from FD patients. The assay was calibrated to measure cTnI levels ≥0.01 ng/ml. Elevated cTnI values (cut-off ≥0.04 ng/ml) were correlated with clinical data. Results cTnI was assessed in 62 FD patients (median age: 47 years, males: 36%). Elevated cTnI levels were detected in 23 (37%) patients. Patients with a cTnI elevation were older (median 55 years versus 36 years, p<0.001). Elevated cTnI levels were associated with the presence of a LVH (16/23 versus 1/39; OR 65.81, CI: 6.747–641.859; p<0.001). In almost all patients with a left ventricular hypertrophy (LVH) elevated cTnI levels were detected (16/17, 94%). Absolute cTnI levels in patients with LVH were higher than in those without (median 0.23 ng/ml versus 0.02 ng/ml; p<0.001). A cTnI level <0.04ng/ml had a high negative predictive value regarding the presence of a LVH (38/39, 97%). In a control group of non-FD patients (n = 17) with LVH (due to hypertension) none showed cTnI levels ≥0.01 ng/ml. Conclusions Elevated cTnI levels are common in FD patients, reflecting cardiac involvement. FD patients might benefit from a continuous cTnI monitoring. PMID:27322070

  2. Accurate colorimetric feedback for RGB LED clusters (United States)

    Man, Kwong; Ashdown, Ian


    We present an empirical model of LED emission spectra that is applicable to both InGaN and AlInGaP high-flux LEDs, and which accurately predicts their relative spectral power distributions over a wide range of LED junction temperatures. We further demonstrate with laboratory measurements that changes in LED spectral power distribution with temperature can be accurately predicted with first- or second-order equations. This provides the basis for a real-time colorimetric feedback system for RGB LED clusters that can maintain the chromaticity of white light at constant intensity to within +/-0.003 Δuv over a range of 45 degrees Celsius, and to within 0.01 Δuv when dimmed over an intensity range of 10:1.

  3. Accurate guitar tuning by cochlear implant musicians.

    Directory of Open Access Journals (Sweden)

    Thomas Lu

    Full Text Available Modern cochlear implant (CI users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼ 30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task.

  4. Efficient Accurate Context-Sensitive Anomaly Detection

    Institute of Scientific and Technical Information of China (English)


    For program behavior-based anomaly detection, the only way to ensure accurate monitoring is to construct an efficient and precise program behavior model. A new program behavior-based anomaly detection model,called combined pushdown automaton (CPDA) model was proposed, which is based on static binary executable analysis. The CPDA model incorporates the optimized call stack walk and code instrumentation technique to gain complete context information. Thereby the proposed method can detect more attacks, while retaining good performance.

  5. On accurate determination of contact angle (United States)

    Concus, P.; Finn, R.


    Methods are proposed that exploit a microgravity environment to obtain highly accurate measurement of contact angle. These methods, which are based on our earlier mathematical results, do not require detailed measurement of a liquid free-surface, as they incorporate discontinuous or nearly-discontinuous behavior of the liquid bulk in certain container geometries. Physical testing is planned in the forthcoming IML-2 space flight and in related preparatory ground-based experiments.

  6. Accurate Control of Josephson Phase Qubits (United States)


    61 ~1986!. 23 K. Kraus, States, Effects, and Operations: Fundamental Notions of Quantum Theory, Lecture Notes in Physics , Vol. 190 ~Springer-Verlag... PHYSICAL REVIEW B 68, 224518 ~2003!Accurate control of Josephson phase qubits Matthias Steffen,1,2,* John M. Martinis,3 and Isaac L. Chuang1 1Center...for Bits and Atoms and Department of Physics , MIT, Cambridge, Massachusetts 02139, USA 2Solid State and Photonics Laboratory, Stanford University

  7. Accurate guitar tuning by cochlear implant musicians. (United States)

    Lu, Thomas; Huang, Juan; Zeng, Fan-Gang


    Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task.

  8. Synthesizing Accurate Floating-Point Formulas


    Ioualalen, Arnault; Martel, Matthieu


    International audience; Many critical embedded systems perform floating-point computations yet their accuracy is difficult to assert and strongly depends on how formulas are written in programs. In this article, we focus on the synthesis of accurate formulas mathematically equal to the original formulas occurring in source codes. In general, an expression may be rewritten in many ways. To avoid any combinatorial explosion, we use an intermediate representation, called APEG, enabling us to rep...

  9. Automatic cardiac gating of small-animal PET from list-mode data

    Energy Technology Data Exchange (ETDEWEB)

    Herraiz, J.L.; Udias, J.M. [Universidad Complutense de Madrid Univ. (Spain). Grupo de Fisica Nuclear; Vaquero, J.J.; Desco, M. [Universidad Carlos III de Madrid (Spain). Dept. de Bioingenieria e Ingenieria Aeroespacial; Cusso, L. [Hospital General Universitario Gregorio Maranon, Madrid (Spain). Unidad de Medicina y Cirugia Experimental


    This work presents a method to obtain automatically the cardiac gating signal in a PET study of rats, by employing the variation with time of the counts in the cardiac region, that can be extracted from list-mode data. In an initial step, the cardiac region is identified in the image space by backward-projecting a small fraction of the acquired data and studying the variation with time of the counts in each voxel inside said region, with frequencies within 2 and 8 Hz. The region obtained corresponds accurately to the left-ventricle of the heart of the rat. In a second step, the lines-of-response (LORs) connected with this region are found by forward-projecting this region. The time variation of the number of counts in these LORs contains the cardiac motion information that we want to extract. This variation of counts with time is band-pass filtered to reduce noise, and the time signal so obtained is used to create the gating signal. The result was compared with a cardiac gating signal obtained from an ECG acquired simultaneously to the PET study. Reconstructed gated images obtained from both gating information are similar. The method proposed demonstrates that valid cardiac gating signals can be obtained for rats from PET list-mode data. (orig.)

  10. A device for rapid and quantitative measurement of cardiac myocyte contractility (United States)

    Gaitas, Angelo; Malhotra, Ricky; Li, Tao; Herron, Todd; Jalife, José


    Cardiac contractility is the hallmark of cardiac function and is a predictor of healthy or diseased cardiac muscle. Despite advancements over the last two decades, the techniques and tools available to cardiovascular scientists are limited in their utility to accurately and reliably measure the amplitude and frequency of cardiomyocyte contractions. Isometric force measurements in the past have entailed cumbersome attachment of isolated and permeabilized cardiomyocytes to a force transducer followed by measurements of sarcomere lengths under conditions of submaximal and maximal Ca2+ activation. These techniques have the inherent disadvantages of being labor intensive and costly. We have engineered a micro-machined cantilever sensor with an embedded deflection-sensing element that, in preliminary experiments, has demonstrated to reliably measure cardiac cell contractions in real-time. Here, we describe this new bioengineering tool with applicability in the cardiovascular research field to effectively and reliably measure cardiac cell contractility in a quantitative manner. We measured contractility in both primary neonatal rat heart cardiomyocyte monolayers that demonstrated a beat frequency of 3 Hz as well as human embryonic stem cell-derived cardiomyocytes with a contractile frequency of about 1 Hz. We also employed the β-adrenergic agonist isoproterenol (100 nmol l-1) and observed that our cantilever demonstrated high sensitivity in detecting subtle changes in both chronotropic and inotropic responses of monolayers. This report describes the utility of our micro-device in both basic cardiovascular research as well as in small molecule drug discovery to monitor cardiac cell contractions.

  11. Simple and accurate optical height sensor for wafer inspection systems (United States)

    Shimura, Kei; Nakai, Naoya; Taniguchi, Koichi; Itoh, Masahide


    An accurate method for measuring the wafer surface height is required for wafer inspection systems to adjust the focus of inspection optics quickly and precisely. A method for projecting a laser spot onto the wafer surface obliquely and for detecting its image displacement using a one-dimensional position-sensitive detector is known, and a variety of methods have been proposed for improving the accuracy by compensating the measurement error due to the surface patterns. We have developed a simple and accurate method in which an image of a reticle with eight slits is projected on the wafer surface and its reflected image is detected using an image sensor. The surface height is calculated by averaging the coordinates of the images of the slits in both the two directions in the captured image. Pattern-related measurement error was reduced by applying the coordinates averaging to the multiple-slit-projection method. Accuracy of better than 0.35 μm was achieved for a patterned wafer at the reference height and ±0.1 mm from the reference height in a simple configuration.

  12. Accurate structural correlations from maximum likelihood superpositions.

    Directory of Open Access Journals (Sweden)

    Douglas L Theobald


    Full Text Available The cores of globular proteins are densely packed, resulting in complicated networks of structural interactions. These interactions in turn give rise to dynamic structural correlations over a wide range of time scales. Accurate analysis of these complex correlations is crucial for understanding biomolecular mechanisms and for relating structure to function. Here we report a highly accurate technique for inferring the major modes of structural correlation in macromolecules using likelihood-based statistical analysis of sets of structures. This method is generally applicable to any ensemble of related molecules, including families of nuclear magnetic resonance (NMR models, different crystal forms of a protein, and structural alignments of homologous proteins, as well as molecular dynamics trajectories. Dominant modes of structural correlation are determined using principal components analysis (PCA of the maximum likelihood estimate of the correlation matrix. The correlations we identify are inherently independent of the statistical uncertainty and dynamic heterogeneity associated with the structural coordinates. We additionally present an easily interpretable method ("PCA plots" for displaying these positional correlations by color-coding them onto a macromolecular structure. Maximum likelihood PCA of structural superpositions, and the structural PCA plots that illustrate the results, will facilitate the accurate determination of dynamic structural correlations analyzed in diverse fields of structural biology.

  13. Clinical application of dual gate Doppler in evaluating cardiac function and synchronization%双多普勒同步取样技术评价心脏功能及同步性的临床应用

    Institute of Scientific and Technical Information of China (English)

    周燕翔; 冷倩倩; 郭瑞强


    Dual gate Doppler is a newly-developed technology in recent years, which can synchronously place two sampling volume. Based on its advantages,dual gate Doppler can not only measure indexes which reflect cardiac function more accurately than conventional Doppler,but also provide a more convenient method to evaluate the cardiac synchronization. And it can reflect the myocardial tissue motions and hemodynamic changes in the heart cavity timely,intuitively and fast,offer a new perspective to quantitatively estimate the coupling relations between wall mechanics and heart cavity fluid mechanics.This article aims to introduce the applications of dual gate Doppler in evaluating cardiac function and synchronization.%双多普勒同步取样技术是近年来出现的新技术;其可以在同一切面同步放置两个取样容积,不仅可以更准确地反映心脏功能,而且可以更简便地评价心脏同步性。同时,双多普勒技术可以实时、直观、快速地显示心肌组织运动与心腔内血流动力学的变化,为定量评价室壁运动力学与心腔内流体力学的耦联关系提供了新视角。本文就双多普勒技术在评价心脏功能及同步性等方面的应用作一综述。

  14. Media for Reflection

    DEFF Research Database (Denmark)

    Knudsen, Morten


    This article develops the concept media for reflection in the interest of conceptualizing the interpretative frames that enable and limit reflection in management and leadership education. The concept ‘media for reflection’ allows us to conceptualize the social and cultural mediation of reflection...... without reducing reflection to an effect of the social structures and cultural norms in which it is embedded. Based on the developed theoretical framework, this article analyses how a renaissance ‘mirror for princes’ and contemporary research-based management education mediate reflection. The content...... of the mediations is analysed as well as the societal and organizational background. Furthermore, the means by which the two media enable and limit reflection in different ways is compared. Finally, the article discusses possible implications of the analysis in terms of management and leadership education....

  15. European cardiac resynchronization therapy survey II: rationale and design. (United States)

    Dickstein, Kenneth; Normand, Camilla; Anker, Stefan D; Auricchio, Angelo; Blomström, Carina Lundqvist; Lundqvist, Carina Blomström; Bogale, Nigussie; Cleland, John; Filippatos, Gerasimos; Gasparini, Maurizio; Gitt, Anselm; Hindricks, Gerhard; Kuck, Karl-Heinz; Ponikowski, Piotr; Stellbrink, Christoph; Ruschitzka, Frank; Linde, Cecilia


    The Cardiac Resynchronization Therapy (CRT) Survey II is a 6 months snapshot survey initiated by two ESC Associations, the European Heart Rhythm Association and the Heart Failure Association, which is designed to describe clinical practice regarding implantation of CRT devices in a broad sample of hospitals in 47 ESC member countries. The large volume of clinical and demographic data collected should reflect current patient selection, implantation, and follow-up practice and provide information relevant for assessing healthcare resource utilization in connection with CRT. The findings of this survey should permit representative benchmarking both nationally and internationally across Europe.

  16. A Case Report on Upper Extremity Pain of Cardiac Origin

    Directory of Open Access Journals (Sweden)

    Turgay Altınbilek


    Full Text Available Upper extremity pain can originate from the musculoskeletal system, or be a reflection of problems originating from various organs. Therefore, it is highly important to perform a detailed clinical evaluation on patients during differential diagnosis. In this case report, we present a 61 year-old male patient who was admitted with pain in both upper extremities and the upper back that presumed to be of cardiac origin following our clinical evaluations. The patient was referred to the cardiology department, where he was diagnosed with coronary heart disease. The patient’s complaints of pain were fully resolved through the application of an intracoronary stent.

  17. Accurate measurement method for tube's endpoints based on machine vision (United States)

    Liu, Shaoli; Jin, Peng; Liu, Jianhua; Wang, Xiao; Sun, Peng


    Tubes are used widely in aerospace vehicles, and their accurate assembly can directly affect the assembling reliability and the quality of products. It is important to measure the processed tube's endpoints and then fix any geometric errors correspondingly. However, the traditional tube inspection method is time-consuming and complex operations. Therefore, a new measurement method for a tube's endpoints based on machine vision is proposed. First, reflected light on tube's surface can be removed by using photometric linearization. Then, based on the optimization model for the tube's endpoint measurements and the principle of stereo matching, the global coordinates and the relative distance of the tube's endpoint are obtained. To confirm the feasibility, 11 tubes are processed to remove the reflected light and then the endpoint's positions of tubes are measured. The experiment results show that the measurement repeatability accuracy is 0.167 mm, and the absolute accuracy is 0.328 mm. The measurement takes less than 1 min. The proposed method based on machine vision can measure the tube's endpoints without any surface treatment or any tools and can realize on line measurement.

  18. Accurate measurement method for tube's endpoints based on machine vision (United States)

    Liu, Shaoli; Jin, Peng; Liu, Jianhua; Wang, Xiao; Sun, Peng


    Tubes are used widely in aerospace vehicles, and their accurate assembly can directly affect the assembling reliability and the quality of products. It is important to measure the processed tube's endpoints and then fix any geometric errors correspondingly. However, the traditional tube inspection method is time-consuming and complex operations. Therefore, a new measurement method for a tube's endpoints based on machine vision is proposed. First, reflected light on tube's surface can be removed by using photometric linearization. Then, based on the optimization model for the tube's endpoint measurements and the principle of stereo matching, the global coordinates and the relative distance of the tube's endpoint are obtained. To confirm the feasibility, 11 tubes are processed to remove the reflected light and then the endpoint's positions of tubes are measured. The experiment results show that the measurement repeatability accuracy is 0.167 mm, and the absolute accuracy is 0.328 mm. The measurement takes less than 1 min. The proposed method based on machine vision can measure the tube's endpoints without any surface treatment or any tools and can realize on line measurement.

  19. Unanticipated Partial Behavioral Reflection


    Roethlisberger, David; Denker, Marcus; Tanter, Éric


    International audience; Dynamic, unanticipated adaptation of running systems is of interest in a variety of situations, ranging from functional upgrades to on-the-fly debugging or monitoring of critical applications. In this paper we study a particular form of computational reflection, called unanticipated partial behavioral reflection, which is particularly well-suited for unanticipated adaptation of real-world systems. Our proposal combines the dynamicity of unanticipated reflection, i.e., ...

  20. Reflection in professional practice


    Hetzner, Stefanie Bianca


    The purpose of this thesis is to contribute to the research on professional learning through reflective practice. The main goal is to examine—against the backdrop of workplace changes and errors—individual and contextual factors that are theoretically assumed to influence reflection in the context of professional work. Reflective practice is defined as a retrospective but future- and goal-oriented cognitive-affective process that basically involves (a) the awareness and review of incident...

  1. Cardiac troponin: an emerging cardiac biomarker in animal health

    Directory of Open Access Journals (Sweden)

    Vishal V. Undhad

    Full Text Available Analysis of cardiac troponin I (cTn I and T (cTnT are considered the “gold standard” for the non-invasive diagnosis of myocardial injury in human and animals. It has replaced traditionally used cardiac biomarkers such as myoglobin, lactate dehydrogenase (LDH, creatine kinase (CK and CK-MB due to its high sensitivity and specificity for the detection of myocardial injury. Cardiac troponins are proteins that control the calcium-mediated interaction between actin and myosin, allowing contraction at the sarcomere level. Concentration of the cTn can be correlated microscopic lesion and loss of immunolabeling in myocardium damage. Troponin concentration remains elevated in blood for 1-2wks so that wide window is available for diagnosis of myocardial damage. The cTn test has >95% specificity and sensitivity and test is less time consuming (10 to 15 minutes and less costly (INR 200 to INR 500. [Vet. World 2012; 5(8.000: 508-511

  2. Self-Reflection

    DEFF Research Database (Denmark)

    Fausing, Bent


    and physical bodies are constantly broken with technology. Perception and reflection are in synergy. Reflection means etymologically to bend back, to mirror, and to think. My presentation will take its point of departure in this etymology and make perspectives to modern use of refection in digital media. I...... will take a look at the establishing of the modern self and possibilities of self-reflection, too. My examples will be from the so-called dark-selfies and from a new selfie form, which merge the present with the previous progressing into the future. I will discuss the media reflections as loos and/or gain...

  3. 3D culture for cardiac cells. (United States)

    Zuppinger, Christian


    This review discusses historical milestones, recent developments and challenges in the area of 3D culture models with cardiovascular cell types. Expectations in this area have been raised in recent years, but more relevant in vitro research, more accurate drug testing results, reliable disease models and insights leading to bioartificial organs are expected from the transition to 3D cell culture. However, the construction of organ-like cardiac 3D models currently remains a difficult challenge. The heart consists of highly differentiated cells in an intricate arrangement.Furthermore, electrical “wiring”, a vascular system and multiple cell types act in concert to respond to the rapidly changing demands of the body. Although cardiovascular 3D culture models have been predominantly developed for regenerative medicine in the past, their use in drug screening and for disease models has become more popular recently. Many sophisticated 3D culture models are currently being developed in this dynamic area of life science. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.

  4. Paediatric cardiac catheterization: an information sheet. (United States)

    Bonnet, Caroline; Greffier, Angelique


    The need to inform patients using validated scientific data is acknowledged internationally. The obligation to inform patients is based on a fundamental principle of French law: the principle of the unavailability of the human body. Before engaging in diagnostic or therapeutic strategies such as paediatric cardiac catheterization, the healthcare professional must explain the disease, the advantages and drawbacks of each treatment strategy and their foreseeable benefit/risk ratio in order to help older children and their parents come to a decision. To obtain this required consent and before the care is provided, the infant and their legal representative must have received clear, accurate and understandable information. An information sheet cannot substitute for verbal information. Guidelines for good practices on the delivery of information have been established by the Health Authorities and officially recognized in a decree from the Ministry of Health. These documents allow professionals to draft a written information document for patients and healthcare users. This document must help the patient to take part in decisions that concern them. The law of 4th March 2002 regarding the rights of patients and the quality of the healthcare system states that 'in cases of litigation, it is the responsibility of the professional or the healthcare establishment to provide proof that the information was given to the person concerned in the conditions set out in the present article. This proof can be brought by any means'.

  5. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone


    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  6. Experimental and clinical study of cardiac hypertrophy by thallium-201 myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Torii, Yukio (Kyoto Prefectural Univ. of Medicine (Japan))


    I studied experimentally the myocardial uptake of /sup 201/Tl in cardiac hypertrophy in rat, and clinically evaluated cardiac shape and dimension in the patients with various types of cardiac hypertrophy. Experimentally, both myocardial blood flow (MBF) and Tl uptake were increased with cardiac weight. There were negative correlations between the extraction fraction and MBF. Tl uptake in Hypertrophy is not always dependent on MBF and affected by the altered metabolism of hypertrophied myocardium. Clinical study was performed in 29 normal subjects and in 90 patients with heart disease. The measurements of left ventricular (LV) size by Tl scintigraphy were well correlated with them by echocardiography. Aortic stenosis and hypertensive heart disease showed thick wall and spherical shape. Both mitral (MR) and aortic (AR) regurgitation showed ventricular dilatation, spherical shape (in chronic MR) and ellipsoid shape (in acute MR and in AR). Decreased ventricular size but normal shape was observed in mitral stenosis and cor pulmonale. Hypertrophic cardiomyopathy showed thick wall with asymmetric septal hypertrophy, while congestive cardiomyopathy showed thin wall with marked ventricular dilatation and spherical shape. I conclude that heart disease has characteristic figures in dimension and shape which may be reflecting cardiac performance or compensating for the load to the heart, and that /sup 201/Tl scintigraphy is useful evaluating cardiac morphology as well as in diagnosing myocardial ischemia.

  7. [Cardiac cephalgia: an underdiagnosed condition? ]. (United States)

    Gutiérrez Morlote, Jesús; Fernández García, José M; Timiraos Fernández, Juan J; Llano Cardenal, Miguel; Llano Catedral, Miguel; Rodríguez Rodríguez, Eloy; Pascual Gómez, Julio


    Cardiac cephalgia, or headache occurring as manifestation of myocardial ischemia, has only recently been recognized as a distinct entity. In patients with known ischemic cardiopathy, its diagnosis depends on the presence of severe headache that is accompanied by nausea, worsened by physical exercise, and only ceases with nitrate administration. We report on two patients who met diagnostic criteria for this entity. In both, headache was the only symptom of coronary ischemia, and delayed its diagnosis. Headache occurred both at rest and during exertion, and resolved only after the administration of nitrates. Cardiac cephalgia should be suspected in patients with a history of ischemic cardiopathy who present with de novo headache, even when thoracic pain is absent, especially if the headache improves with nitrates. Differential diagnosis with migraine is crucial to avoid the administration of vasoconstrictors.

  8. [Cardiac toxicity of 5-fluorouracil]. (United States)

    Fournier, C; Benahmed, M; Blondeau, M


    A 67 year-old patient receives 5-fluorouracil for vocal chord cancer. During the perfusion, atypical angina pain occurs, accompanied with offset of ST above the baseline in standard leads and in V4 through V6. The pain subsides spontaneously in 45 minutes. These ECG alterations are followed 48 hours later by diffuse inverted T waves with lengthened QT. Cardiac ultrasonography and isotopic angiography do not show any abnormality of the left ventricular function, but myocardial tomoscintigraphy with labelled thallium show a lower hypofixation on exertion. The cardiac toxicity of 5-fluorouracil is in frequent. It is usually believed that it involves a coronary spasm, as suggested by the ECG tracing in the reported cases. The incident, which may be painful or painless, may result in a myocardial infarction or even sudden death during the perfusion. Therefore, it is advisable to discontinue the treatment as soon as an angina-type pain occurs.

  9. Progeria syndrome with cardiac complications. (United States)

    Ilyas, Saadia; Ilyas, Hajira; Hameed, Abdul; Ilyas, Muhammad


    A case report of 6-year-old boy with progeria syndrome, with marked cardiac complications is presented. The boy had cardiorespiratory failure. Discoloured purpuric skin patches, alopecia, prominent forehead, protuberant eyes, flattened nasal cartilage, malformed mandible, hypodentition, and deformed rigid fingers and toes were observed on examination. The boy was unable to speak. A sclerotic systolic murmur was audible over the mitral and aortic areas. Chest x-rays showed cardiac enlargement and the electrocardiogram (ECG) showed giant peaked P waves (right atrial hypertrophy) and right ventricular hypertrophy. Atherosclerotic dilated ascending aorta, thickened sclerotic aortic, mitral, and tricuspid valves with increased echo texture, left and right atrial and right ventricular dilatation, reduced left ventricular cavity, and thickened speckled atrial and ventricular septa were observed on echocardiography.

  10. Sudden cardiac death in athletes

    Directory of Open Access Journals (Sweden)

    Fábio Camilo Pellegrino dos Santos


    Full Text Available ABSTRACT The most accepted definition of sudden cardiac death nowadays is an unexplained death occurred suddenly within one hour of symptom onset. If it was not witnessed, individuals need to had been observed for at least 24 hours before the event and should be discarded the possibility of non cardiac causes of sudden death, pulmonary embolism or extensive malignancy. The term athlete refers to individuals of any age who participate in collective or individual regular physical activity, as well as physical training program for regular competitions. The sudden death of a young athlete, whether amateur or professional, especially during competitions, is always dramatic, with strong negative social impact and in the media. The fact that sports are recommended as a formula for longevity and quality of life makes these events a cause for concern in sports and society in general.

  11. Heart fields and cardiac morphogenesis. (United States)

    Kelly, Robert G; Buckingham, Margaret E; Moorman, Antoon F


    In this review, we focus on two important steps in the formation of the embryonic heart: (i) the progressive addition of late differentiating progenitor cells from the second heart field that drives heart tube extension during looping morphogenesis, and (ii) the emergence of patterned proliferation within the embryonic myocardium that generates distinct cardiac chambers. During the transition between these steps, the major site of proliferation switches from progenitor cells outside the early heart to proliferation within the embryonic myocardium. The second heart field and ballooning morphogenesis concepts have major repercussions on our understanding of human heart development and disease. In particular, they provide a framework to dissect the origin of congenital heart defects and the regulation of myocardial proliferation and differentiation of relevance for cardiac repair.

  12. Respiratory gating in cardiac PET

    DEFF Research Database (Denmark)

    Lassen, Martin Lyngby; Rasmussen, Thomas; Christensen, Thomas E


    of our study was to compare the resulting imaging quality by the use of a time-based respiratory gating system in two groups administered either adenosine or dipyridamole as the pharmacological stress agent. METHODS AND RESULTS: Forty-eight patients were randomized to adenosine or dipyridamole cardiac...... stress (82)RB-PET. Respiratory rates and depths were measured by a respiratory gating system in addition to registering actual respiratory rates. Patients undergoing adenosine stress showed a decrease in measured respiratory rate from initial to later scan phase measurements [12.4 (±5.7) vs 5.6 (±4......BACKGROUND: Respiratory motion due to breathing during cardiac positron emission tomography (PET) results in spatial blurring and erroneous tracer quantification. Respiratory gating might represent a solution by dividing the PET coincidence dataset into smaller respiratory phase subsets. The aim...

  13. Systems biology and cardiac arrhythmias. (United States)

    Grace, Andrew A; Roden, Dan M


    During the past few years, the development of effective, empirical technologies for treatment of cardiac arrhythmias has exceeded the pace at which detailed knowledge of the underlying biology has accumulated. As a result, although some clinical arrhythmias can be cured with techniques such as catheter ablation, drug treatment and prediction of the risk of sudden death remain fairly primitive. The identification of key candidate genes for monogenic arrhythmia syndromes shows that to bring basic biology to the clinic is a powerful approach. Increasingly sophisticated experimental models and methods of measurement, including stem cell-based models of human cardiac arrhythmias, are being deployed to study how perturbations in several biologic pathways can result in an arrhythmia-prone heart. The biology of arrhythmia is largely quantifiable, which allows for systematic analysis that could transform treatment strategies that are often still empirical into management based on molecular evidence.

  14. Nutritional Status and Cardiac Autophagy

    Directory of Open Access Journals (Sweden)

    Jihyun Ahn


    Full Text Available Autophagy is necessary for the degradation of long-lasting proteins and nonfunctional organelles, and is activated to promote cellular survival. However, overactivation of autophagy may deplete essential molecules and organelles responsible for cellular survival. Lifelong calorie restriction by 40% has been shown to increase the cardiac expression of autophagic markers, which suggests that it may have a cardioprotective effect by decreasing oxidative damage brought on by aging and cardiovascular diseases. Although cardiac autophagy is critical to regulating protein quality and maintaining cellular function and survival, increased or excessive autophagy may have deleterious effects on the heart under some circumstances, including pressure overload-induced heart failure. The importance of autophagy has been shown in nutrient supply and preservation of energy in times of limitation, such as ischemia. Some studies have suggested that a transition from obesity to metabolic syndrome may involve progressive changes in myocardial inflammation, mitochondrial dysfunction, fibrosis, apoptosis, and myocardial autophagy.


    Gracía Barrera, Ma De Gracia


    The study was performed in order to obtain specific data confirming the influence in the diagnosis of many cardiac pathologies detected by Holter heart rate. Holter heart rate of 24 hours is an electronic device, of small size, which records and stores an electrocardiographic tracing two or three leads, while the patient activities of daily life. It leads us to conduct this study increased requests we've had in our hospital and the numerous reports that have helped in the diagnosis of our patients. We base the study with statistical data, therefore, produce two databases, one that reflects the total of studies conducted in 2013 and another with patients diagnosed with cardiac stimulation and need to refer to it. Crossing these two databases get third with patients referred for cardiac stimulation Holter heart rate realized. With these data we can say that, when this test is requested, it has a great influence on the final diagnosis (87%) and there is a high probability of finding significant findings, without forgetting the clinical and personal aspects of each patient.

  16. Influence of the cardiac myosin hinge region on contractile activity. (United States)

    Margossian, S S; Krueger, J W; Sellers, J R; Cuda, G; Caulfield, J B; Norton, P; Slayter, H S


    The participation of cardiac myosin hinge in contractility was investigated by in vitro motility and ATPase assays and by measurements of sarcomere shortening. The effect on contractile activity was analyzed using an antibody directed against a 20-amino acid peptide within the hinge region of myosin. This antibody bound specifically at the hinge at a distance of 55 nm from the S1/S2 junction, was specific to human, dog, and rat cardiac myosins, did not crossreact with gizzard or skeletal myosin, and had no effect on ATPase activity of purified S1 and myofibrils. However, it completely suppressed the movement of actin filaments in in vitro motility assays and reduced active shortening of sarcomeres of skinned cardiac myocytes by half. Suppression of motion by the anti-hinge antibody may reflect a mechanical constraint imposed by the antibody upon the mobility of the S2 region of myosin. The results suggest that the steps in the mechanochemical energy transduction can be separately influenced through S2.

  17. Accurate measurement of unsteady state fluid temperature (United States)

    Jaremkiewicz, Magdalena


    In this paper, two accurate methods for determining the transient fluid temperature were presented. Measurements were conducted for boiling water since its temperature is known. At the beginning the thermometers are at the ambient temperature and next they are immediately immersed into saturated water. The measurements were carried out with two thermometers of different construction but with the same housing outer diameter equal to 15 mm. One of them is a K-type industrial thermometer widely available commercially. The temperature indicated by the thermometer was corrected considering the thermometers as the first or second order inertia devices. The new design of a thermometer was proposed and also used to measure the temperature of boiling water. Its characteristic feature is a cylinder-shaped housing with the sheath thermocouple located in its center. The temperature of the fluid was determined based on measurements taken in the axis of the solid cylindrical element (housing) using the inverse space marching method. Measurements of the transient temperature of the air flowing through the wind tunnel using the same thermometers were also carried out. The proposed measurement technique provides more accurate results compared with measurements using industrial thermometers in conjunction with simple temperature correction using the inertial thermometer model of the first or second order. By comparing the results, it was demonstrated that the new thermometer allows obtaining the fluid temperature much faster and with higher accuracy in comparison to the industrial thermometer. Accurate measurements of the fast changing fluid temperature are possible due to the low inertia thermometer and fast space marching method applied for solving the inverse heat conduction problem.

  18. Pregnancy as a cardiac stress model. (United States)

    Chung, Eunhee; Leinwand, Leslie A


    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiac adaptation during normal pregnancy. This review provides an overview of the cardiac consequences of pregnancy, including haemodynamic, functional, structural, and morphological adaptations, as well as molecular phenotypes. In addition, this review describes the signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation.


    Directory of Open Access Journals (Sweden)



    Full Text Available : Heart transplantation has emerged as the definitive therapy for patients with end-stage cardiomyopathy. The two most common forms of cardiac disease that lead to transplantation are ischemic cardiomyopathy and dilated cardiomyopathy, which together comprise approximately 90% of cases. The other less common forms of heart disease include viral cardiomyopathy, infiltrative cardiomyopathy, postpartum cardiomyopathy, valvular heart disease and congenital heart disease

  20. Chaos control of cardiac arrhythmias. (United States)

    Garfinkel, A; Weiss, J N; Ditto, W L; Spano, M L


    Chaos theory has shown that many disordered and erratic phenomena are in fact deterministic, and can be understood causally and controlled. The prospect that cardiac arrhythmias might be instances of deterministic chaos is therefore intriguing. We used a recently developed method of chaos control to stabilize a ouabain-induced arrhythmia in rabbit ventricular tissue in vitro. Extension of these results to clinically significant arrhythmias such as fibrillation will require overcoming the additional obstacles of spatiotemporal complexity.

  1. Cardiac autonomic nerve distribution and arrhythmia

    Institute of Scientific and Technical Information of China (English)

    Quan Liu; Dongmei Chen; Yonggang Wang; Xin Zhao; Yang Zheng


    OBJECTIVE: To analyze the distribution characteristics of cardiac autonomic nerves and to explore the correlation between cardiac autonomic nerve distribution and arrhythmia.DATA RETRIEVAL: A computer-based retrieval was performed for papers examining the distribution of cardiac autonomic nerves, using "heart, autonomic nerve, sympathetic nerve, vagus nerve, nerve distribution, rhythm and atrial fibrillation" as the key words.SELECTION CRITERIA: A total of 165 studies examining the distribution of cardiac autonomic nerve were screened, and 46 of them were eventually included.MAIN OUTCOME MEASURES: The distribution and characteristics of cardiac autonomic nerves were observed, and immunohistochemical staining was applied to determine the levels of tyrosine hydroxylase and acetylcholine transferase (main markers of cardiac autonomic nerve distribution). In addition, the correlation between cardiac autonomic nerve distribution and cardiac arrhythmia was investigated.RESULTS: Cardiac autonomic nerves were reported to exhibit a disordered distribution in different sites, mainly at the surface of the cardiac atrium and pulmonary vein, forming a ganglia plexus. The distribution of the pulmonary vein autonomic nerve was prominent at the proximal end rather than the distal end, at the upper left rather than the lower right, at the epicardial membrane rather than the endocardial membrane, at the left atrium rather than the right atrium, and at the posterior wall rather than the anterior wall. The main markers used for cardiac autonomic nerves were tyrosine hydroxylase and acetylcholine transferase. Protein gene product 9.5 was used to label the immunoreactive nerve distribution, and the distribution density of autonomic nerves was determined using a computer-aided morphometric analysis system.CONCLUSION: The uneven distribution of the cardiac autonomic nerves is the leading cause of the occurrence of arrhythmia, and the cardiac autonomic nerves play an important role in the

  2. Niche Genetic Algorithm with Accurate Optimization Performance

    Institute of Scientific and Technical Information of China (English)

    LIU Jian-hua; YAN De-kun


    Based on crowding mechanism, a novel niche genetic algorithm was proposed which can record evolutionary direction dynamically during evolution. After evolution, the solutions's precision can be greatly improved by means of the local searching along the recorded direction. Simulation shows that this algorithm can not only keep population diversity but also find accurate solutions. Although using this method has to take more time compared with the standard GA, it is really worth applying to some cases that have to meet a demand for high solution precision.

  3. Accurate estimation of indoor travel times

    DEFF Research Database (Denmark)

    Prentow, Thor Siiger; Blunck, Henrik; Stisen, Allan


    the InTraTime method for accurately estimating indoor travel times via mining of historical and real-time indoor position traces. The method learns during operation both travel routes, travel times and their respective likelihood---both for routes traveled as well as for sub-routes thereof. In...... are collected within the building complex. Results indicate that InTraTime is superior with respect to metrics such as deployment cost, maintenance cost and estimation accuracy, yielding an average deviation from actual travel times of 11.7 %. This accuracy was achieved despite using a minimal-effort setup...

  4. Accurate diagnosis is essential for amebiasis

    Institute of Scientific and Technical Information of China (English)


    @@ Amebiasis is one of the three most common causes of death from parasitic disease, and Entamoeba histolytica is the most widely distributed parasites in the world. Particularly, Entamoeba histolytica infection in the developing countries is a significant health problem in amebiasis-endemic areas with a significant impact on infant mortality[1]. In recent years a world wide increase in the number of patients with amebiasis has refocused attention on this important infection. On the other hand, improving the quality of parasitological methods and widespread use of accurate tecniques have improved our knowledge about the disease.

  5. The first accurate description of an aurora (United States)

    Schröder, Wilfried


    As technology has advanced, the scientific study of auroral phenomena has increased by leaps and bounds. A look back at the earliest descriptions of aurorae offers an interesting look into how medieval scholars viewed the subjects that we study.Although there are earlier fragmentary references in the literature, the first accurate description of the aurora borealis appears to be that published by the German Catholic scholar Konrad von Megenberg (1309-1374) in his book Das Buch der Natur (The Book of Nature). The book was written between 1349 and 1350.

  6. New law requires 'medically accurate' lesson plans. (United States)


    The California Legislature has passed a bill requiring all textbooks and materials used to teach about AIDS be medically accurate and objective. Statements made within the curriculum must be supported by research conducted in compliance with scientific methods, and published in peer-reviewed journals. Some of the current lesson plans were found to contain scientifically unsupported and biased information. In addition, the bill requires material to be "free of racial, ethnic, or gender biases." The legislation is supported by a wide range of interests, but opposed by the California Right to Life Education Fund, because they believe it discredits abstinence-only material.

  7. Universality: Accurate Checks in Dyson's Hierarchical Model (United States)

    Godina, J. J.; Meurice, Y.; Oktay, M. B.


    In this talk we present high-accuracy calculations of the susceptibility near βc for Dyson's hierarchical model in D = 3. Using linear fitting, we estimate the leading (γ) and subleading (Δ) exponents. Independent estimates are obtained by calculating the first two eigenvalues of the linearized renormalization group transformation. We found γ = 1.29914073 ± 10 -8 and, Δ = 0.4259469 ± 10-7 independently of the choice of local integration measure (Ising or Landau-Ginzburg). After a suitable rescaling, the approximate fixed points for a large class of local measure coincide accurately with a fixed point constructed by Koch and Wittwer.

  8. Compensation for Unconstrained Catheter Shaft Motion in Cardiac Catheters (United States)

    Degirmenci, Alperen; Loschak, Paul M.; Tschabrunn, Cory M.; Anter, Elad; Howe, Robert D.


    Cardiac catheterization with ultrasound (US) imaging catheters provides real time US imaging from within the heart, but manually navigating a four degree of freedom (DOF) imaging catheter is difficult and requires extensive training. Existing work has demonstrated robotic catheter steering in constrained bench top environments. Closed-loop control in an unconstrained setting, such as patient vasculature, remains a significant challenge due to friction, backlash, and physiological disturbances. In this paper we present a new method for closed-loop control of the catheter tip that can accurately and robustly steer 4-DOF cardiac catheters and other flexible manipulators despite these effects. The performance of the system is demonstrated in a vasculature phantom and an in vivo porcine animal model. During bench top studies the robotic system converged to the desired US imager pose with sub-millimeter and sub-degree-level accuracy. During animal trials the system achieved 2.0 mm and 0.65° accuracy. Accurate and robust robotic navigation of flexible manipulators will enable enhanced visualization and treatment during procedures. PMID:27525170

  9. Mechanical modulation of cardiac microtubules. (United States)

    White, Ed


    Microtubules are a major component of the cardiac myocyte cytoskeleton. Interventions that alter it may influence cardiac mechanical and electrical activity by disrupting the trafficking of proteins to and from the surface membrane by molecular motors such as dynein, which use microtubules as tracks to step along. Free tubulin dimers may transfer GTP to the α-subunits of G-proteins, thus an increase in free tubulin could increase the activity of G-proteins; evidence for and against such a role exists. There is more general agreement that microtubules act as compression-resisting structures within myocytes, influencing visco-elasticity of myocytes and increasing resistance to shortening when proliferated and resisting deformation from longitudinal shear stress. In response to pressure overload, there can be post-translational modifications resulting in more stable microtubules and an increase in microtubule density. This is accompanied by contractile dysfunction of myocytes which can be reversed by microtubule disruption. There are reports of mechanically induced changes in electrical activity that are dependent upon microtubules, but at present, a consensus is lacking on whether disruption or proliferation would be beneficial in the prevention of arrhythmias. Microtubules certainly play a role in the response of cardiac myocytes to mechanical stimulation, the exact nature and significance of this role is still to be fully determined.

  10. Review Article of Cardiac Amyloidosis

    Directory of Open Access Journals (Sweden)

    Jittiporn PURATTANAMAL


    Full Text Available Cardiac amyloidosis is a term that means the deposit of abnormal proteins in the myocardium leading to global thickening of the heart walls. The clinical character is that of infiltrative cardiomyopathy. AL amyloidosis is the most common type that involves cardiac failure. Cardiac amyloid precedes clinical congestive heart failure, especially right-sided heart failure. Laboratory investigations have identified the amyloid fibril proteins deposited in the organ tissues. Immunofixation tests are the most sensitive that recognize the paraprotein mean light chain protein or immunoglobulin subtype deposit. Prognosis is poor if AL amyloidosis is untreated. Treatment of systemic involvement in AL amyloidosis is via chemotherapy such as melphalan and prednisolone. UK experts have reported the results of treatment in AL amyloidosis. Regardless of the use of adjunctive chemotherapy, the five-year survival after heart transplantation was generally poorer for AL (20 % at five years, but similar for non-AL amyloidosis (64 % at five years, than heart transplants in other cases. Progression of the systemic disease contributed to increased mortality. A specific treatment that increases the chances of survival is unknown.

  11. Sudden cardiac death risk stratification. (United States)

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J


    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.

  12. Neurologic management following cardiac arrest. (United States)

    Bircher, N G


    Optimal neurologic outcome after cardiac arrest requires careful attention to the details of both intracranial and extracranial homeostasis. A high index of suspicion regarding the potential causes and complications of cardiac arrest facilitates discovery and treatment of problems before they adversely affect neurologic outcome. The future is bright for resuscitation research: Our fundamental understanding of cerebral ischemia and its consequences has dramatically improved, and this knowledge can hopefully be transferred to clinical useful modes of therapy. However, the transition from a promising, therapeutically effective intervention in animals to the demonstration that treatment is effective following cardiac arrest in humans is an important and difficult step. The patient population is heterogeneous before the insult, the duration and severity of the insult are variable, and the effectiveness of cardiopulmonary resuscitation varies among institutions. Therefore, the only means of demonstrating clinical efficacy is the performance of a large clinical trial. The Resuscitation Research Center at the University of Pittsburgh has developed and coordinated a multicenter, multinational team of investigators who have completed one definitive trial of postarrest barbiturate therapy and are currently completing a similar trial using a calcium entry blocker. Despite the formidable obstacles posed by such comprehensive efforts, they provide the mechanism for determining whether the cost of a new treatment modality is justified by the likelihood of improved mortality or morbidity.

  13. Inherited arrhythmias: The cardiac channelopathies

    Directory of Open Access Journals (Sweden)

    Shashank P Behere


    Full Text Available Ion channels in the myocardial cellular membrane are responsible for allowing the cardiac action potential. Genetic abnormalities in these channels can predispose to life-threatening arrhythmias. We discuss the basic science of the cardiac action potential; outline the different clinical entities, including information regarding overlapping diagnoses, touching upon relevant genetics, new innovations in screening, diagnosis, risk stratification, and management. The special considerations of sudden unexplained death and sudden infant death syndrome are discussed. Scientists and clinicians continue to reconcile the rapidly growing body of knowledge regarding the molecular mechanisms and genetics while continuing to improve our understanding of the various clinical entities and their diagnosis and management in clinical setting. Two separate searches were run on the National Center for Biotechnology Information′s website. The first using the term cardiac channelopathies was run on the PubMed database using filters for time (published in past 5 years and age (birth-18 years, yielding 47 results. The second search using the medical subject headings (MeSH database with the search terms "Long QT Syndrome" (MeSH and "Short QT Syndrome" (MeSH and "Brugada Syndrome" (MeSH and "Catecholaminergic Polymorphic Ventricular Tachycardia" (MeSH, applying the same filters yielded 467 results. The abstracts of these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles where further explored and read in full.

  14. Reflective Learning in Practice. (United States)

    Brockbank, Anne, Ed.; McGill, Ian, Ed.; Beech, Nic, Ed.

    This book contains 22 papers on reflective learning in practice. The following papers are included: "Our Purpose" (Ann Brockbank, Ian McGill, Nic Beech); "The Nature and Context of Learning" (Ann Brockbank, Ian McGill, Nic Beech); "Reflective Learning and Organizations" (Ann Brockbank, Ian McGill, Nic Beech);…

  15. Transparencies and Reflections. (United States)

    Hubbard, Guy


    Discusses the use of perspective, or showing things as the human eye sees them, when creating reflections and transparencies in works of art. Provides examples of artwork using transparency, reflection, and refraction by M. C. Escher, Richard Estes, and Janet Fish to give students an opportunity to learn about these three art techniques. (CMK)

  16. Reflective Practitioner Account

    Institute of Scientific and Technical Information of China (English)



    This article focus on the reflective account of an English teacher learning and teaching in higher education with the British post-graduate certificate program of the Yunnan Agdculture University.As n practitioner for smny years in English learning and teaching for many years,it reflects in four fields.

  17. Context indexing of digital cardiac ultrasound records in PACS (United States)

    Lobodzinski, S. Suave; Meszaros, Georg N.


    Recent wide adoption of the DICOM 3.0 standard by ultrasound equipment vendors created a need for practical clinical implementations of cardiac imaging study visualization, management and archiving, DICOM 3.0 defines only a logical and physical format for exchanging image data (still images, video, patient and study demographics). All DICOM compliant imaging studies must presently be archived on a 650 Mb recordable compact disk. This is a severe limitation for ultrasound applications where studies of 3 to 10 minutes long are a common practice. In addition, DICOM digital echocardiography objects require physiological signal indexing, content segmentation and characterization. Since DICOM 3.0 is an interchange standard only, it does not define how to database composite video objects. The goal of this research was therefore to address the issues of efficient storage, retrieval and management of DICOM compliant cardiac video studies in a distributed PACS environment. Our Web based implementation has the advantage of accommodating both DICOM defined entity-relation modules (equipment data, patient data, video format, etc.) in standard relational database tables and digital indexed video with its attributes in an object relational database. Object relational data model facilitates content indexing of full motion cardiac imaging studies through bi-directional hyperlink generation that tie searchable video attributes and related objects to individual video frames in the temporal domain. Benefits realized from use of bi-directionally hyperlinked data models in an object relational database include: (1) real time video indexing during image acquisition, (2) random access and frame accurate instant playback of previously recorded full motion imaging data, and (3) time savings from faster and more accurate access to data through multiple navigation mechanisms such as multidimensional queries on an index, queries on a hyperlink attribute, free search and browsing.

  18. Accurate strand-specific quantification of viral RNA.

    Directory of Open Access Journals (Sweden)

    Nicole E Plaskon

    Full Text Available The presence of full-length complements of viral genomic RNA is a hallmark of RNA virus replication within an infected cell. As such, methods for detecting and measuring specific strands of viral RNA in infected cells and tissues are important in the study of RNA viruses. Strand-specific quantitative real-time PCR (ssqPCR assays are increasingly being used for this purpose, but the accuracy of these assays depends on the assumption that the amount of cDNA measured during the quantitative PCR (qPCR step accurately reflects amounts of a specific viral RNA strand present in the RT reaction. To specifically test this assumption, we developed multiple ssqPCR assays for the positive-strand RNA virus o'nyong-nyong (ONNV that were based upon the most prevalent ssqPCR assay design types in the literature. We then compared various parameters of the ONNV-specific assays. We found that an assay employing standard unmodified virus-specific primers failed to discern the difference between cDNAs generated from virus specific primers and those generated through false priming. Further, we were unable to accurately measure levels of ONNV (- strand RNA with this assay when higher levels of cDNA generated from the (+ strand were present. Taken together, these results suggest that assays of this type do not accurately quantify levels of the anti-genomic strand present during RNA virus infectious cycles. However, an assay permitting the use of a tag-specific primer was able to distinguish cDNAs transcribed from ONNV (- strand RNA from other cDNAs present, thus allowing accurate quantification of the anti-genomic strand. We also report the sensitivities of two different detection strategies and chemistries, SYBR(R Green and DNA hydrolysis probes, used with our tagged ONNV-specific ssqPCR assays. Finally, we describe development, design and validation of ssqPCR assays for chikungunya virus (CHIKV, the recent cause of large outbreaks of disease in the Indian Ocean

  19. Relationship between peak cardiac pumping capability and indices of cardio-respiratory fitness in healthy individuals. (United States)

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


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

  20. How Accurately can we Calculate Thermal Systems?

    Energy Technology Data Exchange (ETDEWEB)

    Cullen, D; Blomquist, R N; Dean, C; Heinrichs, D; Kalugin, M A; Lee, M; Lee, Y; MacFarlan, R; Nagaya, Y; Trkov, A


    I would like to determine how accurately a variety of neutron transport code packages (code and cross section libraries) can calculate simple integral parameters, such as K{sub eff}, for systems that are sensitive to thermal neutron scattering. Since we will only consider theoretical systems, we cannot really determine absolute accuracy compared to any real system. Therefore rather than accuracy, it would be more precise to say that I would like to determine the spread in answers that we obtain from a variety of code packages. This spread should serve as an excellent indicator of how accurately we can really model and calculate such systems today. Hopefully, eventually this will lead to improvements in both our codes and the thermal scattering models that they use in the future. In order to accomplish this I propose a number of extremely simple systems that involve thermal neutron scattering that can be easily modeled and calculated by a variety of neutron transport codes. These are theoretical systems designed to emphasize the effects of thermal scattering, since that is what we are interested in studying. I have attempted to keep these systems very simple, and yet at the same time they include most, if not all, of the important thermal scattering effects encountered in a large, water-moderated, uranium fueled thermal system, i.e., our typical thermal reactors.

  1. Accurate pattern registration for integrated circuit tomography

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Zachary H.; Grantham, Steven; Neogi, Suneeta; Frigo, Sean P.; McNulty, Ian; Retsch, Cornelia C.; Wang, Yuxin; Lucatorto, Thomas B.


    As part of an effort to develop high resolution microtomography for engineered structures, a two-level copper integrated circuit interconnect was imaged using 1.83 keV x rays at 14 angles employing a full-field Fresnel zone plate microscope. A major requirement for high resolution microtomography is the accurate registration of the reference axes in each of the many views needed for a reconstruction. A reconstruction with 100 nm resolution would require registration accuracy of 30 nm or better. This work demonstrates that even images that have strong interference fringes can be used to obtain accurate fiducials through the use of Radon transforms. We show that we are able to locate the coordinates of the rectilinear circuit patterns to 28 nm. The procedure is validated by agreement between an x-ray parallax measurement of 1.41{+-}0.17 {mu}m and a measurement of 1.58{+-}0.08 {mu}m from a scanning electron microscope image of a cross section.

  2. Accurate determination of characteristic relative permeability curves (United States)

    Krause, Michael H.; Benson, Sally M.


    A recently developed technique to accurately characterize sub-core scale heterogeneity is applied to investigate the factors responsible for flowrate-dependent effective relative permeability curves measured on core samples in the laboratory. The dependency of laboratory measured relative permeability on flowrate has long been both supported and challenged by a number of investigators. Studies have shown that this apparent flowrate dependency is a result of both sub-core scale heterogeneity and outlet boundary effects. However this has only been demonstrated numerically for highly simplified models of porous media. In this paper, flowrate dependency of effective relative permeability is demonstrated using two rock cores, a Berea Sandstone and a heterogeneous sandstone from the Otway Basin Pilot Project in Australia. Numerical simulations of steady-state coreflooding experiments are conducted at a number of injection rates using a single set of input characteristic relative permeability curves. Effective relative permeability is then calculated from the simulation data using standard interpretation methods for calculating relative permeability from steady-state tests. Results show that simplified approaches may be used to determine flowrate-independent characteristic relative permeability provided flow rate is sufficiently high, and the core heterogeneity is relatively low. It is also shown that characteristic relative permeability can be determined at any typical flowrate, and even for geologically complex models, when using accurate three-dimensional models.

  3. Accurate pose estimation for forensic identification (United States)

    Merckx, Gert; Hermans, Jeroen; Vandermeulen, Dirk


    In forensic authentication, one aims to identify the perpetrator among a series of suspects or distractors. A fundamental problem in any recognition system that aims for identification of subjects in a natural scene is the lack of constrains on viewing and imaging conditions. In forensic applications, identification proves even more challenging, since most surveillance footage is of abysmal quality. In this context, robust methods for pose estimation are paramount. In this paper we will therefore present a new pose estimation strategy for very low quality footage. Our approach uses 3D-2D registration of a textured 3D face model with the surveillance image to obtain accurate far field pose alignment. Starting from an inaccurate initial estimate, the technique uses novel similarity measures based on the monogenic signal to guide a pose optimization process. We will illustrate the descriptive strength of the introduced similarity measures by using them directly as a recognition metric. Through validation, using both real and synthetic surveillance footage, our pose estimation method is shown to be accurate, and robust to lighting changes and image degradation.

  4. Accurate taxonomic assignment of short pyrosequencing reads. (United States)

    Clemente, José C; Jansson, Jesper; Valiente, Gabriel


    Ambiguities in the taxonomy dependent assignment of pyrosequencing reads are usually resolved by mapping each read to the lowest common ancestor in a reference taxonomy of all those sequences that match the read. This conservative approach has the drawback of mapping a read to a possibly large clade that may also contain many sequences not matching the read. A more accurate taxonomic assignment of short reads can be made by mapping each read to the node in the reference taxonomy that provides the best precision and recall. We show that given a suffix array for the sequences in the reference taxonomy, a short read can be mapped to the node of the reference taxonomy with the best combined value of precision and recall in time linear in the size of the taxonomy subtree rooted at the lowest common ancestor of the matching sequences. An accurate taxonomic assignment of short reads can thus be made with about the same efficiency as when mapping each read to the lowest common ancestor of all matching sequences in a reference taxonomy. We demonstrate the effectiveness of our approach on several metagenomic datasets of marine and gut microbiota.

  5. Inhaled nitric oxide in cardiac surgery: Evidence or tradition? (United States)

    Benedetto, Maria; Romano, Rosalba; Baca, Georgiana; Sarridou, Despoina; Fischer, Andreas; Simon, Andre; Marczin, Nandor


    Inhaled nitric oxide (iNO) therapy as a selective pulmonary vasodilator in cardiac surgery has been one of the most significant pharmacological advances in managing pulmonary hemodynamics and life threatening right ventricular dysfunction and failure. However, this remarkable story has experienced a roller-coaster ride with high hopes and nearly universal demonstration of physiological benefits but disappointing translation of these benefits to harder clinical outcomes. Most of our understanding on the iNO field in cardiac surgery stems from small observational or single centre randomised trials and even the very few multicentre trials fail to ascertain strong evidence base. As a consequence, there are only weak clinical practice guidelines on the field and only European expert opinion for the use of iNO in routine and more specialised cardiac surgery such as heart and lung transplantation and left ventricular assist device (LVAD) insertion. In this review the authors from a specialised cardiac centre in the UK with a very high volume of iNO usage provide detailed information on the early observations leading to the European expert recommendations and reflect on the nature and background of these recommendations. We also provide a summary of the progress in each of the cardiac subspecialties for the last decade and initial survey data on the views of senior anaesthetic and intensive care colleagues on these recommendations. We conclude that the combination of high price tag associated with iNO therapy and lack of substantial clinical evidence is not sustainable on the current field and we are risking loosing this promising therapy from our daily practice. Overcoming the status quo will not be easy as there is not much room for controlled trials in heart transplantation or in the current atmosphere of LVAD implantation. However, we call for international cooperation to conduct definite studies to determine the place of iNO therapy in lung transplantation and high

  6. Reflection and teaching: a taxonomy


    Vos, Henk; Cowan, John


    A major problem in teaching reflection is that educational objectives for reflection in terms of student behaviour are lacking. Therefore a taxonomy of reflection has been developed based on Bloom’s taxonomy. Reflective assignments can then be better focused on any chosen educational objectives. The act of reflection has been analysed and abstracted from goal, content, context, means, and moment of reflecting. Reflection was operationalised as answering reflective questions. Bloom’s taxonomy ...

  7. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob


    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  8. Sensing Cardiac Electrical Activity With a Cardiac Myocyte--Targeted Optogenetic Voltage Indicator

    NARCIS (Netherlands)

    Chang Liao, Mei-Ling; de Boer, Teun P; Mutoh, Hiroki; Raad, Nour; Richter, Claudia; Wagner, Eva; Downie, Bryan R; Unsöld, Bernhard; Arooj, Iqra; Streckfuss-Bömeke, Katrin; Döker, Stephan; Luther, Stefan; Guan, Kaomei; Wagner, Stefan; Lehnart, Stephan E; Maier, Lars S; Stühmer, Walter; Wettwer, Erich; van Veen, Toon; Morlock, Michael M; Knöpfel, Thomas; Zimmermann, Wolfram-Hubertus


    RATIONALE: Monitoring and controlling cardiac myocyte activity with optogenetic tools offer exciting possibilities for fundamental and translational cardiovascular research. Genetically encoded voltage indicators may be particularly attractive for minimal invasive and repeated assessments of cardiac

  9. Review of Teacher's Teaching Reflection

    Institute of Scientific and Technical Information of China (English)



    Teacher's teaching reflection has become the core focus in school.However,there are different understandings of the concept of teacher's teaching reflection.The paper introduces and compares different understandings of the concept of teachers' teaching reflection.Based on the summarizing of the concept on reflection and teaching reflection,this paper tries to provide reference for the teacher's teaching reflection.

  10. Reflectivity in Research Practice

    Directory of Open Access Journals (Sweden)

    Luigina Mortari


    Full Text Available The article grounds on the assumption that researchers, in order to be not mere technicians but competent practitioners of research, should be able to reflect in a deep way. That means they should reflect not only on the practical acts of research but also on the mental experience which constructs the meaning about practice. Reflection is a very important mental activity, both in private and professional life. Learning the practice of reflection is fundamental because it allows people to engage into a thoughtful relationship with the world-life and thus gain an awake stance about one’s lived experience. Reflection is a crucial cognitive practice in the research field. Reflexivity is largely practiced in qualitative research, where it is used to legitimate and validate research procedures. This study introduces different perspectives of analysis by focusing the discourse on the main philosophical approaches to reflection: pragmatistic, critical, hermeneutic, and finally phenomenological. The thesis of this study is that the phenomenological theory makes possible to analyze in depth the reflective activity and just by that to support an adequate process of training of the researcher.

  11. Cognitive impairment after sudden cardiac arrest


    Jaszke-Psonka, Magdalena; Piegza, Magdalena; Ścisło, Piotr; Pudlo, Robert; Piegza, Jacek; Badura-Brzoza, Karina; Leksowska, Aleksandra; Hese, Robert T.; Gorczyca, Piotr W.


    Aim To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders. Material and methods The study group comprised 30 cardiac arrest survivors, the reference group comprised ...

  12. Surgical resection of a giant cardiac fibroma. (United States)

    Stamp, Nikki L; Larbalestier, Robert I


    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively.

  13. Activation of cardiac ryanodine receptors by cardiac glycosides. (United States)

    Sagawa, Toshio; Sagawa, Kazuko; Kelly, James E; Tsushima, Robert G; Wasserstrom, J Andrew


    This study investigated the effects of cardiac glycosides on single-channel activity of the cardiac sarcoplasmic reticulum (SR) Ca2+ release channels or ryanodine receptor (RyR2) channels and how this action might contribute to their inotropic and/or toxic actions. Heavy SR vesicles isolated from canine left ventricle were fused with artificial planar lipid bilayers to measure single RyR2 channel activity. Digoxin and actodigin increased single-channel activity at low concentrations normally associated with therapeutic plasma levels, yielding a 50% of maximal effect of approximately 0.2 nM for each agent. Channel activation by glycosides did not require MgATP and occurred only when digoxin was applied to the cytoplasmic side of the channel. Similar results were obtained in human RyR2 channels; however, neither the crude skeletal nor the purified cardiac channel was activated by glycosides. Channel activation was dependent on [Ca2+] on the luminal side of the bilayer with maximal stimulation occurring between 0.3 and 10 mM. Rat RyR2 channels were activated by digoxin only at 1 microM, consistent with the lower sensitivity to glycosides in rat heart. These results suggest a model in which RyR2 channel activation by digoxin occurs only when luminal [Ca2+] was increased above 300 microM (in the physiological range). Consequently, increasing SR load (by Na+ pump inhibition) serves to amplify SR release by promoting direct RyR2 channel activation via a luminal Ca2+-sensitive mechanism. This high-affinity effect of glycosides could contribute to increased SR Ca2+ release and might play a role in the inotropic and/or toxic actions of glycosides in vivo.

  14. Reflective and refractive objects for mixed reality. (United States)

    Knecht, Martin; Traxler, Christoph; Winklhofer, Christoph; Wimmer, Michael


    In this paper, we present a novel rendering method which integrates reflective or refractive objects into a differential instant radiosity (DIR) framework usable for mixed-reality (MR) applications. This kind of objects are very special from the light interaction point of view, as they reflect and refract incident rays. Therefore they may cause high-frequency lighting effects known as caustics. Using instant-radiosity (IR) methods to approximate these high-frequency lighting effects would require a large amount of virtual point lights (VPLs) and is therefore not desirable due to real-time constraints. Instead, our approach combines differential instant radiosity with three other methods. One method handles more accurate reflections compared to simple cubemaps by using impostors. Another method is able to calculate two refractions in real-time, and the third method uses small quads to create caustic effects. Our proposed method replaces parts in light paths that belong to reflective or refractive objects using these three methods and thus tightly integrates into DIR. In contrast to previous methods which introduce reflective or refractive objects into MR scenarios, our method produces caustics that also emit additional indirect light. The method runs at real-time frame rates, and the results show that reflective and refractive objects with caustics improve the overall impression for MR scenarios.

  15. Ray-Based Reflectance Model for Diffraction

    CERN Document Server

    Cuypers, Tom; Haber, Tom; Bekaert, Philippe; Raskar, Ramesh


    We present a novel method of simulating wave effects in graphics using ray--based renderers with a new function: the Wave BSDF (Bidirectional Scattering Distribution Function). Reflections from neighboring surface patches represented by local BSDFs are mutually independent. However, in many surfaces with wavelength-scale microstructures, interference and diffraction requires a joint analysis of reflected wavefronts from neighboring patches. We demonstrate a simple method to compute the BSDF for the entire microstructure, which can be used independently for each patch. This allows us to use traditional ray--based rendering pipelines to synthesize wave effects of light and sound. We exploit the Wigner Distribution Function (WDF) to create transmissive, reflective, and emissive BSDFs for various diffraction phenomena in a physically accurate way. In contrast to previous methods for computing interference, we circumvent the need to explicitly keep track of the phase of the wave by using BSDFs that include positiv...

  16. Cardiac Arrhythmias: Diagnosis, Symptoms, and Treatments. (United States)

    Fu, Du-Guan


    The cardiac arrhythmia is characterized by irregular rhythm of heartbeat which could be either too slow (100 beats/min) and can happen at any age. The use of pacemaker and defibrillators devices has been suggested for heart arrhythmias patients. The antiarrhythmic medications have been reported for the treatment of cardiac arrhythmias or irregular heartbeats. The diagnosis, symptoms, and treatments of cardiac arrhythmias as well as the radiofrequency ablation, tachycardia, Brugada syndrome, arterial fibrillation, and recent research on the genetics of cardiac arrhythmias have been described here.

  17. Multimodality imaging for resuscitated sudden cardiac death. (United States)

    Chen, Yingming Amy; Deva, Djeven; Kirpalani, Anish; Prabhudesai, Vikram; Marcuzzi, Danny W; Graham, John J; Verma, Subodh; Jimenez-Juan, Laura; Yan, Andrew T


    We present a case that elegantly illustrates the utility of two novel noninvasive imaging techniques, computed tomography (CT) coronary angiography and cardiac MRI, in the diagnosis and management of a 27-year-old man with exertion-induced cardiac arrest caused by an anomalous right coronary artery. CT coronary angiography with 3D reformatting delineated the interarterial course of an anomalous right coronary artery compressed between the aorta and pulmonary artery, whereas cardiac MRI showed a small myocardial infarction in the right coronary artery territory not detected on echocardiography. This case highlights the value of novel multimodality imaging techniques in the risk stratification and management of patients with resuscitated cardiac arrest.

  18. Toward Accurate and Quantitative Comparative Metagenomics (United States)

    Nayfach, Stephen; Pollard, Katherine S.


    Shotgun metagenomics and computational analysis are used to compare the taxonomic and functional profiles of microbial communities. Leveraging this approach to understand roles of microbes in human biology and other environments requires quantitative data summaries whose values are comparable across samples and studies. Comparability is currently hampered by the use of abundance statistics that do not estimate a meaningful parameter of the microbial community and biases introduced by experimental protocols and data-cleaning approaches. Addressing these challenges, along with improving study design, data access, metadata standardization, and analysis tools, will enable accurate comparative metagenomics. We envision a future in which microbiome studies are replicable and new metagenomes are easily and rapidly integrated with existing data. Only then can the potential of metagenomics for predictive ecological modeling, well-powered association studies, and effective microbiome medicine be fully realized. PMID:27565341

  19. Apparatus for accurately measuring high temperatures (United States)

    Smith, D.D.

    The present invention is a thermometer used for measuring furnace temperatures in the range of about 1800/sup 0/ to 2700/sup 0/C. The thermometer comprises a broadband multicolor thermal radiation sensor positioned to be in optical alignment with the end of a blackbody sight tube extending into the furnace. A valve-shutter arrangement is positioned between the radiation sensor and the sight tube and a chamber for containing a charge of high pressure gas is positioned between the valve-shutter arrangement and the radiation sensor. A momentary opening of the valve shutter arrangement allows a pulse of the high gas to purge the sight tube of air-borne thermal radiation contaminants which permits the radiation sensor to accurately measure the thermal radiation emanating from the end of the sight tube.

  20. Accurate renormalization group analyses in neutrino sector

    Energy Technology Data Exchange (ETDEWEB)

    Haba, Naoyuki [Graduate School of Science and Engineering, Shimane University, Matsue 690-8504 (Japan); Kaneta, Kunio [Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8568 (Japan); Takahashi, Ryo [Graduate School of Science and Engineering, Shimane University, Matsue 690-8504 (Japan); Yamaguchi, Yuya [Department of Physics, Faculty of Science, Hokkaido University, Sapporo 060-0810 (Japan)


    We investigate accurate renormalization group analyses in neutrino sector between ν-oscillation and seesaw energy scales. We consider decoupling effects of top quark and Higgs boson on the renormalization group equations of light neutrino mass matrix. Since the decoupling effects are given in the standard model scale and independent of high energy physics, our method can basically apply to any models beyond the standard model. We find that the decoupling effects of Higgs boson are negligible, while those of top quark are not. Particularly, the decoupling effects of top quark affect neutrino mass eigenvalues, which are important for analyzing predictions such as mass squared differences and neutrinoless double beta decay in an underlying theory existing at high energy scale.

  1. Accurate Weather Forecasting for Radio Astronomy (United States)

    Maddalena, Ronald J.


    The NRAO Green Bank Telescope routinely observes at wavelengths from 3 mm to 1 m. As with all mm-wave telescopes, observing conditions depend upon the variable atmospheric water content. The site provides over 100 days/yr when opacities are low enough for good observing at 3 mm, but winds on the open-air structure reduce the time suitable for 3-mm observing where pointing is critical. Thus, to maximum productivity the observing wavelength needs to match weather conditions. For 6 years the telescope has used a dynamic scheduling system (recently upgraded; that requires accurate multi-day forecasts for winds and opacities. Since opacity forecasts are not provided by the National Weather Services (NWS), I have developed an automated system that takes available forecasts, derives forecasted opacities, and deploys the results on the web in user-friendly graphical overviews ( rmaddale/Weather). The system relies on the "North American Mesoscale" models, which are updated by the NWS every 6 hrs, have a 12 km horizontal resolution, 1 hr temporal resolution, run to 84 hrs, and have 60 vertical layers that extend to 20 km. Each forecast consists of a time series of ground conditions, cloud coverage, etc, and, most importantly, temperature, pressure, humidity as a function of height. I use the Liebe's MWP model (Radio Science, 20, 1069, 1985) to determine the absorption in each layer for each hour for 30 observing wavelengths. Radiative transfer provides, for each hour and wavelength, the total opacity and the radio brightness of the atmosphere, which contributes substantially at some wavelengths to Tsys and the observational noise. Comparisons of measured and forecasted Tsys at 22.2 and 44 GHz imply that the forecasted opacities are good to about 0.01 Nepers, which is sufficient for forecasting and accurate calibration. Reliability is high out to 2 days and degrades slowly for longer-range forecasts.

  2. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

    Directory of Open Access Journals (Sweden)

    Malik Madhur


    Full Text Available Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery were prospectively collected as per the EuroSCORE model. The model′s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73 and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6% was double that of predicted mortality (7.5%. The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

  3. Tumors of the cardiac conduction system: are they an explanation for otherwise unexplained sudden cardiac death?

    Institute of Scientific and Technical Information of China (English)


    @@ Cardiac tumors are well described in the literature. The first reports of cardiac tumors date back hundreds of years.The prevalence of primary cardiac tumors at autopsy ranges from 0.001% to 0.3% with secondary tumors more common than in primary tumors.


    Directory of Open Access Journals (Sweden)



    Full Text Available Cardiovascular malformations are the most common cause of congenital malformations, the diagnosis of which requires a close observation in the neonatal period. Early recognition of CHD is important in the neonatal period, as many of them may be fatal if undiagnosed and may require immediate intervention. The objectives of this study are to study the epidemiology of neonatal cardiac murmurs, to identify clinical characteristics which differentiate pathological murmur from functional murmurs and to assess the reliability of clinical evaluation in diagnosing CHD. Method of study included all neonates admitted to the NICU, postnatal ward, attending pediatric OPD or neonatal follow up clinic and were detected to have cardiac murmurs. It was a cross sectional study over a period of 16months. A clinical diagnosis was made based on history and clinical examination. Then Chest X-ray and ECG, Echocardiography was done in all neonates for confirmation of the diagnosis. These neonates were again examined daily till they were in hospital and during the follow-up visit at 6 weeks. The results of 70 neonates in this study conducted over a period of 24 months included the incidence of cardiac murmurs among intramural neonates which was 13.5 for 1000 live births. Most frequent symptom was fast breathing in 10(14.3% cases. VSD was the most common diagnosis clinically in 23 (33% babies. The most frequent Echo diagnosis was acyanotic complex congenital heart disease in 25(36% cases followed by 12(17% cases each of VSD and ASD respectively. Overall in our study 77.1% (54cases of the murmurs were diagnosed correctly and confirmed by Echocardiography The study concluded that it is possible to make clinical diagnosis in many cases of congenital heart diseases, the functional murmurs could be differentiated from those arising from structural heart disease and evaluation of the infants based only on murmurs, few congenital heart diseases can be missed.

  5. ECLS in Pediatric Cardiac Patients (United States)

    Di Nardo, Matteo; MacLaren, Graeme; Marano, Marco; Cecchetti, Corrado; Bernaschi, Paola; Amodeo, Antonio


    Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the “state of art” of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS “urgently” rather than “emergently,” before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients. PMID

  6. Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview

    Directory of Open Access Journals (Sweden)

    Zima Endre


    Full Text Available A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD, however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.

  7. Thoughts on Reflection (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis


    Full Text Available There has been some acknowledgement in the published literature that reflection is a crucial element of the evidence based library and information practice (EBLIP model we have adopted (Booth 2004, 2006; Grant 2007; Helliwell 2007. As we work through a problem and try to incorporate the best available evidence into our decision making, reflection is required at several stages, including the very identification of the problem through to our assessment of the process itself and what we have learned in order to inform future practice. However, reflection and reflective writing have not fully been integrated into the process we espouse, and very little has been done to look more closely at this element of the model and how it can be integrated into professional learning.In a recently published research article, Sen (2010 confirms the relationship between reflection and several aspects of professional practice. These include critical review and decision making, two aspects that are tied closely to the evidence based process. Sen notes: Students were more likely to show evidence of learning, self‐development, the ability to review issues crucially, awareness of their own mental functions, ability to make decision [sic] and being empowered when they had mastered the art of reflective practice and the more deeply analytical reflective writing. (p.84 EBLIP (the journal tries to incorporate elements of reflection within the articles we publish. While we clearly believe in the need for our profession to do quality research and publish that research so that it can be accessible to practitioners, we also know that research cannot be looked at in isolation. Our evidence summaries are one way of reflecting critically on previously published research, and in the same vein, our classics bring older research studies back to the foreground. This work needs to continue to be discussed and looked at for its impact on our profession.More directly, the Using

  8. [Morgagni hernia causing cardiac tamponade]. (United States)

    S Breinig; Paranon, S; Le Mandat, A; Galinier, P; Dulac, Y; Acar, P


    Morgagni hernia is a rare malformation (3% of diaphragmatic hernias). This hernia is usually asymptomatic in children. We report on a case revealed by an unusual complication. Severe cyanosis was due to right-to-left atrial shunt through the foramen ovale assessed by 2D echocardiography. Diagnosis of the Morgagni hernia was made with CT scan. The intrathoracic liver compressed the right chambers of the heart causing tamponade. Cardiac compression was reversed after surgery and replacement of the liver in the abdomen. Six months after the surgery, the infant was symptom-free with normal size right chambers of the heart.

  9. Cardiac imaging: does radiation matter? (United States)

    Einstein, Andrew J.; Knuuti, Juhani


    The use of ionizing radiation in cardiovascular imaging has generated considerable discussion. Radiation should not be considered in isolation, but rather in the context of a careful examination of the benefits, risks, and costs of cardiovascular imaging. Such consideration requires an understanding of some fundamental aspects of the biology, physics, epidemiology, and terminology germane to radiation, as well as principles of radiological protection. This paper offers a concise, contemporary perspective on these areas by addressing pertinent questions relating to radiation and its application to cardiac imaging. PMID:21828062

  10. 10.2.Cardiac arrhythmias

    Institute of Scientific and Technical Information of China (English)


    930257 Electrophysiologic study of reperfu-sion arrhythmias.YIN Hong (尹红),et al.Af-fil Hosp,Shandong Med Univ,Jinan.Chin CirJ 1993;8(1):37—39.Twenty dogs of experimental ischemic reper-fusion were studied with a three-dimensionalmapping system of cardiac electric activity andmultiple—level myocardial recordings by bipolarplunge—needle electrodes.27% of the nonsus-tained ventricular tachycardia (NSVT) of intra-mural reentry occurred in the ischemic subendo-

  11. Cerebral oximetry in cardiac anesthesia (United States)

    Vretzakis, George; Georgopoulou, Stauroula; Stamoulis, Konstantinos; Stamatiou, Georgia; Tsakiridis, Kosmas; Katsikogianis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Mpakas, Andreas; Beleveslis, Thomas; Koletas, Alexander; Siminelakis, Stavros N.; Zarogoulidis, Konstantinos


    Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. Current literature indicates that it can stratify patients preoperatively according their risk. Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients. PMID:24672700

  12. A cardiac hemangioma treated by a right minithoracotomy approach with thoracoscopic assistance. (United States)

    Sakai, Katsuaki; Tanigawa, Kazuyoshi; Odate, Tomohiro; Miura, Takashi; Tsuneto, Akira; Abe, Kuniko; Hashizume, Koji; Eishi, Kiyoyuki


    Cardiac hemangiomas are extremely rare tumors, accounting for only 2.5% of all cardiac tumors. Most of these develop in the ventricles, and obtaining a good field of view is, therefore, the key to successful operation. A 40-year-old female visited a local hospital due to palpitation. Transthoracic echocardiography revealed a spherical high-echo mass (13.5 × 10.7 mm in diameter) between the papillary muscles. She was referred to our hospital to undergo close examination. Cardiac contrast-enhanced magnetic resonance imaging was performed to differentiate between malignant and benign lesions. However, this did not provide any findings leading to a definite diagnosis. To make a diagnosis and prevent embolism, the mass was excised using a right minithoracotomy approach with thoracoscopic assistance. The post-operative pathological diagnosis was a cardiac capillary-cavernous hemangioma. A right minithoracotomy approach combined with thoracoscopy allowed accurate evaluation of the mass in the left ventricle beyond the mitral valve and its accurate excision.

  13. Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age

    DEFF Research Database (Denmark)

    Weeke, Peter; Folke, Fredrik; Gislason, Gunnar H;


    were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. RESULTS......BACKGROUND: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. METHODS: OHCA patients......: We identified 16,924 OHCA patients, median age 70.0 years (Q1-Q3: 59-80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference 89) were...

  14. Optimisation of a Generic Ionic Model of Cardiac Myocyte Electrical Activity

    Directory of Open Access Journals (Sweden)

    Tianruo Guo


    Full Text Available A generic cardiomyocyte ionic model, whose complexity lies between a simple phenomenological formulation and a biophysically detailed ionic membrane current description, is presented. The model provides a user-defined number of ionic currents, employing two-gate Hodgkin-Huxley type kinetics. Its generic nature allows accurate reconstruction of action potential waveforms recorded experimentally from a range of cardiac myocytes. Using a multiobjective optimisation approach, the generic ionic model was optimised to accurately reproduce multiple action potential waveforms recorded from central and peripheral sinoatrial nodes and right atrial and left atrial myocytes from rabbit cardiac tissue preparations, under different electrical stimulus protocols and pharmacological conditions. When fitted simultaneously to multiple datasets, the time course of several physiologically realistic ionic currents could be reconstructed. Model behaviours tend to be well identified when extra experimental information is incorporated into the optimisation.

  15. Crib death: further support for the concept of fatal cardiac electrical instability as the final common pathway. (United States)

    Ottaviani, Giulia; Matturri, Luigi; Rossi, Lino; James, Thomas N


    This work intends to be a review of the current status of knowledge on the cardiac conduction system in the crib death as well as remaining challenges, including reflections upon authors' personal works as well as many studies by others. The cardiac conduction system findings of resorptive degeneration, His bundle dispersion, Mahaim fibers, cartilaginous meta-hyperplasia, persistent fetal dispersion, left sided His bundle, hemorrhage of the atrio-ventricular junction, septation of the bifurcation, atrio-ventricular node dispersion, sinus node hypoplasia, Zahn node, His bundle hypoplasia, atrio-ventricular node and His bundle dualism are hereby discussed by the authors. The cardiac hypotheses postulating that crib death could be due to lethal cardiac arrhythmias or heart block were considered of great interest in the 1970s. After a general abandon of the conduction studies in crib death, the cardiac concept of crib death is gathering a renewed interest, as well as the occurrence of infantile junctional tachycardia. Both the morphological and functional derangement underlying crib death remain poorly understood, assuring that it remains to be a major medical and social problem. Despite the non-specificity of most of the cardiac conduction findings in crib death, we believe that they, in association with altered neurovegetative stimuli, could underlie potentially malignant arrhythmias, providing a morphologic support for the cardiac concept of crib death.

  16. Image registration and analysis for quantitative myocardial perfusion: application to dynamic circular cardiac CT (United States)

    Isola, A. A.; Schmitt, H.; van Stevendaal, U.; Begemann, P. G.; Coulon, P.; Boussel, L.; Grass, M.


    Large area detector computed tomography systems with fast rotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively, ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce x-ray dose and limit motion artefacts. Even in the case of highly accurate prospective triggering and stable heart rate, spatial misalignment of the cardiac volumes acquired and reconstructed per cardiac cycle may occur due to small motion pattern variations from cycle to cycle. These misalignments reduce the accuracy of the quantitative analysis of myocardial perfusion parameters on a per voxel basis. An image-based solution to this problem is elastic 3D image registration of dynamic volume sequences with variable contrast, as it is introduced in this contribution. After circular cone-beam CT reconstruction of cardiac volumes covering large areas of the myocardial tissue, the complete series is aligned with respect to a chosen reference volume. The results of the registration process and the perfusion analysis with and without registration are evaluated quantitatively in this paper. The spatial alignment leads to improved quantification of myocardial perfusion for three different pig data sets.

  17. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Mancuso, Frederico José Neves, E-mail: [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Gois, Aécio Flavio Teixeira [Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)


    Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

  18. A visible light imaging device for cardiac rate detection with reduced effect of body movement (United States)

    Jiang, Xiaotian; Liu, Ming; Zhao, Yuejin


    A visible light imaging system to detect human cardiac rate is proposed in this paper. A color camera and several LEDs, acting as lighting source, were used to avoid the interference of ambient light. From people's forehead, the cardiac rate could be acquired based on photoplethysmography (PPG) theory. The template matching method was used after the capture of video. The video signal was discomposed into three signal channels (RGB) and the region of interest was chosen to take the average gray value. The green channel signal could provide an excellent waveform of pulse wave on the account of green lights' absorptive characteristics of blood. Through the fast Fourier transform, the cardiac rate was exactly achieved. But the research goal was not just to achieve the cardiac rate accurately. With the template matching method, the effects of body movement are reduced to a large extent, therefore the pulse wave can be detected even while people are in the moving state and the waveform is largely optimized. Several experiments are conducted on volunteers, and the results are compared with the ones gained by a finger clamped pulse oximeter. The contrast results between these two ways are exactly agreeable. This method to detect the cardiac rate and the pulse wave largely reduces the effects of body movement and can probably be widely used in the future.

  19. Image registration and analysis for quantitative myocardial perfusion: application to dynamic circular cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Isola, A A [Philips Research Laboratories, X-ray Imaging Systems Department, Weisshausstrasse 2, D-52066 Aachen (Germany); Schmitt, H; Van Stevendaal, U; Grass, M [Philips Research Laboratories, Sector Digital Imaging, Roentgenstrasse 24-26, D-22335 Hamburg (Germany); Begemann, P G [Department of Radiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg (Germany); Coulon, P [Philips Healthcare France, 33 rue de Verdun, F-92150 Suresnes Cedex (France); Boussel, L, E-mail: [Department of Radiology, Louis Pradel Hospital, CREATIS, UMR CNRS 5515, INSERM U630, Lyon (France)


    Large area detector computed tomography systems with fast rotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively, ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce x-ray dose and limit motion artefacts. Even in the case of highly accurate prospective triggering and stable heart rate, spatial misalignment of the cardiac volumes acquired and reconstructed per cardiac cycle may occur due to small motion pattern variations from cycle to cycle. These misalignments reduce the accuracy of the quantitative analysis of myocardial perfusion parameters on a per voxel basis. An image-based solution to this problem is elastic 3D image registration of dynamic volume sequences with variable contrast, as it is introduced in this contribution. After circular cone-beam CT reconstruction of cardiac volumes covering large areas of the myocardial tissue, the complete series is aligned with respect to a chosen reference volume. The results of the registration process and the perfusion analysis with and without registration are evaluated quantitatively in this paper. The spatial alignment leads to improved quantification of myocardial perfusion for three different pig data sets.

  20. Image-based motion estimation for cardiac CT via image registration (United States)

    Cammin, J.; Taguchi, K.


    Images reconstructed from tomographic projection data are subject to motion artifacts from organs that move during the duration of the scan. The effect can be reduced by taking the motion into account in the reconstruction algorithm if an estimate of the deformation exists. This paper presents the estimation of the three-dimensional cardiac motion by registering reconstructed images from cardiac quiet phases as a first step towards motion-compensated cardiac image reconstruction. The non-rigid deformations of the heart are parametrized on a coarse grid on the image volume and are interpolated with cubic b-splines. The optimization problem of finding b-spline coefficients that best describe the observed deformations is ill-posed due to the large number of parameters and the resulting motion vector field is sensitive to the choice of initial parameters. Particularly challenging is the task to capture the twisting motion of the heart. The motion vector field from a dynamic computer phantom of the human heart is used to initialize the transformation parameters for the optimization process with realistic starting values. The results are evaluated by comparing the registered images and the obtained motion vector field to the case when the registration is performed without using prior knowledge about the expected cardiac motion. We find that the registered images are similar for both approaches, but the motion vector field obtained from motion estimation initialized with the phantom describes the cardiac contraction and twisting motion more accurately.

  1. Assessment of cardiac sympathetic nerve integrity with positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Raffel, David M. E-mail:; Wieland, Donald M


    The autonomic nervous system plays a critical role in the regulation of cardiac function. Abnormalities of cardiac innervation have been implicated in the pathophysiology of many heart diseases, including sudden cardiac death and congestive heart failure. In an effort to provide clinicians with the ability to regionally map cardiac innervation, several radiotracers for imaging cardiac sympathetic neurons have been developed. This paper reviews the development of neuronal imaging agents and discusses their emerging role in the noninvasive assessment of cardiac sympathetic innervation.

  2. Robust and accurate transient light transport decomposition via convolutional sparse coding. (United States)

    Hu, Xuemei; Deng, Yue; Lin, Xing; Suo, Jinli; Dai, Qionghai; Barsi, Christopher; Raskar, Ramesh


    Ultrafast sources and detectors have been used to record the time-resolved scattering of light propagating through macroscopic scenes. In the context of computational imaging, decomposition of this transient light transport (TLT) is useful for applications, such as characterizing materials, imaging through diffuser layers, and relighting scenes dynamically. Here, we demonstrate a method of convolutional sparse coding to decompose TLT into direct reflections, inter-reflections, and subsurface scattering. The method relies on the sparsity composition of the time-resolved kernel. We show that it is robust and accurate to noise during the acquisition process.

  3. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT (United States)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.


    blood flow estimation. In conclusion, quantitative model-based dynamic cardiac CT perfusion assessment is capable of accurately estimating MBF across a range of cardiac outputs and tissue perfusion states, outperforms comparable static perfusion estimates, and is relatively robust to noise and temporal subsampling.

  4. Creation, Identity and Reflection

    Directory of Open Access Journals (Sweden)

    Alina Beatrice Cheşcă


    Full Text Available The paper “Creation, Identity and Reflection” approaches the identification in the “mirror” of reality with creation, in other words seeking the authors’ identity in the reflected images. Reflection means attempting to find oneself, the mirror being the main principle of creation. Many characters become interesting only when they step into the world beyond the mirror, when their faces are doubled by the other self or when their selves are returned by other characters. The narcissistic concept of the mirror, i.e. the reflection in the mirror and the representation of the mirror itself, is a recurrent one in literature, but the reflection of the self which is not the self (as it is a reflection does not necessarily appear in a mirror or in a photograph or portrait. Sometimes, the not-self is returned to the self by another person or character. As far as Oscar Wilde’s theories are concerned, the main idea is that people are interesting for their masks, not for their inner nature. What Wilde calls “inner nature” is the characters’ un-reflected self and the mask is the reflection, the self in the mirror. Some characters’ relationships develop within a fiction that they dramatically try to preserve and protect with the risk of suffering. They refuse to take off the masks which define them in the others’ minds and hearts; the narcissistic individuals (both artists and characters seek and love their own image which they project upon facts, thus creating a fictive realm.

  5. Fast and accurate exhaled breath ammonia measurement. (United States)

    Solga, Steven F; Mudalel, Matthew L; Spacek, Lisa A; Risby, Terence H


    This exhaled breath ammonia method uses a fast and highly sensitive spectroscopic method known as quartz enhanced photoacoustic spectroscopy (QEPAS) that uses a quantum cascade based laser. The monitor is coupled to a sampler that measures mouth pressure and carbon dioxide. The system is temperature controlled and specifically designed to address the reactivity of this compound. The sampler provides immediate feedback to the subject and the technician on the quality of the breath effort. Together with the quick response time of the monitor, this system is capable of accurately measuring exhaled breath ammonia representative of deep lung systemic levels. Because the system is easy to use and produces real time results, it has enabled experiments to identify factors that influence measurements. For example, mouth rinse and oral pH reproducibly and significantly affect results and therefore must be controlled. Temperature and mode of breathing are other examples. As our understanding of these factors evolves, error is reduced, and clinical studies become more meaningful. This system is very reliable and individual measurements are inexpensive. The sampler is relatively inexpensive and quite portable, but the monitor is neither. This limits options for some clinical studies and provides rational for future innovations.

  6. Noninvasive hemoglobin monitoring: how accurate is enough? (United States)

    Rice, Mark J; Gravenstein, Nikolaus; Morey, Timothy E


    Evaluating the accuracy of medical devices has traditionally been a blend of statistical analyses, at times without contextualizing the clinical application. There have been a number of recent publications on the accuracy of a continuous noninvasive hemoglobin measurement device, the Masimo Radical-7 Pulse Co-oximeter, focusing on the traditional statistical metrics of bias and precision. In this review, which contains material presented at the Innovations and Applications of Monitoring Perfusion, Oxygenation, and Ventilation (IAMPOV) Symposium at Yale University in 2012, we critically investigated these metrics as applied to the new technology, exploring what is required of a noninvasive hemoglobin monitor and whether the conventional statistics adequately answer our questions about clinical accuracy. We discuss the glucose error grid, well known in the glucose monitoring literature, and describe an analogous version for hemoglobin monitoring. This hemoglobin error grid can be used to evaluate the required clinical accuracy (±g/dL) of a hemoglobin measurement device to provide more conclusive evidence on whether to transfuse an individual patient. The important decision to transfuse a patient usually requires both an accurate hemoglobin measurement and a physiologic reason to elect transfusion. It is our opinion that the published accuracy data of the Masimo Radical-7 is not good enough to make the transfusion decision.

  7. Accurate free energy calculation along optimized paths. (United States)

    Chen, Changjun; Xiao, Yi


    The path-based methods of free energy calculation, such as thermodynamic integration and free energy perturbation, are simple in theory, but difficult in practice because in most cases smooth paths do not exist, especially for large molecules. In this article, we present a novel method to build the transition path of a peptide. We use harmonic potentials to restrain its nonhydrogen atom dihedrals in the initial state and set the equilibrium angles of the potentials as those in the final state. Through a series of steps of geometrical optimization, we can construct a smooth and short path from the initial state to the final state. This path can be used to calculate free energy difference. To validate this method, we apply it to a small 10-ALA peptide and find that the calculated free energy changes in helix-helix and helix-hairpin transitions are both self-convergent and cross-convergent. We also calculate the free energy differences between different stable states of beta-hairpin trpzip2, and the results show that this method is more efficient than the conventional molecular dynamics method in accurate free energy calculation.

  8. Accurate fission data for nuclear safety

    CERN Document Server

    Solders, A; Jokinen, A; Kolhinen, V S; Lantz, M; Mattera, A; Penttila, H; Pomp, S; Rakopoulos, V; Rinta-Antila, S


    The Accurate fission data for nuclear safety (AlFONS) project aims at high precision measurements of fission yields, using the renewed IGISOL mass separator facility in combination with a new high current light ion cyclotron at the University of Jyvaskyla. The 30 MeV proton beam will be used to create fast and thermal neutron spectra for the study of neutron induced fission yields. Thanks to a series of mass separating elements, culminating with the JYFLTRAP Penning trap, it is possible to achieve a mass resolving power in the order of a few hundred thousands. In this paper we present the experimental setup and the design of a neutron converter target for IGISOL. The goal is to have a flexible design. For studies of exotic nuclei far from stability a high neutron flux (10^12 neutrons/s) at energies 1 - 30 MeV is desired while for reactor applications neutron spectra that resembles those of thermal and fast nuclear reactors are preferred. It is also desirable to be able to produce (semi-)monoenergetic neutrons...

  9. Towards Accurate Modeling of Moving Contact Lines

    CERN Document Server

    Holmgren, Hanna


    A main challenge in numerical simulations of moving contact line problems is that the adherence, or no-slip boundary condition leads to a non-integrable stress singularity at the contact line. In this report we perform the first steps in developing the macroscopic part of an accurate multiscale model for a moving contact line problem in two space dimensions. We assume that a micro model has been used to determine a relation between the contact angle and the contact line velocity. An intermediate region is introduced where an analytical expression for the velocity exists. This expression is used to implement boundary conditions for the moving contact line at a macroscopic scale, along a fictitious boundary located a small distance away from the physical boundary. Model problems where the shape of the interface is constant thought the simulation are introduced. For these problems, experiments show that the errors in the resulting contact line velocities converge with the grid size $h$ at a rate of convergence $...

  10. Does a pneumotach accurately characterize voice function? (United States)

    Walters, Gage; Krane, Michael


    A study is presented which addresses how a pneumotach might adversely affect clinical measurements of voice function. A pneumotach is a device, typically a mask, worn over the mouth, in order to measure time-varying glottal volume flow. By measuring the time-varying difference in pressure across a known aerodynamic resistance element in the mask, the glottal volume flow waveform is estimated. Because it adds aerodynamic resistance to the vocal system, there is some concern that using a pneumotach may not accurately portray the behavior of the voice. To test this hypothesis, experiments were performed in a simplified airway model with the principal dimensions of an adult human upper airway. A compliant constriction, fabricated from silicone rubber, modeled the vocal folds. Variations of transglottal pressure, time-averaged volume flow, model vocal fold vibration amplitude, and radiated sound with subglottal pressure were performed, with and without the pneumotach in place, and differences noted. Acknowledge support of NIH Grant 2R01DC005642-10A1.

  11. Accurate lineshape spectroscopy and the Boltzmann constant. (United States)

    Truong, G-W; Anstie, J D; May, E F; Stace, T M; Luiten, A N


    Spectroscopy has an illustrious history delivering serendipitous discoveries and providing a stringent testbed for new physical predictions, including applications from trace materials detection, to understanding the atmospheres of stars and planets, and even constraining cosmological models. Reaching fundamental-noise limits permits optimal extraction of spectroscopic information from an absorption measurement. Here, we demonstrate a quantum-limited spectrometer that delivers high-precision measurements of the absorption lineshape. These measurements yield a very accurate measurement of the excited-state (6P1/2) hyperfine splitting in Cs, and reveals a breakdown in the well-known Voigt spectral profile. We develop a theoretical model that accounts for this breakdown, explaining the observations to within the shot-noise limit. Our model enables us to infer the thermal velocity dispersion of the Cs vapour with an uncertainty of 35 p.p.m. within an hour. This allows us to determine a value for Boltzmann's constant with a precision of 6 p.p.m., and an uncertainty of 71 p.p.m.

  12. Accurate upper body rehabilitation system using kinect. (United States)

    Sinha, Sanjana; Bhowmick, Brojeshwar; Chakravarty, Kingshuk; Sinha, Aniruddha; Das, Abhijit


    The growing importance of Kinect as a tool for clinical assessment and rehabilitation is due to its portability, low cost and markerless system for human motion capture. However, the accuracy of Kinect in measuring three-dimensional body joint center locations often fails to meet clinical standards of accuracy when compared to marker-based motion capture systems such as Vicon. The length of the body segment connecting any two joints, measured as the distance between three-dimensional Kinect skeleton joint coordinates, has been observed to vary with time. The orientation of the line connecting adjoining Kinect skeletal coordinates has also been seen to differ from the actual orientation of the physical body segment. Hence we have proposed an optimization method that utilizes Kinect Depth and RGB information to search for the joint center location that satisfies constraints on body segment length and as well as orientation. An experimental study have been carried out on ten healthy participants performing upper body range of motion exercises. The results report 72% reduction in body segment length variance and 2° improvement in Range of Motion (ROM) angle hence enabling to more accurate measurements for upper limb exercises.

  13. Accurate thermoplasmonic simulation of metallic nanoparticles (United States)

    Yu, Da-Miao; Liu, Yan-Nan; Tian, Fa-Lin; Pan, Xiao-Min; Sheng, Xin-Qing


    Thermoplasmonics leads to enhanced heat generation due to the localized surface plasmon resonances. The measurement of heat generation is fundamentally a complicated task, which necessitates the development of theoretical simulation techniques. In this paper, an efficient and accurate numerical scheme is proposed for applications with complex metallic nanostructures. Light absorption and temperature increase are, respectively, obtained by solving the volume integral equation (VIE) and the steady-state heat diffusion equation through the method of moments (MoM). Previously, methods based on surface integral equations (SIEs) were utilized to obtain light absorption. However, computing light absorption from the equivalent current is as expensive as O(NsNv), where Ns and Nv, respectively, denote the number of surface and volumetric unknowns. Our approach reduces the cost to O(Nv) by using VIE. The accuracy, efficiency and capability of the proposed scheme are validated by multiple simulations. The simulations show that our proposed method is more efficient than the approach based on SIEs under comparable accuracy, especially for the case where many incidents are of interest. The simulations also indicate that the temperature profile can be tuned by several factors, such as the geometry configuration of array, beam direction, and light wavelength.

  14. Fast and Provably Accurate Bilateral Filtering. (United States)

    Chaudhury, Kunal N; Dabhade, Swapnil D


    The bilateral filter is a non-linear filter that uses a range filter along with a spatial filter to perform edge-preserving smoothing of images. A direct computation of the bilateral filter requires O(S) operations per pixel, where S is the size of the support of the spatial filter. In this paper, we present a fast and provably accurate algorithm for approximating the bilateral filter when the range kernel is Gaussian. In particular, for box and Gaussian spatial filters, the proposed algorithm can cut down the complexity to O(1) per pixel for any arbitrary S . The algorithm has a simple implementation involving N+1 spatial filterings, where N is the approximation order. We give a detailed analysis of the filtering accuracy that can be achieved by the proposed approximation in relation to the target bilateral filter. This allows us to estimate the order N required to obtain a given accuracy. We also present comprehensive numerical results to demonstrate that the proposed algorithm is competitive with the state-of-the-art methods in terms of speed and accuracy.

  15. Analytical and assay issues for use of cardiac troponin testing for risk stratification in primary care. (United States)

    Wu, Alan H B; Christenson, Robert H


    Cardiac troponin is the standard marker for diagnosis of acute myocardial infarction and risk stratification of patients who present to an emergency department with signs and symptoms of acute cardiac ischemia. Over the past few years, the analytical sensitivity of assays for cardiac troponin has improved significantly to the point where a detectable amount of troponin can be measured in essentially all healthy subjects. Recent studies have shown that use of a highly sensitive troponin assays may provide value to traditional markers of primary disease risk for patients, i.e., for those who have no history of heart disease. There are barriers to the adoption of cardiac troponin for screening high risk cohorts such as the elderly, diabetics and perhaps even the asymptomatic population. Strategies used for the assignment of cutoff concentrations in acute care, i.e., the 99 th percentile, may not be appropriate for primary care as changes over baseline levels may provide more accurate information of risk than cross-sectional results. A review of biological variation has shown that cardiac troponin as a biomarker has low index of individuality, indicating that reference values are of little utility. Whether or not cardiac troponin can be released in reversible injury is a debate that could have significance for detecting minor myocardial injury. A major hurdle for use of troponin in primary care is the lack of assay standardization and nomenclature for the different generations of troponin assays. Standardization requires knowledge of what is released after cardiac injury and what the various cardiac troponin assays are measuring. Currently it is not clear if the cardiac troponin release after ischemic injury is identical to that in circulation of healthy individuals. This may affect the design of future assays and standardization approaches. There is potential that a marker of myocardial injury such as troponin can add to the value of existing indicators and biomarkers

  16. Cardiac cell proliferation assessed by EdU, a novel analysis of cardiac regeneration. (United States)

    Zeng, Bin; Tong, Suiyang; Ren, Xiaofeng; Xia, Hao


    Emerging evidence suggests that mammalian hearts maintain the capacity for cardiac regeneration. Rapid and sensitive identification of cardiac cellular proliferation is prerequisite for understanding the underlying mechanisms and strategies of cardiac regeneration. The following immunologically related markers of cardiac cells were analyzed: cardiac transcription factors Nkx2.5 and Gata 4; specific marker of cardiomyocytes TnT; endothelial cell marker CD31; vascular smooth muscle marker smooth muscle myosin IgG; cardiac resident stem cells markers IsL1, Tbx18, and Wt1. Markers were co-localized in cardiac tissues of embryonic, neonatal, adult, and pathological samples by 5-ethynyl-2'-deoxyuridine (EdU) staining. EdU was also used to label isolated neonatal cardiomyocytes in vitro. EdU robustly labeled proliferating cells in vitro and in vivo, co-immunostaining with different cardiac cells markers. EdU can rapidly and sensitively label proliferating cardiac cells in developmental and pathological states. Cardiac cell proliferation assessed by EdU is a novel analytical tool for investigating the mechanism and strategies of cardiac regeneration in response to injury.

  17. Cardiac troponin elevations among critically ill patients.

    NARCIS (Netherlands)

    Klein Gunnewiek, J.M.T.; Hoeven, J.G. van der


    PURPOSE OF THE REVIEW: Elevated levels of cardiac troponins, indicative of the presence of cardiac injury, have been reported in critically ill patients. In this review, the incidence, significance, and clinical relevance of elevated troponin levels among this group of patients will be discussed. RE

  18. [Cardiac Pacemakers, implantable defibrillators and IRM]. (United States)

    Frank, R; Hidden-Lucet, F; Himbert, C; Petitot, J C; Fontaine, G


    The IRM is formally contraindicated to the pacemaker and cardiac defibrillator wearers because of the risk of inhibition or inappropriate stimulations during the examination. However if the examination is essential, suitable programming of the apparatus and a constant monitoring of the heartbeat rate by a qualified doctor in cardiac stimulation must make it possible to avoid any accident.

  19. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick


    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  20. Coagulopathy and hemostatic monitoring in cardiac surgery

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sølbeck, Sacha; Genet, Gustav;


    Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse...

  1. Cardiac troponins in dogs and cats

    DEFF Research Database (Denmark)

    Langhorn, Rebecca; Willesen, Jakob


    . Conventionally, the cardiac troponins have been used for diagnosis of acute myocardial infarction in humans and have become the gold standard biomarkers for this indication. They have become increasingly recognized as an objective measure of cardiomyocyte status in both cardiac and noncardiac disease, supplying...

  2. Preoperative respiratory physical therapy in cardiac surgery

    NARCIS (Netherlands)

    Hulzebos, H.J.


    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in

  3. Cardiac MRI of the athlete's heart

    NARCIS (Netherlands)

    Prakken, N.H.J.


    The increase in pre-participation cardiovascular screening using the Lausanne protocol will ultimately lead to an increased use of cardiac MRI and MDCT in the cardiovascular work-up of athletes. The role of cardiac MRI is well established in the evaluation of cardiomyopathies, myocarditis, aortic st

  4. Cardiac manifestations of inborn errors of metabolism.

    NARCIS (Netherlands)

    Evangeliou, A.; Papadopoulou-Legbelou, K.; Daphnis, E.; Ganotakis, E.; Vavouranakis, I.; Michailidou, H.; Hitoglou-Makedou, A.; Nicolaidou, P.; Wevers, R.A.; Varlamis, G.


    AIM: The aim of the study was to investigate the frequency and type of cardiac manifestations in a defined group of patients with inborn errors of metabolism. This paper also explores the key role of cardiac manifestations in the diagnosis of inborn errors of metabolism in daily practice. METHODS: O

  5. Drugs, QTc prolongation and sudden cardiac death

    NARCIS (Netherlands)

    S.M.J.M. Straus (Sabine)


    textabstract__Abstract__ The term sudden cardiac death pertains to an unexpected death from cardiac causes within a short time period and has been described throughout history. The ancient Egyptians inscribed on the tomb of a nobleman some 4500 years ago that he had died suddenly and without appare

  6. Primary cardiac hemangioendothelioma: a case report

    Institute of Scientific and Technical Information of China (English)

    WANG Li-feng; LIU Ming; ZHU Hong; HAN Wei; HU Cheng-yi; QI Ji-ping; MEI Huan-lin; GE Re-le; ZHOU Min


    @@ Primary cardiac hemangioendothelioma is extremely rare.1-3 Up to now less than twenty cases have been reported in English literature, the data about this kind of cardiac tumors are scanty. In this report, a case of a huge hemangio-endothelioma that arose from the right atrium and was successfully resected is presented.

  7. Cardiac spindle cell hemangioma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ju Young; Lee, In Jae; Min, Kwang Sun; Jeon, Eui Yong; Lee, Yul; Bae, Sang Hoon [Hallym University College of Medicine, Anyang (Korea, Republic of)


    Spindle cell hemangioma is an uncommon vascular lesion histologically resembling a cavernous hemangioma and Kaposi's sarcoma with a predilection for the extremities. There are no radiologic reports concerning cardiac spindle cell hemangioma in the current literature. We report here a case of cardiac spindle cell hemangioma.

  8. Corticosteroids in cardiac surgery: a continuing controversy

    NARCIS (Netherlands)

    Dieleman, J.M.


    Cardiac surgery leads to significant improvements in symptoms of cardiac disease and quality of life, but is still associated with a substantial risk of adverse events and postoperative disability. The perioperative systemic inflammatory response syndrome (SIRS) likely plays a role in the developmen

  9. Update in cardiac arrhythmias and pacing. (United States)

    García-Bolao, Ignacio; Ruiz-Mateas, Francisco; Bazan, Victor; Berruezo, Antonio; Alcalde, Oscar; Leal del Ojo, Juan; Acosta, Juan; Martínez Sellés, Manuel; Mosquera, Ignacio


    This article discusses the main advances in cardiac arrhythmias and pacing published between 2013 and 2014. Special attention is given to the interventional treatment of atrial fibrillation and ventricular arrhythmias, and on advances in cardiac pacing and implantable cardioverter defibrillators, with particular reference to the elderly patient.

  10. Athletes at Risk for Sudden Cardiac Death (United States)

    Subasic, Kim


    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  11. Epicardial origin of cardiac CFU-Fs. (United States)

    Slukvin, Igor I


    The epicardium has been recognized as a source of cardiovascular progenitors during embryogenesis and postnatal life. In this issue of Cell Stem Cell, Chong et al. (2011) identify cardiac CFU-Fs as cardiac-resident cells of epicardial origin with broad multilineage differentiation potential.

  12. Cardiac Vagal Regulation and Early Peer Status (United States)

    Graziano, Paulo A.; Keane, Susan P.; Calkins, Susan D.


    A sample of 341 5 1/2-year-old children participating in an ongoing longitudinal study was the focus of a study on the relation between cardiac vagal regulation and peer status. To assess cardiac vagal regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA change (suppression) to 3 cognitively and emotionally challenging tasks…

  13. Ultrasound Imaging in Teaching Cardiac Physiology (United States)

    Johnson, Christopher D.; Montgomery, Laura E. A.; Quinn, Joe G.; Roe, Sean M.; Stewart, Michael T.; Tansey, Etain A.


    This laboratory session provides hands-on experience for students to visualize the beating human heart with ultrasound imaging. Simple views are obtained from which students can directly measure important cardiac dimensions in systole and diastole. This allows students to derive, from first principles, important measures of cardiac function, such…

  14. Stem cell sources for cardiac regeneration

    NARCIS (Netherlands)

    Roccio, M.; Goumans, M. J.; Sluijter, J. P. G.; Doevendans, P. A.


    Cell-based cardiac repair has the ambitious aim to replace the malfunctioning cardiac muscle developed after myocardial infarction, with new contractile cardiomyocytes and vessels. Different stem cell populations have been intensively studied in the last decade as a potential source of new cardiomyo

  15. Cardiac Rehabilitation in Older Adults. (United States)

    Schopfer, David W; Forman, Daniel E


    The biology of aging and the pathophysiology of cardiovascular disease (CVD) overlap, with the effect that CVD is endemic in the growing population of older adults. Moreover, CVD in older adults is usually complicated by age-related complexities, including multimorbidity, polypharmacy, frailty, and other intricacies that add to the risks of ambiguous symptoms, deconditioning, iatrogenesis, falls, disability, and other challenges. Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with cardiovascular conditions. Although CR was originally designed primarily as an exercise training program for younger adults after a myocardial infarction or coronary artery bypass surgery, it has evolved as a comprehensive lifestyle program (promoting physical activity as well as education, diet, risk reduction, and adherence) for a broader range of CVD (coronary heart disease, heart failure, and valvular heart disease). It provides a valuable opportunity to address and moderate many of the challenges pertinent for the large and growing population of older adults with CVD. Cardiac rehabilitation promotes physical function (cardiorespiratory fitness as well as strength and balance) that helps overcome disease and deconditioning as well as related vulnerabilities such as disability, frailty, and falls. Similarly, CR facilitates education, monitoring, and guidance to reduce iatrogenesis and promote adherence. Furthermore, CR fosters cognition, socialization, and independence in older patients. Yet despite all its conceptual benefits, CR is significantly underused in older populations. This review discusses benefits and the paradoxical underuse of CR, as well as evolving models of care that may achieve greater application and efficacy.

  16. Cardiac involvement in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    V. De Gennaro Colonna


    Full Text Available Rheumatoid arthritis (RA is a systemic disease of unknown etiology characterized by a chronic inflammatory process mainly leading to destruction of synovial membrane of small and major diarthrodial joints. The prevalence of RA within the general adult population is about 1% and female subjects in fertile age result mostly involved. It’s an invalidating disease, associated with changes in life quality and a reduced life expectancy. Moreover, we can observe an increased mortality rate in this population early after the onset of the disease. The mortality excess can be partially due to infective, gastrointestinal, renal or pulmonary complications and malignancy (mainly lung cancer and non- Hodgkin lymphoma. Among extra-articular complications, cardiovascular (CV involvement represents one of the leading causes of morbidity and mortality. Every cardiac structure can be affected by different pathogenic pathways: heart valves, conduction system, myocardium, endocardium, pericardium and coronary arteries. Consequently, different clinical manifestations can be detected, including: pericarditis, myocarditis, myocardial fibrosis, arrhythmias, alterations of conduction system, coronaropathies and ischemic cardiopathy, valvular disease, pulmonary hypertension and heart failure. Considering that early cardiac involvement negatively affects the prognosis, it is mandatory to identify high CV risk RA patients to better define long-term management of this population.

  17. Clofibrate, calcium and cardiac muscle. (United States)

    Fairhurst, A S; Wickie, G; Peabody, T


    The anti-hyperlipidemic drug clofibrate produces negative inotropic effects and arrythmias in isolated perfused rabbit heart Langendorff preparations. In electrically stimulated rat left atria, clofibrate produces negative inotropic effects, the speed of onset and extent of which are decreased by raising the Ca concentration of the bathing medium. Sensitivity of isolated rat atria to clofibrate is not increased when the tissues are stimulated under slow Ca channel conditions, in which the tissues are activated by either isoproterenol or dibutyryl cyclic AMP, although sensitivity to clofibrate is decreased when atria are exposed to increasing concentrations of norepinephrine. Increasing the stimulation frequency of isolated guinea-pig atria to produce a positive treppe also decreases the inhibitory effect of clofibrate, while in rat atria the typical negative treppe is altered towards a positive treppe in presence of clofibrate. The effects of paired electrical stimulation are not diminished by the drug, suggesting that Ca release from the sarcoplasmic reticulum is not affected by clofibrate, although the drug inhibits the rate of Ca uptake by isolated cardiac sarcoplasmic reticulum and mitochondria. These results suggest that clofibrate has multiple effects on Ca functions in cardiac muscle.

  18. Cardiac safety of liposomal anthracyclines. (United States)

    Ewer, Michael S; Martin, Francis J; Henderson, Craig; Shapiro, Charles L; Benjamin, Robert S; Gabizon, Alberto A


    Conventional anthracyclines are active against many tumor types, but cardiotoxicity related to the cumulative dose may limit their use; this is particularly problematic for patients with risk factors for increased toxicity, for those who have received any anthracycline in the past, or for those who are to receive other cardiotoxic agents. Preclinical studies determined that encapsulating conventional anthracyclines in liposomes reduced the incidence and severity of cumulative dose-related cardiomyopathy while preserving antitumor activity. In controlled clinical trials, the risk of cardiotoxicity was significantly lower when nonpegylated liposomal doxorubicin (Myocet [NPLD]) was substituted for conventional doxorubicin, but the risk was not significantly different when NPLD was used in place of conventional epirubicin. Direct comparisons to conventional doxorubicin therapy showed comparable efficacy but significantly lower risk of cardiotoxicity with pegylated liposomal doxorubicin (Doxil/Caelyx [PLD]) therapy. Retrospective and prospective trials have not identified a maximum "cardiac safe" dose of PLD, despite use of cumulative doses exceeding 2,000 mg/m2 in some patients. Liposomal daunorubicin (DaunoXome [DNX]) may be associated with a lower risk of cardiotoxicity than conventional anthracyclines, but comparative trials are not available. With respect to combination chemotherapy, early results of clinical trials suggest that combining trastuzumab or a taxane with NPLD or PLD instead of a conventional anthracycline significantly reduces cardiotoxicity risk without reducing chemotherapeutic efficacy. Further results are eagerly awaited from ongoing controlled trials of cardiac safety with long-term liposomal anthracycline therapy, either alone or in combination with other potentially cardiotoxic agents.

  19. Paradoxical hypertension with cardiac tamponade. (United States)

    Argulian, Edgar; Herzog, Eyal; Halpern, Dan G; Messerli, Franz H


    Subacute (medical) tamponade develops over a period of days or even weeks. Previous studies have shown that subacute tamponade is uncommonly associated with hypotension. On the contrary, many of those patients are indeed hypertensive at initial presentation. We sought to determine the prevalence and predictors of hypertensive cardiac tamponade and hemodynamic response to pericardial effusion drainage. We conducted a retrospective study of patients who underwent pericardial effusion drainage for subacute pericardial tamponade. Diagnosis of pericardial tamponade was established by the treating physician based on clinical data and supportive echocardiographic findings. Patients were defined as hypertensive if initial systolic blood pressure (BP) was ≥140 mm Hg. Thirty patients with subacute tamponade who underwent pericardial effusion drainage were included in the analysis. Eight patients (27%) were hypertensive with a mean systolic BP of 167 compared to 116 mm Hg in 22 nonhypertensive patients. Hypertensive patients with tamponade were more likely to have advanced renal disease (63% vs 14%, p tamponade after pericardial effusion drainage. Those results are consistent with previous studies with an estimated prevalence of hypertensive tamponade from 27% to 43%. In conclusion, a hypertensive response was observed in approximately 1/3 of patients with subacute pericardial tamponade. Relief of cardiac tamponade commonly resulted in a decrease in BP.

  20. [Technologies for cardiac valve prostheses]. (United States)

    Nakano, Kiyoharu


    To show the technological development of cardiac valve prostheses, a historical review of both mechanical and biological valve prostheses and a current overview of modern cardiac valve devices are provided. Scince the 1st implantation of Starr-Edwards ball valve in 1960, both mechanical and biological valve prostheses have advanced. The valve design, the material of the leaflet and the hausing of mechanical prostheses have improved. Currently, the majority of the mechanical prostheses are bileaflet tilting disc valves made of pyrolytic carbon, which is antithromboembolic. However, anticoagulation therapy with warfarin is still required. As for the bioprostheses, although the fixation and anti-mineralization methods of the tissues improved, the durability of these valves is still limited. For the material of the current biological valves, the porcine aortic valve or bovine pericardium are used. The tissues are fixed by non-pressure or low-pressure method in glutaraldehyde solution. A stented and non-stented valves are available. Epoch-making events in this field are the implantation of new bioprosthetic valves using tissue engineering methods and the development of the transcatheter valve replacement therapies.

  1. Predictive Modeling of Cardiac Ischemia (United States)

    Anderson, Gary T.


    The goal of the Contextual Alarms Management System (CALMS) project is to develop sophisticated models to predict the onset of clinical cardiac ischemia before it occurs. The system will continuously monitor cardiac patients and set off an alarm when they appear about to suffer an ischemic episode. The models take as inputs information from patient history and combine it with continuously updated information extracted from blood pressure, oxygen saturation and ECG lines. Expert system, statistical, neural network and rough set methodologies are then used to forecast the onset of clinical ischemia before it transpires, thus allowing early intervention aimed at preventing morbid complications from occurring. The models will differ from previous attempts by including combinations of continuous and discrete inputs. A commercial medical instrumentation and software company has invested funds in the project with a goal of commercialization of the technology. The end product will be a system that analyzes physiologic parameters and produces an alarm when myocardial ischemia is present. If proven feasible, a CALMS-based system will be added to existing heart monitoring hardware.

  2. Gene transfer to promote cardiac regeneration. (United States)

    Collesi, Chiara; Giacca, Mauro


    There is an impelling need to develop new therapeutic strategies for patients with myocardial infarction and heart failure. Leading from the large quantity of new information gathered over the last few years on the mechanisms controlling cardiomyocyte proliferation during embryonic and fetal life, it is now possible to devise innovative therapies based on cardiac gene transfer. Different protein-coding genes controlling cell cycle progression or cardiomyocyte specification and differentiation, along with microRNA mimics and inhibitors regulating pre-natal and early post-natal cell proliferation, are amenable to transformation in potential therapeutics for cardiac regeneration. These gene therapy approaches are conceptually revolutionary, since they are aimed at stimulating the intrinsic potential of differentiated cardiac cells to proliferate, rather than relying on the implantation of exogenously expanded cells to achieve tissue regeneration. For efficient and prolonged cardiac gene transfer, vectors based on the Adeno-Associated Virus stand as safe, efficient and reliable tools for cardiac gene therapy applications.

  3. Towards Accurate Application Characterization for Exascale (APEX)

    Energy Technology Data Exchange (ETDEWEB)

    Hammond, Simon David [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)


    Sandia National Laboratories has been engaged in hardware and software codesign activities for a number of years, indeed, it might be argued that prototyping of clusters as far back as the CPLANT machines and many large capability resources including ASCI Red and RedStorm were examples of codesigned solutions. As the research supporting our codesign activities has moved closer to investigating on-node runtime behavior a nature hunger has grown for detailed analysis of both hardware and algorithm performance from the perspective of low-level operations. The Application Characterization for Exascale (APEX) LDRD was a project concieved of addressing some of these concerns. Primarily the research was to intended to focus on generating accurate and reproducible low-level performance metrics using tools that could scale to production-class code bases. Along side this research was an advocacy and analysis role associated with evaluating tools for production use, working with leading industry vendors to develop and refine solutions required by our code teams and to directly engage with production code developers to form a context for the application analysis and a bridge to the research community within Sandia. On each of these accounts significant progress has been made, particularly, as this report will cover, in the low-level analysis of operations for important classes of algorithms. This report summarizes the development of a collection of tools under the APEX research program and leaves to other SAND and L2 milestone reports the description of codesign progress with Sandia’s production users/developers.

  4. Optimizing cell arrays for accurate functional genomics

    Directory of Open Access Journals (Sweden)

    Fengler Sven


    Full Text Available Abstract Background Cellular responses emerge from a complex network of dynamic biochemical reactions. In order to investigate them is necessary to develop methods that allow perturbing a high number of gene products in a flexible and fast way. Cell arrays (CA enable such experiments on microscope slides via reverse transfection of cellular colonies growing on spotted genetic material. In contrast to multi-well plates, CA are susceptible to contamination among neighboring spots hindering accurate quantification in cell-based screening projects. Here we have developed a quality control protocol for quantifying and minimizing contamination in CA. Results We imaged checkered CA that express two distinct fluorescent proteins and segmented images into single cells to quantify the transfection efficiency and interspot contamination. Compared with standard procedures, we measured a 3-fold reduction of contaminants when arrays containing HeLa cells were washed shortly after cell seeding. We proved that nucleic acid uptake during cell seeding rather than migration among neighboring spots was the major source of contamination. Arrays of MCF7 cells developed without the washing step showed 7-fold lower percentage of contaminant cells, demonstrating that contamination is dependent on specific cell properties. Conclusions Previously published methodological works have focused on achieving high transfection rate in densely packed CA. Here, we focused in an equally important parameter: The interspot contamination. The presented quality control is essential for estimating the rate of contamination, a major source of false positives and negatives in current microscopy based functional genomics screenings. We have demonstrated that a washing step after seeding enhances CA quality for HeLA but is not necessary for MCF7. The described method provides a way to find optimal seeding protocols for cell lines intended to be used for the first time in CA.

  5. Accurate paleointensities - the multi-method approach (United States)

    de Groot, Lennart


    The accuracy of models describing rapid changes in the geomagnetic field over the past millennia critically depends on the availability of reliable paleointensity estimates. Over the past decade methods to derive paleointensities from lavas (the only recorder of the geomagnetic field that is available all over the globe and through geologic times) have seen significant improvements and various alternative techniques were proposed. The 'classical' Thellier-style approach was optimized and selection criteria were defined in the 'Standard Paleointensity Definitions' (Paterson et al, 2014). The Multispecimen approach was validated and the importance of additional tests and criteria to assess Multispecimen results must be emphasized. Recently, a non-heating, relative paleointensity technique was proposed -the pseudo-Thellier protocol- which shows great potential in both accuracy and efficiency, but currently lacks a solid theoretical underpinning. Here I present work using all three of the aforementioned paleointensity methods on suites of young lavas taken from the volcanic islands of Hawaii, La Palma, Gran Canaria, Tenerife, and Terceira. Many of the sampled cooling units are <100 years old, the actual field strength at the time of cooling is therefore reasonably well known. Rather intuitively, flows that produce coherent results from two or more different paleointensity methods yield the most accurate estimates of the paleofield. Furthermore, the results for some flows pass the selection criteria for one method, but fail in other techniques. Scrutinizing and combing all acceptable results yielded reliable paleointensity estimates for 60-70% of all sampled cooling units - an exceptionally high success rate. This 'multi-method paleointensity approach' therefore has high potential to provide the much-needed paleointensities to improve geomagnetic field models for the Holocene.

  6. Effects of Radiation Exposure From Cardiac Imaging: How Good Are the Data? (United States)

    Einstein, Andrew J.


    Concerns about medical exposure to ionizing radiation have become heightened in recent years due to rapid growth in procedure volumes and the high radiation doses incurred from some procedures. This article summarizes the evidence base undergirding concerns about radiation exposure in cardiac imaging. After classifying radiation effects, explaining terminology used to quantify the radiation received by patients, and describing typical doses from cardiac imaging procedures, I address the major epidemiological studies having bearing on radiation effects at doses comparable to those received by patients undergoing cardiac imaging. These include studies of atomic bomb survivors, nuclear industry workers, and children exposed in utero to x-rays, all of which have evidenced increased cancer risks at low doses. Additional higher dose epidemiological studies of cohorts exposed to radiation in the context of medical treatment are described and found to be generally compatible with these cardiac-dose-level studies, albeit with exceptions. Using risk projection models developed by the US National Academies that incorporate these data and reflect several evidence-based assumptions, cancer risk from cardiac imaging can be estimated and compared to benefits from imaging. Several ongoing epidemiological studies will provide better understanding of radiation-associated cancer risks. PMID:22300689

  7. Spatial distribution of specialized cardiac care units in the state of Santa Catarina. (United States)

    Cirino, Silviana; Lima, Fabiana Santos; Gonçalves, Mirian Buss


    OBJECTIVE To analyze the methodology used for assessing the spatial distribution of specialized cardiac care units. METHODS A modeling and simulation method was adopted for the practical application of cardiac care service in the state of Santa Catarina, Southern Brazil, using the p-median model. As the state is divided into 21 health care regions, a methodology which suggests an arrangement of eight intermediate cardiac care units was analyzed, comparing the results obtained using data from 1996 and 2012. RESULTS Results obtained using data from 2012 indicated significant changes in the state, particularly in relation to the increased population density in the coastal regions. The current study provided a satisfactory response, indicated by the homogeneity of the results regarding the location of the intermediate cardiac care units and their respective regional administrations, thereby decreasing the average distance traveled by users to health care units, located in higher population density areas. The validity of the model was corroborated through the analysis of the allocation of the median vertices proposed in 1996 and 2012. CONCLUSIONS The current spatial distribution of specialized cardiac care units is more homogeneous and reflects the demographic changes that have occurred in the state over the last 17 years. The comparison between the two simulations and the current configuration showed the validity of the proposed model as an aid in decision making for system expansion.

  8. Biology Reflective Assessment Curriculum (United States)

    Bayley, Cheryl Ann

    Often students and educators view assessments as an obligation and finality for a unit. In the current climate of high-stakes testing and accountability, the balance of time, resources and emphasis on students' scores related to assessment have been slanted considerably toward the summative side. This tension between assessment for accountability and assessment to inform teaching strains instruction and educators' ability to use that information to design learning opportunities that help students develop deeper conceptual understanding. A substantive body of research indicates that formative and reflective assessment can significantly improve student learning. Biology Reflective Assessment Curriculum (BRAC) examines support provided for high school science students through assessment practices. This investigation incorporates the usage of reflective assessments as a guiding practice for differentiated instruction and student choice. Reflective assessment is a metacognitive strategy that promotes self-monitoring and evaluation. The goals of the curriculum are to promote self-efficacy and conceptual understanding in students learning biology through developing their metacognitive awareness. BRAC was implemented in a high school biology classroom. Data from assessments, metacognitive surveys, self-efficacy surveys, reflective journals, student work, a culminating task and field notes were used to evaluate the effectiveness of the curriculum. The results suggest that students who develop their metacognitive skills developed a deeper conceptual understanding and improved feelings of self-efficacy when they were engaged in a reflective assessment unit embedded with student choice. BRAC is a tool for teachers to use assessments to assist students in becoming metacognitive and to guide student choice in learning opportunities.

  9. Long Wave Reflection and Transmission over A Sloping Step

    Institute of Scientific and Technical Information of China (English)

    Hsien-Kuo CHANG; Jin-Cheng LIOU


    This investigation examines long wave reflection and transmission induced by a sloping step. Bellman and Kalaba's(1959) invariant imbedding is introduced to find wave reflection. An alternative method matching both the surface elevation and its surface slope of each region at the junction is applied to the determination of wave reflection and transmission.The proposed methods are compared with the accurate numerical results of Porter and Porter (2000) and those of Mei(1983) for a vertical step. The wave reflection obtained for a mildly sloping step differs significantly from the result of Mei. The wave reflection is found to fluctuate owing to wave trapping for the mild sloping step. The height and the face slope of the step are important for determining wave reflection and transmission coefficients.

  10. Acoustic Bottom Reflectivity (United States)


    Calculates the reflection loss as function of frequency. ---PLOTV/ PLOTF ---Plots loss and phase as function of angle or frequency. ---QUIT--- ENTER YOUR...34Y" if you want to leave PLOTV or PLOTF and return to the HELP MENU. A similar procedure to plot results as a function of frequency is contained in... PLOTF and works in the same way. Figures A-1 and A-2 show the results for an 18-layer sample input file, FLOOR18.DAT, giving the reflection loss as a

  11. Reflecting telescope optics

    CERN Document Server

    Wilson, Raymond N


    R.N. Wilson's two-volume treatise on reflecting telescope optics has become a classic in its own right. It is intended to give a complete treatment of the subject, addressing professionals in research and industry as well as students of astronomy and amateur astronomers. This first volume, Basic Design Theory and its Historical Development, is devoted to the theory of reflecting telescope optics and systematically recounts the historical progress. The author's approach is morphological, with strong emphasis on the historical development. The book is richly illustrated including spot-diagrams a

  12. Lidocaine block of cardiac sodium channels. (United States)

    Bean, B P; Cohen, C J; Tsien, R W


    Lidocaine block of cardiac sodium channels was studied in voltage-clamped rabbit purkinje fibers at drug concentrations ranging from 1 mM down to effective antiarrhythmic doses (5-20 muM). Dose-response curves indicated that lidocaine blocks the channel by binding one-to-one, with a voltage-dependent K(d). The half-blocking concentration varied from more than 300 muM, at a negative holding potential where inactivation was completely removed, to approximately 10 muM, at a depolarized holding potential where inactivation was nearly complete. Lidocaine block showed prominent use dependence with trains of depolarizing pulses from a negative holding potential. During the interval between pulses, repriming of I (Na) displayed two exponential components, a normally recovering component (tauless than 0.2 s), and a lidocaine-induced, slowly recovering fraction (tau approximately 1-2 s at pH 7.0). Raising the lidocaine concentration magnified the slowly recovering fraction without changing its time course; after a long depolarization, this fraction was one-half at approximately 10 muM lidocaine, just as expected if it corresponded to drug-bound, inactivated channels. At less than or equal to 20 muM lidocaine, the slowly recovering fraction grew exponentially to a steady level as the preceding depolarization was prolonged; the time course was the same for strong or weak depolarizations, that is, with or without significant activation of I(Na). This argues that use dependence at therapeutic levels reflects block of inactivated channels, rather than block of open channels. Overall, these results provide direct evidence for the "modulated-receptor hypothesis" of Hille (1977) and Hondeghem and Katzung (1977). Unlike tetrodotoxin, lidocaine shows similar interactions with Na channels of heart, nerve, and skeletal muscle.

  13. Integral representation of Skorokhod reflection

    CERN Document Server

    Anantharam, Venkat


    We show that a certain integral representation of the one-sided Skorokhod reflection of a continuous bounded variation function characterizes the reflection in that it possesses a unique maximal solution which solves the Skorokhod reflection problem.

  14. Reflection in learning at work

    DEFF Research Database (Denmark)

    Pedersen, Steen Høyrup


    Three domains and approaches of learning - adult learning, problem-solving and cirtical reflection theory are used as different lenses through which the question: what is reflection and how is reflection related to learning, - are interpreted....

  15. Runtime software architecture based on reflective middleware

    Institute of Scientific and Technical Information of China (English)

    HUANG Gang; MEI Hong; YANG Fuqing


    There exists a consensus that software architecture (SA) plays a central role in software development and also plays an important role in the lifecycle phases after software delivery. Particularly, SA can be used to reduce the great difficulty and cost of software maintenance and evolution. In this paper, runtime software architecture (RSA) based on reflective middleware is proposed to support architecture-based software maintenance and evolution. In this approach, the actual states and behaviors of the runtime system can be observed and manipulated in a consistent and understandable way through its architectural view. Being an accurate, up-to-date, semantic and operable view of SA, RSA looks components and connectors as "white-box" entities to accurately and thoroughly describe the runtime system, extends traditional architecture description languages to formally describe itself and naturally inherit plentiful semantics in traditional views of SA, and utilizes reflective middleware to observe and manipulate the runtime system. In order to demonstrate the feasibility of this approach, a reflective J2EE application server, called PKUAS, is implemented to observe and manipulate the components, connectors and constraints in the runtime system. Finally, the performance evaluation proves that making RSA explicit and operable at runtime has little effect on the runtime system.

  16. Exercises in anatomy: cardiac isomerism. (United States)

    Anderson, Robert H; Sarwark, Anne E; Spicer, Diane E; Backer, Carl L


    It is well recognized that the patients with the most complex cardiac malformations are those with so-called visceral heterotaxy. At present, it remains a fact that most investigators segregate these patients on the basis of their splenic anatomy, describing syndromes of so-called asplenia and polysplenia. It has also been known for quite some time, nonetheless, that the morphology of the tracheobronchial tree is usually isomeric in the setting of heterotaxy. And it has been shown that the isomerism found in terms of bronchial arrangement correlates in a better fashion with the cardiac anatomy than does the presence of multiple spleens, or the absence of any splenic tissue. In this exercise in anatomy, we use hearts from the Idriss archive of Lurie Children's Hospital in Chicago to demonstrate the isomeric features found in the hearts obtained from patients known to have had heterotaxy. We first demonstrate the normal arrangements, showing how it is the extent of the pectinate muscles in the atrial appendages relative to the atrioventricular junctions that distinguishes between morphologically right and left atrial chambers. We also show the asymmetry of the normal bronchial tree, and the relationships of the first bronchial branches to the pulmonary arteries supplying the lower lobes of the lungs. We then demonstrate that diagnosis of multiple spleens requires the finding of splenic tissue on either side of the dorsal mesogastrium. Turning to hearts obtained from patients with heterotaxy, we illustrate isomeric right and left atrial appendages. We emphasize that it is only the appendages that are universally isomeric, but point out that other features support the notion of cardiac isomerism. We then show that description also requires a full account of veno-atrial connections, since these can seemingly be mirror-imaged when the arrangement within the heart is one of isomerism of the atrial appendages. We show how failure to recognize the presence of such isomeric

  17. Tissue-Doppler assessment of cardiac left ventricular function during short-term adjuvant epirubicin therapy for breast cancer

    DEFF Research Database (Denmark)

    Appel, Jon M; Sogaard, Peter; Mortensen, Christiane E;


    It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure. The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast...... cancer when using Doppler tissue imaging of longitudinal left ventricular function....

  18. [Definition of accurate planning target volume margins for esophageal cancer radiotherapy]. (United States)

    Lesueur, P; Servagi-Vernat, S


    More than 4000 cases of esophagus neoplasms are diagnosed every year in France. Radiotherapy, which can be delivered in preoperative or exclusive with a concomitant chemotherapy, plays a central role in treatment of esophagus cancer. Even if efficacy of radiotherapy no longer has to be proved, the prognosis of esophagus cancer remains unfortunately poor with a high recurrence rate. Toxicity of esophageal radiotherapy is correlated with the irradiation volume, and limits dose escalation and local control. Esophagus is a deep thoracic organ, which undergoes cardiac and respiratory motion, making the radiotherapy delivery more difficult and increasing the planning target volume margins. Definition of accurate planning target volume margins, taking into account the esophagus' intrafraction motion and set up margins is very important to be sure to cover the clinical target volume and restrains acute and late radiotoxicity. In this article, based on a review of the literature, we propose planning target volume margins adapted to esophageal radiotherapy.

  19. Does the spectral format matter in diffuse reflection spectroscopy? (United States)

    Reeves, James B


    Near-infrared, and more recently, mid-infrared diffuse reflection spectroscopy (more commonly and erroneously called reflectance spectroscopy) have come to be extensively used to determine the composition of products ranging from forages and drugs to soils. In these methods, spectra are generally collected as reflectance or R and transformed to log (1/reflectance). However, some near-infrared researchers do not transform the data, but use the data directly as reflectance. As it is generally held that procedures such as partial least squares regression do not work well with nonlinear data and the log (1/reflectance) transformation is held to be a best effort at linearization for near-infrared diffuse reflection spectral data, the question arises as to why then does not everyone transform the data? The objective of this work was to investigate this question using near-infrared and mid-infrared spectra in various formats. Calibrations were developed using spectral data from forages in several formats: reflectance, log (1/reflectance), non-background corrected single beam spectra, interferograms, and Kubelka-Munk transformed data. Calibrations were developed using both non-pretreated spectra and using data pretreatments such as derivatives. Results showed that calibrations using partial least squares regression did not require any specific data format. Accurate calibrations were developed for fiber, digestibility, and protein measures in forages using any of the aforementioned spectral formats including non-background-corrected single beam spectra and even interferograms. While calibrations could be developed using any of the formats, results indicated that those using Kubelka-Munk and especially interferograms did not perform as well as the others, although they were still quite good. In conclusion, results using forage spectra indicated that accurate and equivalent calibrations can be developed using diffuse reflectance data, with (reflectance) or without background

  20. CpG-ODN attenuates pathological cardiac hypertrophy and heart failure by activation of PI3Kα-Akt signaling.

    Directory of Open Access Journals (Sweden)

    Liang Yang

    Full Text Available Phosphoinositide-3-kinase α (PI3Kα represents a potential novel drug target for pathological cardiac hypertrophy (PCH and heart failure. Oligodeoxynucleotides containing CpG motifs (CpG-ODN are classic agonists of Toll-like receptor 9 (TLR9, which typically activates PI3K-Akt signaling in immune cells; however, the role of the nucleotide TLR9 agonists in cardiac myocytes is largely unknown. Here we report that CpG-ODN C274 could both attenuate PCH and improve cardiac dysfunction by activating PI3Kα-Akt signaling cascade. In vitro studies indicated that C274 could blunt reactivation of fetal cardiac genes and cell enlargement induced by a hypertrophic agent, isoproterenol. The anti-hypertrophic effect of C274 was suppressed by a pan-PI3K inhibitor, LY294002, or a small interfering RNA targeting PI3Kα. In vivo studies demonstrated that PCH, as marked by increased heart weight (HW and cardiac ANF mRNA, was normalized by pre-administration with C274. In addition, Doppler echocardiography detected cardiac ventricular dilation, and contractile dysfunction in isoproterenol-treated animals, consistent with massive replacement fibrosis, reflecting cardiac cell death. As expected, pre-treatment of mice with C274 could prevent cardiac dysfunction associated with diminished cardiac cell death and fibrosis. In conclusion, CpG-ODNs are novel cardioprotective agents possessing antihypertrophic and anti-cell death activity afforded by engagement of the PI3Kα-Akt signaling. CpG-ODNs may have clinical use curbing the progression of PCH and preventing heart failure.

  1. Progress in use of brain natriuretic peptide in congenital heart disease and perioperative pediatric cardiac operation%脑钠肽在小儿先天性心脏病及围手术期的应用进展

    Institute of Scientific and Technical Information of China (English)



    脑钠肽是一种神经内分泌激素,它与先天性心脏病患儿心功能不全和肺动脉高压程度呈正相关,已成为评估先天性心脏病患儿心功能不全程度、反映先天性心脏病患儿术前术后心功能状态的简便、准确的生物化学指标.它对先天性心脏病心脏手术预后有预测作用,对围手术期治疗有指导意义,能减少术后并发症和病死率,成为迅速、即时床边检查的辅助手段.该文就其与先天性心脏病的相关性和在先天性心脏病围手术期应用进展作一概述.%Brain natriuretic peptide (BNP) is a neuroendocrine hormone,which has a positive correlation with degree of cardiac dysfunction and pulmonary arterial hypertension of children with congenital heart disease (CHD).BNP has been shown to be a simple,accurate and useful biochemical indicator in assessing cardiac dysfunction degree and reflecting perioperative cardiac function state of children with CHD.It has prognostic value in congenital heart surgery and can guide the perioperative treatment and reduce the postoperative complications and mortality.It is a quick,instant bedside inspection supplementary means.This article describes the relevance between BNP and CHD and the application progress of BNP in pefioperative of CHD.

  2. Cardiac Function Remains Impaired Despite Reversible Cardiac Remodeling after Acute Experimental Viral Myocarditis

    Directory of Open Access Journals (Sweden)

    Peter Moritz Becher


    Full Text Available Background. Infection with Coxsackievirus B3 induces myocarditis. We aimed to compare the acute and chronic phases of viral myocarditis to identify the immediate effects of cardiac inflammation as well as the long-term effects after resolved inflammation on cardiac fibrosis and consequently on cardiac function. Material and Methods. We infected C57BL/6J mice with Coxsackievirus B3 and determined the hemodynamic function 7 as well as 28 days after infection. Subsequently, we analyzed viral burden and viral replication in the cardiac tissue as well as the expression of cytokines and matrix proteins. Furthermore, cardiac fibroblasts were infected with virus to investigate if viral infection alone induces profibrotic signaling. Results. Severe cardiac inflammation was determined and cardiac fibrosis was consistently colocalized with inflammation during the acute phase of myocarditis. Declined cardiac inflammation but no significantly improved hemodynamic function was observed 28 days after infection. Interestingly, cardiac fibrosis declined to basal levels as well. Both cardiac inflammation and fibrosis were reversible, whereas the hemodynamic function remains impaired after healed viral myocarditis in C57BL/6J mice.


    Institute of Scientific and Technical Information of China (English)

    Yin-ping Chu; Jin-lian Cheng; Ru-kun Chen; Yu-bo Fan; Fang Pu


    Objective To assess the influence of mimic cardiac rate on hydrodynamics of different mechanical prosthetic cardiac valves.Methods US-made CarboMedics bileaflet valve, China-made Jiuling bileaflet valve and C-L tilting disc valve were tested via a pulsatile flow simulator in the aortic position. Testing conditions were set at mimic cardiac rates of 55 bpm, 75 bpm, 100bpm with a constant mimic cardiac output of 4 L/min. The mean pressure differences (△P), leakage volumes (LEV) and closing volumes (CLV) across each valve, and effective orifice areas (EOA) were analyzed.Results Within physiological range, △p, LEV, and CLV decreased as mimic cardiac rate increased, with a large extent of variance. EOA increased along with an increase in mimic cardiac rate. It was a different response in terms of cardiac rate alteration for different types of mechanical prosthetic cardiac valves.Conclusion Mimic cardiac rate change affects hydrodynamics of mechanical prosthetic cardiac valves. Within physiological range, the hydrodynamic of prosthetic bileaflet valve is better than that of tilting disc valve.

  4. Reflecting on Data (United States)

    Kraus, Rudolf V.


    This article describes a two-day optics laboratory activity that investigates the scientific phenomenon of reflection, which students are generally familiar with but usually have not studied in depth. This investigation can be used on its own or as part of a larger unit on optics. This lesson encourages students to think critically and…

  5. Wave Reflection Model Tests

    DEFF Research Database (Denmark)

    Burcharth, H. F.; Larsen, Brian Juul

    The investigation concerns the design of a new internal breakwater in the main port of Ibiza. The objective of the model tests was in the first hand to optimize the cross section to make the wave reflection low enough to ensure that unacceptable wave agitation will not occur in the port. Secondly...

  6. Reflection by Porro Prisms (United States)

    Greenslade, Thomas B.


    Students all know that reflection from a plane mirror produces an image that is reversed right to left and so cannot be read by anyone but Leonardo da Vinci, who kept his notes in mirror writing. A useful counter-example is the Porro prism, which produces an image that is not reversed.

  7. Lights, Camera, Reflection! (United States)

    Mourlam, Daniel


    There are many ways to critique teaching, but few are more effective than video. Personal reflection through the use of video allows one to see what really happens in the classrooms--good and bad--and provides a visual path forward for improvement, whether it be in one's teaching, work with a particular student, or learning environment. This…

  8. Value reflected health education

    DEFF Research Database (Denmark)

    Wistoft, Karen; Nordentoft, Helle Merete


    This article examines the impact of a value-reflected approach in health education by demonstrating the nature of professional competence development connected to this approach. It is based on findings from two three-year health educational development projects carried out by school health nurses...... develop pedagogical competences in health education improving school childrens’ health....

  9. Changes Brought by Reflection

    Institute of Scientific and Technical Information of China (English)


    Feng: A number of changes have taken place in Europe after reflection, such as specific anti-terrorist measures, progress in the construction of integration, changes in the structure of political forces and adjustments in the EU foreign policy. Would you make some comments first, Dr. Sun?

  10. Self-Reflection

    DEFF Research Database (Denmark)

    Fausing, Bent

    Reflecting has a double meaning, mirroring and thinking. The seminar will investigate how these two meanings intervene in each other. As we perceive we are already in pre-refectory state, and thinking involves a lot of not only thoughts, but also of senses and sensing, wherefrom our thoughts star...

  11. Descartes, Cardiac Heat, and Alchemy. (United States)

    Heitsch, Dorothea


    René Descartes (1596-1650) insisted on a heat and light theory to explain cardiac movement, and used concepts such as distillation of the vital spirits, fermentation in the digestive process, and fermentation in the circulation of the blood. I argue that his theory of the body as a heat-exchange system was based on alchemical and natural philosophical notions of fire and light expounded by precursors and contemporaries who included Jean D'Espagnet, Jean Fernel, Jan Baptist van Helmont, and Andreas Libavius. Descartes endeavoured to mechanise their approaches, creating a theory in which fire and heat, a legacy from thermal explanations of physiology, were transformed into alchemical fire, and then into mechanistic or physicalist heat.

  12. A self-interaction-free local hybrid functional: Accurate binding energies vis-\\`a-vis accurate ionization potentials from Kohn-Sham eigenvalues

    CERN Document Server

    Schmidt, Tobias; Makmal, Adi; Kronik, Leeor; Kümmel, Stephan


    We present and test a new approximation for the exchange-correlation (xc) energy of Kohn-Sham density functional theory. It combines exact exchange with a compatible non-local correlation functional. The functional is by construction free of one-electron self-interaction, respects constraints derived from uniform coordinate scaling, and has the correct asymptotic behavior of the xc energy density. It contains one parameter that is not determined ab initio. We investigate whether it is possible to construct a functional that yields accurate binding energies and affords other advantages, specifically Kohn-Sham eigenvalues that reliably reflect ionization potentials. Tests for a set of atoms and small molecules show that within our local-hybrid form accurate binding energies can be achieved by proper optimization of the free parameter in our functional, along with an improvement in dissociation energy curves and in Kohn-Sham eigenvalues. However, the correspondence of the latter to experimental ionization potent...

  13. [Cardiopulmonary resuscitation in cardiac arrest following trauma]. (United States)

    Leidel, B A; Kanz, K-G


    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  14. Subject-specific models for image-guided cardiac surgery (United States)

    Wierzbicki, Marcin; Moore, John; Drangova, Maria; Peters, Terry


    Three-dimensional visualization for planning and guidance is still not routinely available for minimally invasive cardiac surgery (MICS). This can be addressed by providing the surgeon with subject-specific geometric models derived from 3D preoperative images for planning of port locations or to rehearse the procedure. For guidance purposes, these models can also be registered to the subject using intraoperative images. In this paper, we present a method for extracting subject-specific heart geometry from preoperative MR images. The main obstacle we face is the low quality of clinical data in terms of resolution, signal-to-noise ratio, and presence of artefacts. Instead of using these images directly, we approach the problem in three steps: (1) generate a high quality template model, (2) register the template with the preoperative data, and (3) animate the result over the cardiac cycle. Validation of this approach showed that dynamic subject-specific models can be generated with a mean error of 3.6 ± 1.1 mm from low resolution target images (6 mm slices). Thus, the models are sufficiently accurate for MICS training and procedure planning. In terms of guidance, we also demonstrate how the resulting models may be adapted to the operating room using intraoperative ultrasound imaging.

  15. Two cases of chronic radiodermatitis caused by cardiac catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, Makiko; Soh, Inketsu; Sueki, Hirohiko; Iijima, Masafumi [Showa Univ., Tokyo (Japan). School of Medicine; Hayashi, Ken; Wakugawa, Motoshi


    Coronary angiography (CAG) and percutaneous transluminal coronary angioplasty (PTCA) associated with fluoroscopy and cineradiography deliver higher radiation doses than any other conventional methods and, as a result, expose patients to ionizing radiation. We herein report two cases of radiodermatitis caused by cardiac catheterization whose irradiation dose could be retrospectively calculated. One sixty-year-old female and one sixty eight-year-old female who had suffered from myocardial infarction and angina pectoris, respectively, developed erythematous plaques on the right submammary area and the lesions were initially diagnosed to be fixed drug eruptions. The lesions of submammary area gradually showed the findings of poikiloderma and finally demonstrated ulceration, however, we could not make an accurate diagnosis at that time, due to our lack of knowledge about these radiologic examinations. The cumulative irradiation dose of these cases was calculated to be 58.5 Gy and 45.5 Gy, respectively, and both cases were finally diagnosed to have chronic radiodermatitis as a result of cardiac catheterization. (author)

  16. The Learning Curve for a Fetal Cardiac Intervention Team

    Directory of Open Access Journals (Sweden)

    Stephen P. Emery


    Full Text Available Objectives. Multiple technical difficulties are encountered when a multidisciplinary team of subspecialists begins a minimally-invasive fetal cardiac interventional program. We describe the learning curve. Study Design. Ten pregnant sheep underwent ultrasound-guided balloon valvuloplasty of the aortic valve. Team members and their roles remained constant through the trial. The time between needle insertion and entrance of the left ventricle at the aortic root was recorded. F-test was used to assess significance (P≤.05. Results. The time required to accurately position the needle tip at the aortic root decreased significantly over the course of the trial, from 12 minutes with the first attempt to one minute with the last (P=.003. Conclusion. A significant learning curve is encountered when a multidisciplinary team begins a minimally-invasive fetal cardiac intervention program. However, technical proficiency can be achieved with practice. Institutions interested in developing such a program should consider practice in an animal model before proceeding to the human fetus.

  17. Being a reflective teacher——reflection on group management

    Institute of Scientific and Technical Information of China (English)

    Pan; Lehui


    <正>Introduction According to Pollard and Triggs(1997),reflective teaching is a process through which the capacity to make such professional judgments can be developed and maintained.Then what is a reflective teacher?Reflective teacher is someone who reflects systematically on her practice in a constant attempt to improve

  18. The role of cardiac magnetic resonance in valvular heart disease. (United States)

    Lopez-Mattei, Juan C; Shah, Dipan J


    The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion.

  19. Cardiac trauma confirmed by cardiac markers in dogs: two case reports Trauma cardíaco confirmado por marcadores cardíacos em cães: relato de dois casos


    Diniz, P. P. V. P.; Schwartz,D.S.; R.C. Collicchio-Zuanaze


    Two clinical cases of cardiac contusion in dogs were studied Radiographic evaluation showed pneumothorax and alveolar pattern on diaphragmatic pulmonary lobe in one dog, and arrhythmias in both dogs. Cardiac troponin I and CK-MB serum analysis associated with clinical history and eletrocardiographic findings indicated accurately the extension of myocardial injury secondary to trauma.Relatam-se dois casos de miocardite em cães. A avaliação radiográfica mostrou pneumotórax e padrão alveolar no ...

  20. [Research progress of cardiac systems biology]. (United States)

    Wang, Juan; Shang, Tong


    Systems Biology is one of the most widely discussed fields among emerging post-genomic disciplines. Medical systems biology is an important component of systems biology. The goals of medical systems biology are gaining a complete understanding of human body in normal and disease states. Driven by the great importance of cardiovascular diseases, cardiac systems biology is improving rapidly. This review provides an overview of major themes in the developing field of cardiac systems biology, including some of the high-throughput experiments and strategies used to integrate the datasets, various types of computational approaches used for developing useful quantitative models, and successful examples, future directions of cardiac systems biology.

  1. Cardiac Arrest: Obstetric CPR/ACLS. (United States)

    Cobb, Benjamin; Lipman, Steven


    In contrast with other high-resource countries, maternal mortality has seen an increase in the United States. Caring for pregnant women in cardiac arrest may prove uniquely challenging given the rarity of the event coupled by the physiological changes of pregnancy. Optimization of resuscitative efforts warrants special attention as described in the 2015 American Heart Association's "Scientific Statement on Maternal Cardiac Arrest." Current recommendations address a variety of topics ranging from the basic components of chest compressions and airway management to some of the logistical complexities and operational challenges involved in maternal cardiac arrest.

  2. Cardiac and Respiratory Disease in Aged Horses. (United States)

    Marr, Celia M


    Respiratory and cardiac diseases are common in older horses. Advancing age is a specific risk factor for cardiac murmurs and these are more likely in males and small horses. Airway inflammation is the most common respiratory diagnosis. Recurrent airway obstruction can lead to irreversible structural change and bronchiectasis; with chronic hypoxia, right heart dysfunction and failure can develop. Valvular heart disease most often affects the aortic and/or the mitral valve. Management of comorbidity is an essential element of the therapeutic approach to cardiac and respiratory disease in older equids.

  3. Cardiac surgery in nonagenarians: pushing the boundary one further decade. (United States)

    Easo, Jerry; Hölzl, Philipp P F; Horst, Michael; Dikov, Valentin; Litmathe, Jens; Dapunt, Otto


    With increasing age of the general population, the necessity for cardiac surgery in the collective of patients aged 90 and older has been increasing. To aid in the choice of adequate therapy we investigated our experience for the group of nonagenarians undergoing surgical interventions. From 6/2000 to 9/2007, 17 patients aged 90 and older underwent open-heart surgery at our institution. We performed a retrospective data analysis including baseline preoperative clinical status, intra- and postoperative results and the long-term survival in the further postoperative course. We performed cardiac surgical procedures in 17 patients (male/female ratio 6/11), including isolated aortic valve replacement (n = 7), aortic root replacement (n = 2), isolated coronary bypass surgery (n = 4), combined coronary and valve surgery (n = 5), re-operative valve replacement (n = 1) and root replacement with arch repair (n = 1). Emergency procedures were performed in 11.8% (2/17). Mean age was 91.9 ± 1.2 years, ranging 90.1-94.2. Mean follow-up was 3.2 ± 2.2 years. The 30-day mortality was 17.6% (3/17), overall mortality at 42.9 follow-up patient years was 58.8% (10/17). We conclude that cardiac surgery procedures can be performed with therapeutic benefit for selected nonagenarians safely and with acceptable operative risk. After analysis our clinical experience we believe age alone not to be a contraindication for surgical intervention, consideration of the physiologic status of the patient reflects on the postoperative outcome. Survival of the patients investigated that survived the initial 30-day postoperative period was similar to the estimated survival of the equally aged general population in Germany.

  4. Dual-phase cardiac diffusion tensor imaging with strain correction.

    Directory of Open Access Journals (Sweden)

    Christian T Stoeck

    Full Text Available In this work we present a dual-phase diffusion tensor imaging (DTI technique that incorporates a correction scheme for the cardiac material strain, based on 3D myocardial tagging.In vivo dual-phase cardiac DTI with a stimulated echo approach and 3D tagging was performed in 10 healthy volunteers. The time course of material strain was estimated from the tagging data and used to correct for strain effects in the diffusion weighted acquisition. Mean diffusivity, fractional anisotropy, helix, transverse and sheet angles were calculated and compared between systole and diastole, with and without strain correction. Data acquired at the systolic sweet spot, where the effects of strain are eliminated, served as a reference.The impact of strain correction on helix angle was small. However, large differences were observed in the transverse and sheet angle values, with and without strain correction. The standard deviation of systolic transverse angles was significantly reduced from 35.9±3.9° to 27.8°±3.5° (p<0.001 upon strain-correction indicating more coherent fiber tracks after correction. Myocyte aggregate structure was aligned more longitudinally in systole compared to diastole as reflected by an increased transmural range of helix angles (71.8°±3.9° systole vs. 55.6°±5.6°, p<0.001 diastole. While diastolic sheet angle histograms had dominant counts at high sheet angle values, systolic histograms showed lower sheet angle values indicating a reorientation of myocyte sheets during contraction.An approach for dual-phase cardiac DTI with correction for material strain has been successfully implemented. This technique allows assessing dynamic changes in myofiber architecture between systole and diastole, and emphasizes the need for strain correction when sheet architecture in the heart is imaged with a stimulated echo approach.

  5. Cardiac Electrophysiology: Normal and Ischemic Ionic Currents and the ECG (United States)

    Klabunde, Richard E.


    Basic cardiac electrophysiology is foundational to understanding normal cardiac function in terms of rate and rhythm and initiation of cardiac muscle contraction. The primary clinical tool for assessing cardiac electrical events is the electrocardiogram (ECG), which provides global and regional information on rate, rhythm, and electrical…

  6. Cardiac carcinoid: tricuspid delayed hyperenhancement on cardiac 64-slice multidetector CT and magnetic resonance imaging.

    LENUS (Irish Health Repository)

    Martos, R


    INTRODUCTION: Carcinoid heart disease is a rare condition in adults. Its diagnosis can be easily missed in a patient presenting to a primary care setting. We revised the advantages of using coronary multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) in diagnosing this condition. MATERIALS AND METHODS: We studied a 65-year-old patient with carcinoid heart disease and right heart failure using transthoracic Doppler-echocardiogram, cardiac MDCT and MRI. Cardiac echocardiogram revealed marked thickening and retraction of the tricuspid leaflets with dilated right atrium and ventricle. Cardiac MDCT and MRI demonstrated fixation and retraction of the tricuspid leaflets with delayed contrast hyperenhancement of the tricuspid annulus. CONCLUSION: This case demonstrates fascinating imaging findings of cardiac carcinoid disease and highlights the increasing utility of contrast-enhanced MRI and cardiac MDCT in the diagnosis of this interesting condition.

  7. A severe penetrating cardiac injury in the absence of cardiac tamponade. (United States)

    Connelly, Tara M; Kolcow, Walenty; Veerasingam, Dave; DaCosta, Mark


    Penetrating cardiac injury is rare and frequently not survivable. Significant haemorrhage resulting in cardiac tamponade commonly ensues. Such cardiac tamponade is a clear clinical, radiological and sonographic indicator of significant underlying injury. In the absence of cardiac tamponade, diagnosis can be more challenging. In this case of a 26-year old sailor stabbed at sea, a significant pericardial effusion and cardiac tamponade did not occur despite an injury transversing the pericardium. Instead, the pericardial haemorrhage drained into the left pleural cavity resulting in a haemothorax. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion, a concomitant cerebrovascular event and a long delay from injury to appropriate medical treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate a primary chordae of the anterior mitral leaflet.

  8. Preventing tomorrow's sudden cardiac death today: part I: Current data on risk stratification for sudden cardiac death. (United States)

    Al-Khatib, Sana M; Sanders, Gillian D; Bigger, J Thomas; Buxton, Alfred E; Califf, Robert M; Carlson, Mark; Curtis, Anne; Curtis, Jeptha; Fain, Eric; Gersh, Bernard J; Gold, Michael R; Haghighi-Mood, Ali; Hammill, Stephen C; Healey, Jeff; Hlatky, Mark; Hohnloser, Stefan; Kim, Raymond J; Lee, Kerry; Mark, Daniel; Mianulli, Marcus; Mitchell, Brent; Prystowsky, Eric N; Smith, Joseph; Steinhaus, David; Zareba, Wojciech


    Accurate and timely prediction of sudden cardiac death (SCD) is a necessary prerequisite for effective prevention and therapy. Although the largest number of SCD events occurs in patients without overt heart disease, there are currently no tests that are of proven predictive value in this population. Efforts in risk stratification for SCD have focused primarily on predicting SCD in patients with known structural heart disease. Despite the ubiquity of tests that have been purported to predict SCD vulnerability in such patients, there is little consensus on which test, in addition to the left ventricular ejection fraction, should be used to determine which patients will benefit from an implantable cardioverter defibrillator. On July 20 and 21, 2006, a group of experts representing clinical cardiology, cardiac electrophysiology, biostatistics, economics, and health policy were joined by representatives of the US Food and Drug administration, Centers for Medicare Services, Agency for Health Research and Quality, the Heart Rhythm Society, and the device and pharmaceutical industry for a round table meeting to review current data on strategies of risk stratification for SCD, to explore methods to translate these strategies into practice and policy, and to identify areas that need to be addressed by future research studies. The meeting was organized by the Duke Center for the Prevention of SCD at the Duke Clinical Research Institute and was funded by industry participants. This article summarizes the presentations and discussions that occurred at that meeting.

  9. Quantification of wave reflection using peripheral blood pressure waveforms. (United States)

    Kim, Chang-Sei; Fazeli, Nima; McMurtry, M Sean; Finegan, Barry A; Hahn, Jin-Oh


    This paper presents a novel minimally invasive method for quantifying blood pressure (BP) wave reflection in the arterial tree. In this method, two peripheral BP waveforms are analyzed to obtain an estimate of central aortic BP waveform, which is used together with a peripheral BP waveform to compute forward and backward pressure waves. These forward and backward waves are then used to quantify the strength of wave reflection in the arterial tree. Two unique strengths of the proposed method are that 1) it replaces highly invasive central aortic BP and flow waveforms required in many existing methods by less invasive peripheral BP waveforms, and 2) it does not require estimation of characteristic impedance. The feasibility of the proposed method was examined in an experimental swine subject under a wide range of physiologic states and in 13 cardiac surgery patients. In the swine subject, the method was comparable to the reference method based on central aortic BP and flow. In cardiac surgery patients, the method was able to estimate forward and backward pressure waves in the absence of any central aortic waveforms: on the average, the root-mean-squared error between actual versus computed forward and backward pressure waves was less than 5 mmHg, and the error between actual versus computed reflection index was less than 0.03.

  10. Molecular Aspects of Exercise-induced Cardiac Remodeling. (United States)

    Bernardo, Bianca C; McMullen, Julie R


    Exercise-induced cardiac remodeling is typically an adaptive response associated with cardiac myocyte hypertrophy and renewal, increased cardiac myocyte contractility, sarcomeric remodeling, cell survival, metabolic and mitochondrial adaptations, electrical remodeling, and angiogenesis. Initiating stimuli/triggers of cardiac remodeling include increased hemodynamic load, increased sympathetic activity, and the release of hormones and growth factors. Prolonged and strenuous exercise may lead to maladaptive exercise-induced cardiac remodeling including cardiac dysfunction and arrhythmia. In addition, this article describes novel therapeutic approaches for the treatment of heart failure that target mechanisms responsible for adaptive exercise-induced cardiac remodeling, which are being developed and tested in preclinical models.

  11. Short-term Exposure to Microgravity and the Associated Risk of Sudden Cardiac Arrest: Implications for Commercial Spaceflight (United States)

    Laing, Kevin J. C.; Russamono, Thais


    The likelihood of trained astronauts developing a life threatening cardiac event during spaceflight is relatively rare, whilst the incidence in untrained individuals is unknown. Space tourists who live a sedentary lifestyle have reduced cardiovascular function, but the associated danger of sudden cardiac arrest (SCA) during a suborbital spaceflight (SOSF) is unclear. Risk during SOSF was examined by reviewing several microgravity studies and methods of determining poor cardiovascular condition. Accurately assessing cardiovascular function and improving baroreceptor sensitivity through exercise is suggested to reduce the incidence of SCA during future SOSFs. Future studies will benefit from past participants sharing medical history; allowing creation of risk profiles and suitable guidelines.

  12. Evaluation of a novel integrated sensor system for synchronous measurement of cardiac vibrations and cardiac potentials. (United States)

    Chuo, Yindar; Tavakolian, Kouhyar; Kaminska, Bozena


    The measurement of human body vibrations as a result of heart beating, simultaneously with cardiac potentials have been demonstrated in past studies to bring additional value to diagnostic cardiology through the detection of irregularities in the mechanical movement of the heart. The equipment currently available to the medical community is either large and bulky or difficult to synchronize. To address this problem, a novel integrated sensor system has been developed to record cardiac vibration and cardiac potential simultaneously and synchronously from a single compact site on the chest. The developed sensor system is lightweight, small in size, and suitable for mounting on active moving patients. The sensor is evaluated for its adequacy in measuring cardiac vibrations and potentials. In this evaluation, 45 independent signal recording are studied from 15 volunteers, and the morphology of the recorded signals are analyzed qualitatively (by visual inspection) and quantitatively (by computational methods) against larger devices used in established cardiac vibration studies (reference devices). It is found that the cardiac vibration signals acquired by the integrated sensor has 92.37% and 81.76% identically identifiable systolic and diastolic cardiac complexes, respectively, when compared to the cardiac vibration signals recorded simultaneously from the reference device. Further, the cardiac potential signals acquired by the integrated sensor show a high correlation coefficient of 0.8912 and a high estimated signal-to-noise-ratio of 22.00 dB when compared to the reference electrocardiograph (non-standard leads) acquired through a common clinical machine. The results suggest that the tiny, wearable, integrated sensor system that synchronously measures cardiac vibrations and cardiac potentials may be practical for use as an alternative or assistive cardiac diagnostic tool.

  13. Reflection and teaching: a taxonomy

    NARCIS (Netherlands)

    Vos, Henk; Cowan, John


    A major problem in teaching reflection is that educational objectives for reflection in terms of student behaviour are lacking. Therefore a taxonomy of reflection has been developed based on Bloom’s taxonomy. Reflective assignments can then be better focused on any chosen educational objectives. The

  14. Clinical linguistics: conversational reflections. (United States)

    Crystal, David


    This is a report of the main points I made in an informal "conversation" with Paul Fletcher and the audience at the 14th ICPLA conference in Cork. The observations arose randomly, as part of an unstructured 1-h Q&A, so they do not provide a systematic account of the subject, but simply reflect the issues which were raised by the conference participants during that time.

  15. Reflections and Interpretations

    DEFF Research Database (Denmark)

    Reflections and Interpretations is an anthology on The Freedom Writers’ methodology. It is an anthology for all those with a professional need for texts explaining, not only how The Freedom Writers’ tools are being used, but also why they work so convincingly well. It is not an anthology of guide...... of guidelines; it is an anthology of explanations based on theory. And it is an anthology written by Freedom Writer Teachers – who else could do it?...

  16. Subcutaneous Tissue Thickness is an Independent Predictor of Image Noise in Cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Staniak, Henrique Lane; Sharovsky, Rodolfo [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Pereira, Alexandre Costa [Hospital das Clínicas - Universidade de São Paulo, São Paulo, SP (Brazil); Castro, Cláudio Campi de; Benseñor, Isabela M.; Lotufo, Paulo A. [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil); Faculdade de Medicina - Universidade de São Paulo, São Paulo, SP (Brazil); Bittencourt, Márcio Sommer, E-mail: [Hospital Universitário - Universidade de São Paulo, São Paulo, SP (Brazil)


    Few data on the definition of simple robust parameters to predict image noise in cardiac computed tomography (CT) exist. To evaluate the value of a simple measure of subcutaneous tissue as a predictor of image noise in cardiac CT. 86 patients underwent prospective ECG-gated coronary computed tomographic angiography (CTA) and coronary calcium scoring (CAC) with 120 kV and 150 mA. The image quality was objectively measured by the image noise in the aorta in the cardiac CTA, and low noise was defined as noise < 30HU. The chest anteroposterior diameter and lateral width, the image noise in the aorta and the skin-sternum (SS) thickness were measured as predictors of cardiac CTA noise. The association of the predictors and image noise was performed by using Pearson correlation. The mean radiation dose was 3.5 ± 1.5 mSv. The mean image noise in CT was 36.3 ± 8.5 HU, and the mean image noise in non-contrast scan was 17.7 ± 4.4 HU. All predictors were independently associated with cardiac CTA noise. The best predictors were SS thickness, with a correlation of 0.70 (p < 0.001), and noise in the non-contrast images, with a correlation of 0.73 (p < 0.001). When evaluating the ability to predict low image noise, the areas under the ROC curve for the non-contrast noise and for the SS thickness were 0.837 and 0.864, respectively. Both SS thickness and CAC noise are simple accurate predictors of cardiac CTA image noise. Those parameters can be incorporated in standard CT protocols to adequately adjust radiation exposure.

  17. Ethanol exposure alters early cardiac function in the looping heart: a mechanism for congenital heart defects? (United States)

    Karunamuni, Ganga; Gu, Shi; Doughman, Yong Qiu; Peterson, Lindsy M; Mai, Katherine; McHale, Quinn; Jenkins, Michael W; Linask, Kersti K; Rollins, Andrew M; Watanabe, Michiko


    Alcohol-induced congenital heart defects are frequently among the most life threatening and require surgical correction in newborns. The etiology of these defects, collectively known as fetal alcohol syndrome, has been the focus of much study, particularly involving cellular and molecular mechanisms. Few studies have addressed the influential role of altered cardiac function in early embryogenesis because of a lack of tools with the capability to assay tiny beating hearts. To overcome this gap in our understanding, we used optical coherence tomography (OCT), a nondestructive imaging modality capable of micrometer-scale resolution imaging, to rapidly and accurately map cardiovascular structure and hemodynamics in real time under physiological conditions. In this study, we exposed avian embryos to a single dose of alcohol/ethanol at gastrulation when the embryo is sensitive to the induction of birth defects. Late-stage hearts were analyzed using standard histological analysis with a focus on the atrio-ventricular valves. Early cardiac function was assayed using Doppler OCT, and structural analysis of the cardiac cushions was performed using OCT imaging. Our results indicated that ethanol-exposed embryos developed late-stage valvuloseptal defects. At early stages, they exhibited increased regurgitant flow and developed smaller atrio-ventricular cardiac cushions, compared with controls (uninjected and saline-injected embryos). The embryos also exhibited abnormal flexion/torsion of the body. Our evidence suggests that ethanol-induced alterations in early cardiac function have the potential to contribute to late-stage valve and septal defects, thus demonstrating that functional parameters may serve as early and sensitive gauges of cardiac normalcy and abnormalities.

  18. Dynamic real-time 4D cardiac MDCT image display using GPU-accelerated volume rendering. (United States)

    Zhang, Qi; Eagleson, Roy; Peters, Terry M


    Intraoperative cardiac monitoring, accurate preoperative diagnosis, and surgical planning are important components of minimally-invasive cardiac therapy. Retrospective, electrocardiographically (ECG) gated, multidetector computed tomographical (MDCT), four-dimensional (3D + time), real-time, cardiac image visualization is an important tool for the surgeon in such procedure, particularly if the dynamic volumetric image can be registered to, and fused with the actual patient anatomy. The addition of stereoscopic imaging provides a more intuitive environment by adding binocular vision and depth cues to structures within the beating heart. In this paper, we describe the design and implementation of a comprehensive stereoscopic 4D cardiac image visualization and manipulation platform, based on the opacity density radiation model, which exploits the power of modern graphics processing units (GPUs) in the rendering pipeline. In addition, we present a new algorithm to synchronize the phases of the dynamic heart to clinical ECG signals, and to calculate and compensate for latencies in the visualization pipeline. A dynamic multiresolution display is implemented to enable the interactive selection and emphasis of volume of interest (VOI) within the entire contextual cardiac volume and to enhance performance, and a novel color and opacity adjustment algorithm is designed to increase the uniformity of the rendered multiresolution image of heart. Our system provides a visualization environment superior to noninteractive software-based implementations, but with a rendering speed that is comparable to traditional, but inferior quality, volume rendering approaches based on texture mapping. This retrospective ECG-gated dynamic cardiac display system can provide real-time feedback regarding the suspected pathology, function, and structural defects, as well as anatomical information such as chamber volume and morphology.

  19. Partial reflections of radio waves from the lower ionosphere (United States)

    Connolly, D. J.; Tanenbaum, S. B.


    The addition of phase difference measurements to partial reflection experiments is discussed, and some advantages of measuring electron density this way are pointed out. The additional information obtained reduces the requirement for an accurate predetermination of collision frequency. Calculations are also made to estimate the errors expected in partial-reflection experiments due to the assumption of Fresnel reflection and to the neglect of coupling between modes. In both cases, the errors are found to be of the same order as known errors in the measurements due to current instrumental limitations.

  20. Resolution of abnormal cardiac MRI T2 signal following immune suppression for cardiac sarcoidosis. (United States)

    Crouser, Elliott D; Ruden, Emily; Julian, Mark W; Raman, Subha V


    Cardiac MR (CMR) with late gadolinium enhancement is commonly used to detect cardiac damage in the setting of cardiac sarcoidosis. The addition of T2 mapping to CMR was recently shown to enhance cardiac sarcoidosis detection and correlates with increased cardiac arrhythmia risk. This study was conducted to determine if CMR T2 abnormalities and related arrhythmias are reversible following immune suppression therapy. A retrospective study of subjects with cardiac sarcoidosis with abnormal T2 signal on baseline CMR and a follow-up CMR study at least 4 months later was conducted at The Ohio State University from 2011 to 2015. Immune suppression treated participants had a significant reduction in peak myocardial T2 value (70.0±5.5 vs 59.2±6.1 ms, pretreatment vs post-treatment; p=0.017), and 83% of immune suppression treated subjects had objective improvement in cardiac arrhythmias. Two subjects who had received inadequate immune suppression treatment experienced progression of cardiac sarcoidosis. This report indicates that abnormal CMR T2 signal represents an acute inflammatory manifestation of cardiac sarcoidosis that is potentially reversible with adequate immune suppression therapy.

  1. Faulty cardiac repolarization reserve in alternating hemiplegia of childhood broadens the phenotype. (United States)

    Jaffer, Fatima; Avbersek, Andreja; Vavassori, Rosaria; Fons, Carmen; Campistol, Jaume; Stagnaro, Michela; De Grandis, Elisa; Veneselli, Edvige; Rosewich, Hendrik; Gianotta, Melania; Zucca, Claudio; Ragona, Francesca; Granata, Tiziana; Nardocci, Nardo; Mikati, Mohamed; Helseth, Ashley R; Boelman, Cyrus; Minassian, Berge A; Johns, Sophia; Garry, Sarah I; Scheffer, Ingrid E; Gourfinkel-An, Isabelle; Carrilho, Ines; Aylett, Sarah E; Parton, Matthew; Hanna, Michael G; Houlden, Henry; Neville, Brian; Kurian, Manju A; Novy, Jan; Sander, Josemir W; Lambiase, Pier D; Behr, Elijah R; Schyns, Tsveta; Arzimanoglou, Alexis; Cross, J Helen; Kaski, Juan P; Sisodiya, Sanjay M


    with those hemiplegia, have characteristics reflecting those of inherited cardiac channelopathies and most likely amount to impaired repolarization reserve. The dynamic electrocardiogram and neurological features point to periodic systemic decompensation in ATP1A3-expressing organs. Cardiac dysfunction may account for some of the unexplained premature mortality of alternating hemiplegia. Systematic cardiac investigation is warranted in alternating hemiplegia of childhood, as cardiac arrhythmic morbidity and mortality are potentially preventable.

  2. A smartphone based cardiac coherence biofeedback system. (United States)

    De Jonckheere, J; Ibarissene, I; Flocteil, M; Logier, R


    Cardiac coherence biofeedback training consist on slowing one's breathing to 0.1 Hz in order to simulate the baroreflex sensitivity and increase the respiratory sinus arrhythmia efficiency. Several studies have shown that these breathing exercises can constitute an efficient therapy in many clinical contexts like cardiovascular diseases, asthma, fibromyalgia or post-traumatic stress. Such a non-intrusive therapeutic solution needs to be performed on an 8 to 10 weeks period. Even if some heart rate variability based solutions exist, they presented some mobility constrain rendering these cardiac / respiratory control technologies more difficult to perform on a daily used. In this paper, we present a new simplified smartphone based solution allowing people to process efficient cardiac coherence biofeedback exercises. Based on photo-plethysmographic imaging through the smartphone camera, this sensor-less technology allows controlling cardiac coherence biofeedback exercises through a simplified heart rate variability algorithm.

  3. Depression After a Cardiac Event or Diagnosis (United States)

    ... Recognition & Awards Healthy Workplace Food and Beverage Toolkit Depression After A Cardiac Event or Diagnosis Updated:Jun 16,2014 Cardiovascular disease can trigger depression; counseling and medication can help beat it. When ...

  4. The Western Denmark Cardiac Computed Tomography Registry

    DEFF Research Database (Denmark)

    Nielsen, Lene Hüche; Nørgaard, Bjarne Linde; Tilsted, Hans Henrik;


    -CCTR, showed that coronary CT angiographies accounted for only 23% of all nonregistered cardiac CTs, indicating >90% completeness of coronary CT angiographies in the WDHR-CCTR. The completeness of individual variables varied substantially (range: 0%-100%), but was >85% for more than 70% of all variables. Using......BACKGROUND: As a subregistry to the Western Denmark Heart Registry (WDHR), the Western Denmark Cardiac Computed Tomography Registry (WDHR-CCTR) is a clinical database established in 2008 to monitor and improve the quality of cardiac computed tomography (CT) in Western Denmark. OBJECTIVE: We...... expected numbers; and 4) positive predictive values as well as negative predictive values of 19 main patient and procedure variables. RESULTS: By December 31, 2012, almost 22,000 cardiac CTs with up to 40 variables for each procedure have been registered. Of these, 87% were coronary CT angiography...

  5. Cardiac Computed Tomography (Multidetector CT, or MDCT) (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Computed Tomography (Multidetector CT, or MDCT) Updated:Sep 19, ... The ECG is also needed to help the computer that is connected to the CT scanner create ...

  6. Cardiac Imaging in Heart Failure with Comorbidities. (United States)

    Wong, Chiew; Chen, Sylvia; Iyngkaran, Pupalan


    Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.

  7. Cardiac tissue engineering: state of the art. (United States)

    Hirt, Marc N; Hansen, Arne; Eschenhagen, Thomas


    The engineering of 3-dimensional (3D) heart muscles has undergone exciting progress for the past decade. Profound advances in human stem cell biology and technology, tissue engineering and material sciences, as well as prevascularization and in vitro assay technologies make the first clinical application of engineered cardiac tissues a realistic option and predict that cardiac tissue engineering techniques will find widespread use in the preclinical research and drug development in the near future. Tasks that need to be solved for this purpose include standardization of human myocyte production protocols, establishment of simple methods for the in vitro vascularization of 3D constructs and better maturation of myocytes, and, finally, thorough definition of the predictive value of these methods for preclinical safety pharmacology. The present article gives an overview of the present state of the art, bottlenecks, and perspectives of cardiac tissue engineering for cardiac repair and in vitro testing.

  8. Incidental Cardiac Findings on Thoracic Imaging.

    LENUS (Irish Health Repository)

    Kok, Hong Kuan


    The cardiac structures are well seen on nongated thoracic computed tomography studies in the investigation and follow-up of cardiopulmonary disease. A wide variety of findings can be incidentally picked up on careful evaluation of the pericardium, cardiac chambers, valves, and great vessels. Some of these findings may represent benign variants, whereas others may have more profound clinical importance. Furthermore, the expansion of interventional and surgical practice has led to the development and placement of new cardiac stents, implantable pacemaker devices, and prosthetic valves with which the practicing radiologist should be familiar. We present a collection of common incidental cardiac findings that can be readily identified on thoracic computed tomography studies and briefly discuss their clinical relevance.

  9. Cardiac manifestations of Pallister-Killian syndrome. (United States)

    Tilton, Richard K; Wilkens, Alisha; Krantz, Ian D; Izumi, Kosuke


    Pallister-Killian syndrome (PKS) is a sporadic multisystem genetic diagnosis characterized by facial dysmorphia, variable developmental delay and intellectual impairment, hypotonia, hearing loss, seizures, differences in skin pigmentation, temporal alopecia, diaphragmatic hernia, congenital heart defects, and other systemic abnormalities. Although congenital heart defects have been described in association with PKS, the full spectrum of heart disease is still not entirely known. Here, we describe the pattern of cardiac findings of 81 probands with PKS who have had at least one cardiac evaluation, demonstrating structural heart difference in 37% of our cohort (n = 30). Septal defects such as atrial or ventricular septal defects (n = 12) were the most commonly seen congenital heart differences. Additional findings included the occasional occurrence of bicuspid aortic valve, aortic dilatation, and cardiac hypertrophy/cardiomyopathy. We suggest cardiac evaluation for all individuals with PKS at the time of diagnosis as well as subsequent longitudinal follow-up to monitor for the development of cardiomyopathy and aortic dilatation.

  10. Cardiac sarcoidosis. State of the art

    Directory of Open Access Journals (Sweden)

    Muñoz-Ortiz, Edison


    Full Text Available Sarcoidosis is a rare disease of unknown etiology, described over 80 years ago. It is a multisystemic disorder characterized by the presence of granulomatous lesions without caseation. Cardiac involvement varies according to the region, but it is generally accepted that 5 % of patients with systemic sarcoidosis have cardiac infiltration with clinical evidence; however, autopsy studies indicate that up to 20 % to 30 % of patients with sarcoidosis have myocardial involvement. Several factors -environmental, occupational and infectious- have been proposed as triggers of the process in individuals with genetic predisposition. Cardiac sarcoidosis may have a wide range of presentations and may even be asymptomatic; the most common manifestations are heart failure, abnormal heart rhythm and lethal ventricular arrhythmias. Treatment includes medications for heart failure, steroids and immune-suppressants, management of lethal arrhythmias with ablation and/or implantable cardioverter defibrillator and cardiac transplantation in severe cases.

  11. National Cardiac Device Surveillance Program Database (United States)

    Department of Veterans Affairs — The National Cardiac Device Surveillance Program Database supports the Eastern Pacemaker Surveillance Center (EPSC) staff in its function of monitoring some 11,000...

  12. Nanomaterials for Cardiac Myocyte Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Rodolfo Amezcua


    Full Text Available Since their synthesizing introduction to the research community, nanomaterials have infiltrated almost every corner of science and engineering. Over the last decade, one such field has begun to look at using nanomaterials for beneficial applications in tissue engineering, specifically, cardiac tissue engineering. During a myocardial infarction, part of the cardiac muscle, or myocardium, is deprived of blood. Therefore, the lack of oxygen destroys cardiomyocytes, leaving dead tissue and possibly resulting in the development of arrhythmia, ventricular remodeling, and eventual heart failure. Scarred cardiac muscle results in heart failure for millions of heart attack survivors worldwide. Modern cardiac tissue engineering research has developed nanomaterial applications to combat heart failure, preserve normal heart tissue, and grow healthy myocardium around the infarcted area. This review will discuss the recent progress of nanomaterials for cardiovascular tissue engineering applications through three main nanomaterial approaches: scaffold designs, patches, and injectable materials.

  13. Cardiac, Skeletal, and smooth muscle mitochondrial respiration

    DEFF Research Database (Denmark)

    Park, Song-Young; Gifford, Jayson R; Andtbacka, Robert H I


    Unlike cardiac and skeletal muscle, little is known about vascular smooth muscle mitochondrial function. Therefore, this study examined mitochondrial respiratory rates in the smooth muscle of healthy human feed arteries and compared with that of healthy cardiac and skeletal muscle. Cardiac......, skeletal, and smooth muscle was harvested from a total of 22 subjects (53±6 yrs) and mitochondrial respiration assessed in permeabilized fibers. Complex I+II, state 3 respiration, an index of oxidative phosphorylation capacity, fell progressively from cardiac, skeletal, to smooth muscle (54±1; 39±4; 15......±1 pmol•s(-1)•mg (-1), psmooth muscle (222±13; 115±2; 48±2 umol•g(-1)•min(-1), p

  14. How performance feedback and reflection affect transactive memory

    NARCIS (Netherlands)

    Kleij, R. van der; Hoeppermans, M.


    Research on transactive memory has showed the positive effects of training together. This study investigated how feedback and reflection affect transactive memory in settings where there is no time for elaborate team training. Newly formed teams were given accurate, false or no feedback about their

  15. Evaluation of Reflections in a MIMO OTA Test Setup

    DEFF Research Database (Denmark)

    Barrio, Samantha Caporal Del; Franek, Ondrej; Krenz, Gunter


    With the commercialization of MIMO devices, accurate over-the-air testing has become a major research area in mobile communications. Several test methods are investigated in the related work. This paper discusses the anechoic chamber method and specifically deals with reflections between probes...

  16. Emerging Biomarkers in Heart Failure and Cardiac Cachexia

    Directory of Open Access Journals (Sweden)

    Goran Loncar


    Full Text Available Biomarkers are objective tools with an important role for diagnosis, prognosis and therapy optimization in patients with heart failure (HF. To date, natriuretic peptides are closest to optimal biomarker standards for clinical implications in HF. Therefore, the efforts to identify and test new biomarkers in HF are reasonable and justified. Along the natural history of HF, cardiac cachexia may develop, and once at this stage, patient performance and prognosis is particularly poor. For these reasons, numerous biomarkers reflecting hormonal, inflammatory and oxidative stress pathways have been investigated, but only a few convey relevant information. The complex pathophysiology of HF appears far too complex to be embraced by a single biomarker; thus, a combined approach appears reasonable. With these considerations, we have reviewed the recent developments in the field to highlight key candidates with diagnostic, prognostic and therapy optimization properties, either alone or in combination.

  17. Simulation Tool for GNSS Ocean Surface Reflections (United States)

    Høeg, Per; von Benzon, Hans-Henrik; Durgonics, Tibor


    GNSS coherent and incoherent reflected signals have the potential of deriving large scale parameters of ocean surfaces, as barotropic variability, eddy currents and fronts, Rossby waves, coastal upwelling, mean ocean surface heights, and patterns of the general ocean circulation. In the reflection zone the measurements may derive parameters as sea surface roughness, winds, waves, heights and tilts from the spectral measurements. Previous measurements from the top of mountains and airplanes have shown such results leading. The coming satellite missions, CYGNSS, COSMIC-2, and GEROS on the International Space Station, are focusing on GNSS ocean reflection measurements. Thus, simulation studies highlighting the assumptions for the data retrievals and the precision and the accuracy of such measurements are of interest for assessing the observational method. The theory of propagation of microwaves in the atmosphere is well established, and methods for propagation modeling range from ray tracing to numerical solutions to the wave equation. Besides ray tracing there are propagation methods that use mode theory and a finite difference solution to the parabolic equation. The presented propagator is based on the solution of the parabolic equation. The parabolic equation in our simulator is solved using the split-step sine transformation. The Earth's surface is modeled with the use of an impedance model. The value of the Earth impedance is given as a function of the range along the surface of the Earth. This impedance concept gives an accurate lower boundary condition in the determination of the electromagnetic field, and makes it possible to simulate reflections and the effects of transitions between different mediums. A semi-isotropic Philips spectrum is used to represent the air-sea interaction. Simulated GPS ocean surface reflections will be presented and discussed based on different ocean characteristics. The spectra of the simulated surface reflections will be analyzed

  18. Methemoglobinaemia in Cardiac Patients on Nitrate Therapy

    Directory of Open Access Journals (Sweden)

    Abdel Aziz A. Ghanem


    Full Text Available Background: Methaemoglobinaemia refers to the oxidation of ferrous iron to ferric iron within the haemoglobin molecule, which occurs following oxidative stresses. The subsequent impairment in oxygen transport may lead to progressive hypoxia that is highly dangerous condition especially in borderline patients like the cardiac patient.Objectives: In the present work, authors explore the extent of methaemoglobinaemia in cardiac patients receiving nitrate therapy.Methodology: The study included 970 cardiac patients presented in cardiology department, Mansoura Specialised Medical Hospital, Egypt, in the period from February to July 2009. Patients were taking oral, sublingual, dermal preparation or a combination of two preparations.Results: cases of the study had methemoglobin level 1.1782 ± 0.3476 g/dL with insignificant difference between males and females. Methemoglobin showed positive correlation with carboxyhemogloin and negative correlation with O2 content and O2 saturation. It was significantly higher in cardiac patient with chest infection, anaemia and diabetic patients but didn't differ in hepatic or non hepatic cardiac patients. 3.2% of cardiac patients who receive more than one nitrate preparation (either oral and dermal or oral and sublingual therapy have methemoglobin level significantly higher than those who receive single preparation. There is significant difference in methemoglobin level in cardiac patients complaining of myocardial infarction “MI”, unstable Angina, atrial fibrillation “AF” and hypertensive heart disease “HTN”.Conclusions: It is concluded that commonly used dosages of nitrates are capable of causing elevations of methemoglobin ranged from 0.9 – 5.3 g/dl. Although the elevation in methaemoglobin (MetHb levels was not of routine clinical significance, there was statistically significant increase in MetHb levels in cardiac patients with another pathologic condition as anaemia, diabetes mellitus or chest

  19. Blunt cardiac rupture in a toddler

    Directory of Open Access Journals (Sweden)

    Peep Talving


    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  20. The obesity paradox in cardiac arrest patients. (United States)

    Chalkias, Athanasios; Xanthos, Theodoros


    Evidence from clinical cohorts indicates an obesity paradox in overweight and obese patients who seem to have a more favorable short-term and long-term prognosis than leaner patients. Although obese cardiac arrest victims are theoretically more difficult to be resuscitated due to difficulties in providing adequate chest compressions, ventilation, and oxygenation, research so far has shown that there is an obesity paradox in cardiac arrest.

  1. Automated Segmentation of Cardiac Magnetic Resonance Images

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Nilsson, Jens Chr.; Grønning, Bjørn A.


    is based on determination of the left-ventricular endocardial and epicardial borders. Since manual border detection is laborious, automated segmentation is highly desirable as a fast, objective and reproducible alternative. Automated segmentation will thus enhance comparability between and within cardiac...... studies and increase accuracy by allowing acquisition of thinner MRI-slices. This abstract demonstrates that statistical models of shape and appearance, namely the deformable models: Active Appearance Models, can successfully segment cardiac MRIs....

  2. Anesthetic issues for robotic cardiac surgery


    Wendy K Bernstein; Andrew Walker


    As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiolog...

  3. Cardiac CT Angiography in Congestive Heart Failure. (United States)

    Levine, Avi; Hecht, Harvey S


    Cardiac CT angiography has become an important tool for the diagnosis and treatment of congestive heart failure. Differentiation of ischemic from nonischemic cardiomyopathy; evaluation of myocardial perfusion; characterization of hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia; and delineation of congenital heart defects and valvular abnormalities are the primary diagnostic applications. Therapeutic use includes visualization of the coronary venous anatomy for optimal implementation of cardiac resynchronization therapy and evaluation of left ventricular assist devices and transplant vasculopathy.

  4. Management of Cardiac Electronic Device Infections

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nielsen, Jens Cosedis


    Cardiac implantable electronic device (CIED) infection is an increasing problem. Reasons for this are uncertain, but likely relate to an increasing proportion of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices implanted, as well as implantations...... in 'higher risk' candidates, i.e. patients with heart failure, diabetes and renal failure. Challenges within the field of CIED infections are multiple with prevention being the most important challenge. Careful prescription of CIED treatment and careful patient preparation before implantation is important...

  5. Graded vascular autonomic control versus discontinuous cardiac control during gradual upright tilt. (United States)

    Bahjaoui-Bouhaddi, M; Cappelle, S; Henriet, M T; Dumoulin, G; Wolf, J P; Regnard, J


    Indexes of heart rate variability (HRV) and the slope of cardiac baroreflex are extensively used for non invasive assessment of circulatory autonomic control in pathophysiology. We performed this study (1) to assess the sensitivity of these indexes towards small graded postural stimulations and (2) to delineate the informations provided about the settings of both vascular tone and cardiac activity. Twenty healthy subjects were randomly tilted for eight minutes at each of the six angles: -10 degrees, 0 degrees (supine), 10 degrees, 30 degrees, 45 degrees, and 60 degrees. Instant RR-interval and finger blood pressure (BP) were continuously recorded, and venous blood was collected at the end of each 8 min position for catecholamines determination. Group average heart rate, noradrenaline and diastolic BP (DBP) increased linearly with head-up tilt angle from 10 degrees. Systolic BP (SBB) ranked only two distinct series -10 degrees, 0 degrees, 10 degrees versus 30 degrees, 45 degrees, 60 degrees, as did the number of spontaneous baroreflex (SBR) sequences. The spectral power of the low-frequency (LF) and high-frequency (HF) of RR variability and the ratio LF/HF changed rather abruptly from either 30 degrees or 45 degrees, depending on each individual. Both HF/tot i.e. the ratio of HF to total spectral RR variability and the slope of SBR decreased markedly from 10 degrees to 30 degrees and less but more gradually from 30 degrees to 60 degrees. Thus, our observations argue for gradual adjustments of vascular tone as reflected by highly consistent changes in plasma noradrenaline and diastolic arterial pressure, contrasting with a main discontinuous autonomic setting of cardiac activity as reflected by changes in the harmonic components of spectral RR variability and in the slope of cardiac baroreflex. The pattern of changes in systolic arterial pressure attested the discontinuous cardiac autonomic control rather than the gradual setting of arterial tone. We submit that

  6. Role of Circulating Fibrocytes in Cardiac Fibrosis

    Institute of Scientific and Technical Information of China (English)

    Rong-Jie Lin; Zi-Zhuo Su; Shu-Min Liang; Yu-Yang Chen; Xiao-Rong Shu; Ru-Qiong Nie; Jing-Feng Wang


    Objective: It is revealed that circulating fibrocytes are elevated in patients/animals with cardiac fibrosis, and this review aims to provide an introduction to circulating fibrocytes and their role in cardiac fibrosis.Data Sources: This review is based on the data from 1994 to present obtained from PubMed.The search terms were "circulating fibrocytes" and "cardiac fibrosis".Study Selection: Articles and critical reviews, which are related to circulating fibrocytes and cardiac fibrosis, were selected.Results: Circulating fibrocytes, which are derived from hematopoietic stem cells, represent a subset of peripheral blood mononuclear cells exhibiting mixed morphological and molecular characteristics ofhematopoietic and mesenchymal cells (CD34+/CD45+/collagen I+).They can produce extracellular matrix and many cytokines.It is shown that circulating fibrocytes participate in many fibrotic diseases, including cardiac fibrosis.Evidence accumulated in recent years shows that aging individuals and patients with hypertension, heart failure, coronary heart disease, and atrial fibrillation have more circulating fibrocytes in peripheral blood and/or heart tissue, and this elevation of circulating fibrocytes is correlated with the degree of fibrosis in the hearts.Conclusions: Circulating fibrocytes are effector cells in cardiac fibrosis.

  7. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest (United States)

    Abdelghani, Samy A.; Rosenthal, Todd M.; Morin, Daniel P.


    Background: Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. Methods: We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. Results: Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. Conclusion: At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators. PMID:27660578

  8. Ultrasound assessment of fetal cardiac function (United States)

    Crispi, Fàtima; Valenzuela‐Alcaraz, Brenda; Cruz‐Lemini, Monica


    Abstract Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function. PMID:28191192

  9. Epigenetic mechanisms in cardiac development and disease

    Institute of Scientific and Technical Information of China (English)

    Marcus Vallaster; Caroline Dacwag Vallaster; Sean M. Wu


    During mammalian development,cardiac specification and ultimately lineage commitment to a specific cardiac cell type is accomplished by the action of specific transcription factors (TFs) and their meticulous control on an epigenetic level.In this review,we detail how cardiacspecific TFs function in concert with nucleosome remodeling and histone-modifying enzymes to regulate a diverse network of genes required for processes such as cell growth and proliferation,or epithelial to mesenchymal transition (EMT),for instance.We provide examples of how several cardiac TFs,such as Nkx2.5,WHSC1,Tbx5,and Tbx1,which are associated with developmental and congenital heart defects,are required for the recruitment of histone modifiers,such as Jarid2,p300,and Ash21,and components of ATP-dependent remodeling enzymes like Brg1,Baf60c,and Baf180.Binding of these TFs to their respective sites at cardiac genes coincides with a distinct pattern of histone marks,indicating that the precise regulation of cardiac gene networks is orchestrated by interactions between TFs and epigenetic modifiers.Furthermore,we speculate that an epigenetic signature,comprised of TF occupancy,histone modifications,and overall chromatin organization,is an underlying mechanism that governs cardiac morphogenesis and disease.

  10. Stem cells for cardiac repair: an introduction

    Institute of Scientific and Technical Information of China (English)

    Bastiaan C du Pr(e); Pieter A Doevendans; Linda W van Laake


    Cardiovascular disease is a major cause of morbidity and mortality throughout the world. Most cardiovascular diseases, such as ischemic heart disease and cardiomyopathy, are associated with loss of functional cardiomyocytes. Unfortunately, the heart has a limited regenerative capacity and is not able to replace these cardiomyocytes once lost. In recent years, stem cells have been put forward as a potential source for cardiac regeneration. Pre-clinical studies that use stem cell-derived cardiac cells show promising results. The mechanisms, though, are not well understood, results have been variable, sometimes transient in the long term, and often without a mechanistic explanation. There are still several major hurdles to be taken. Stem cell-derived cardiac cells should resemble original cardiac cell types and be able to integrate in the damaged heart. Integration requires administration of stem cell-derived cardiac cells at the right time using the right mode of delivery. Once delivered, transplanted cells need vascularization, electrophysiological coupling with the injured heart, and prevention of immunological rejection. Finally, stem cell therapy needs to be safe, reproducible, and affordable. In this review, we will give an introduction to the principles of stem cell based cardiac repair.

  11. Stem cell sources for cardiac regeneration. (United States)

    Roccio, M; Goumans, M J; Sluijter, J P G; Doevendans, P A


    Cell-based cardiac repair has the ambitious aim to replace the malfunctioning cardiac muscle developed after myocardial infarction, with new contractile cardiomyocytes and vessels. Different stem cell populations have been intensively studied in the last decade as a potential source of new cardiomyocytes to ameliorate the injured myocardium, compensate for the loss of ventricular mass and contractility and eventually restore cardiac function. An array of cell types has been explored in this respect, including skeletal muscle, bone marrow derived stem cells, embryonic stem cells (ESC) and more recently cardiac progenitor cells. The best-studied cell types are mouse and human ESC cells, which have undisputedly been demonstrated to differentiate into cardiomyocyte and vascular lineages and have been of great help to understand the differentiation process of pluripotent cells. However, due to their immunogenicity, risk of tumor development and the ethical challenge arising from their embryonic origin, they do not provide a suitable cell source for a regenerative therapy approach. A better option, overcoming ethical and allogenicity problems, seems to be provided by bone marrow derived cells and by the recently identified cardiac precursors. This report will overview current knowledge on these different cell types and their application in cardiac regeneration and address issues like implementation of delivery methods, including tissue engineering approaches that need to be developed alongside.

  12. Role of Circulating Fibrocytes in Cardiac Fibrosis (United States)

    Lin, Rong-Jie; Su, Zi-Zhuo; Liang, Shu-Min; Chen, Yu-Yang; Shu, Xiao-Rong; Nie, Ru-Qiong; Wang, Jing-Feng; Xie, Shuang-Lun


    Objective: It is revealed that circulating fibrocytes are elevated in patients/animals with cardiac fibrosis, and this review aims to provide an introduction to circulating fibrocytes and their role in cardiac fibrosis. Data Sources: This review is based on the data from 1994 to present obtained from PubMed. The search terms were “circulating fibrocytes” and “cardiac fibrosis”. Study Selection: Articles and critical reviews, which are related to circulating fibrocytes and cardiac fibrosis, were selected. Results: Circulating fibrocytes, which are derived from hematopoietic stem cells, represent a subset of peripheral blood mononuclear cells exhibiting mixed morphological and molecular characteristics of hematopoietic and mesenchymal cells (CD34+/CD45+/collagen I+). They can produce extracellular matrix and many cytokines. It is shown that circulating fibrocytes participate in many fibrotic diseases, including cardiac fibrosis. Evidence accumulated in recent years shows that aging individuals and patients with hypertension, heart failure, coronary heart disease, and atrial fibrillation have more circulating fibrocytes in peripheral blood and/or heart tissue, and this elevation of circulating fibrocytes is correlated with the degree of fibrosis in the hearts. Conclusions: Circulating fibrocytes are effector cells in cardiac fibrosis. PMID:26831236

  13. Biomimetic materials design for cardiac tissue regeneration. (United States)

    Dunn, David A; Hodge, Alexander J; Lipke, Elizabeth A


    Cardiovascular disease is the leading cause of death worldwide. In the absence of sufficient numbers of organs for heart transplant, alternate approaches for healing or replacing diseased heart tissue are under investigation. Designing biomimetic materials to support these approaches will be essential to their overall success. Strategies for cardiac tissue engineering include injection of cells, implantation of three-dimensional tissue constructs or patches, injection of acellular materials, and replacement of valves. To replicate physiological function and facilitate engraftment into native tissue, materials used in these approaches should have properties that mimic those of the natural cardiac environment. Multiple aspects of the cardiac microenvironment have been emulated using biomimetic materials including delivery of bioactive factors, presentation of cell-specific adhesion sites, design of surface topography to guide tissue alignment and dictate cell shape, modulation of mechanical stiffness and electrical conductivity, and fabrication of three-dimensional structures to guide tissue formation and function. Biomaterials can be engineered to assist in stem cell expansion and differentiation, to protect cells during injection and facilitate their retention and survival in vivo, and to provide mechanical support and guidance for engineered tissue formation. Numerous studies have investigated the use of biomimetic materials for cardiac regeneration. Biomimetic material design will continue to exploit advances in nanotechnology to better recreate the cellular environment and advance cardiac regeneration. Overall, biomimetic materials are moving the field of cardiac regenerative medicine forward and promise to deliver new therapies in combating heart disease.

  14. Weighted Nuclear Norm Minimization Based Tongue Specular Reflection Removal

    Directory of Open Access Journals (Sweden)

    Zhenchao Cui


    Full Text Available In computational tongue diagnosis, specular reflection is generally inevitable in tongue image acquisition, which has adverse impact on the feature extraction and tends to degrade the diagnosis performance. In this paper, we proposed a two-stage (i.e., the detection and inpainting pipeline approach to address this issue: (i by considering both highlight reflection and subreflection areas, a superpixel-based segmentation method was adopted for the detection of the specular reflection areas; (ii by extending the weighted nuclear norm minimization (WNNM model, a nonlocal inpainting method is proposed for specular reflection removal. Experimental results on synthetic and real images show that the proposed method is accurate in detecting the specular reflection areas and is effective in restoring tongue image with more natural texture information of tongue body.

  15. Plasma cytokines do not reflect expression of pro- and anti-inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs

    DEFF Research Database (Denmark)

    Brix-Christensen, V.; Vestergaard, C.; Chew, M.


    Background: Plasma concentrations of inflammatory markers are increased in response to the trauma of cardiac surgery and cardiopulmonary bypass (CPB). It is, however, unknown whether the plasma cytokine levels and cytokine mRNA expression at organ level reflect each other. Methods: Twenty-six pig...... poorly reflected mRNA expression of the pro- and anti-inflammatory cytokines....

  16. Troponin not just a simple cardiac marker: prognostic significance of cardiac troponin

    Institute of Scientific and Technical Information of China (English)

    Benny Mulyanto Setiadi; LEI Han; CHANG Jing


    Objective The object of this study was to review the role of cardiac troponin as a prognostic factor in acute coronary syndrome patients of varying circumstances.Data sources The data used in this review were obtained mainly from the studies of cardiac troponin reported in pubmed from 1981 to 2006.Study selection Relevant articles on studies of cardiac troponin were selected.Results Elevated cardiac troponin in patients with ST elevation and non ST elevation myocardial infarction was associated with adverse outcomes, including a higher incidence of congestive heart failure, shock, and death. Patients with elevated cardiac troponin value seemed to benefit more from invasive strategies including a percutaneous coronary intervention and bypass surgery, but elevated cardiac troponin was also correlated with adverse outcomes, including a higher degree of failure, shock, and mortality in patients undergoing percutaneous coronary intervention; a higher degree of perioperative myocardial infarction, low cardiac output syndrome, cardiopulmonary resuscitation, and new-onset ventricular arrhythmia in patients undergoing bypass surgery were also observed. Elevated troponin after a percutaneous coronary intervention seemed to be associated with short-term adverse outcomes rather than long-term adverse outcomes, unless the elevation of the troponin post percutaneous coronary intervention was quite high (about 5 times above normal). On the contrary, elevated cardiac troponin after bypass surgery was more confusing to analyze since it happened in almost all patients. Furthermore, differences in cutoff values and time measurements in some studies add more confusion; thus, further research is warranted.Conclusions The prognostic value of cardiac troponin is demonstrated in almost all acute coronary syndrome patients. In addition to its high sensitivity and specificity, the prognostic value of cardiac troponin is another reason to make it the "golden cardiac marker' of this time.

  17. Transplantation of 5-azacytidine treated cardiac fibroblasts improves cardiac function of infarct hearts in rats

    Institute of Scientific and Technical Information of China (English)

    TANG Cheng-chun; MA Gan-shan; CHEN Ji-yuan


    Background Cellular cardiomyoplasty by transplantation of various cell types has been investigated as potential treatments for the improvement of cardiac function after myocardial injury. A major barrier for the clinical application of cell transplantation is obtaining sufficiently large quantities of suitable cells. AIIogeneic cellular cardiomyoplasty may provide an alternative source of abundant, transplantable, myogenic cells by in vitro manipulation of cardiac fibroblasts using chemicals including 5-azacytidine. This study evaluated cardiomyogenic differentiation of cardiac fibroblasts, their survival in myocardial scar tissue, and the effect of the implanted cells on heart function.Methods Primary cardiac fibroblasts from neonatal rats were treated with 5-azacytidine (10 μmol/L) or control.Treatment of 5-azacytidine caused myogenic differentiation of cultured cardiac fibroblasts, as defined by elongation and fusion into multinucleated myotubes with sarcomeric structures as identified by electron microscopy, and positive immunostaining for cardiac specific proteins, troponin I and β-myosin heavy chain (β-MHC) and the gap junction protein connexin 43. The myogenic cells (1.0x106) were transplanted into the infarcted myocardium 2 weeks after coronary artery occlusion.Results By 1 month after transplantation, the converted fibroblasts gave rise to a cluster of cardiac-like muscle cells that in the hearts occupied a large part of the scar with positive immunostaining for the myogenic proteins troponin I and β-MHC. Engrafted cells also expressed the gap junction protein connexin 43 in a disorganized manner. There was no positive staining in the control hearts treated with injections of culture medium. Heart function was evaluated at 6 weeks after myocardial injury with echocardiographic and hemodynamic measurements. Improvement in cardiac function was seen in the hearts transplanted with the 5-azacytidine-treated cardiac fibroblasts which was absent in the

  18. Cardiac MRI for myocardial ischemia.

    LENUS (Irish Health Repository)

    Daly, Caroline


    Proper assessment of the physiologic impact of coronary artery stenosis on the LV myocardium can affect patient prognosis and treatment decisions. Cardiac magnetic resonance imaging (CMR) assesses myocardial perfusion by imaging the myocardium during a first-pass transit of an intravenous gadolinium bolus, with spatial and temporal resolution substantially higher than nuclear myocardial perfusion imaging. Coupled with late gadolinium enhancement (LGE) imaging for infarction during the same imaging session, CMR with vasodilating stress perfusion imaging can qualitatively and quantitatively assess the myocardial extent of hypoperfusion from coronary stenosis independent of infarcted myocardium. This approach has been validated experimentally, and multiple clinical trials have established its diagnostic robustness when compared to stress single-photon emission computed tomography. In specialized centers, dobutamine stress CMR has been shown to have incremental diagnostic value above stress echocardiography due to its high imaging quality and ability to image the heart with no restriction of imaging window. This paper reviews the technical aspects, diagnostic utility, prognostic values, challenges to clinical adaptation, and future developments of stress CMR imaging.

  19. Microwave Treatment for Cardiac Arrhythmias (United States)

    Hernandez-Moya, Sonia


    NASA seeks to transfer the NASA developed microwave ablation technology, designed for the treatment of ventricular tachycardia (irregular heart beat), to industry. After a heart attack, many cells surrounding the resulting scar continue to live but are abnormal electrically; they may conduct impulses unusually slowly or fire when they would typically be silent. These diseased areas might disturb smooth signaling by forming a reentrant circuit in the muscle. The objective of microwave ablation is to heat and kill these diseased cells to restore appropriate electrical activity in the heart. This technology is a method and apparatus that provides for propagating microwave energy into heart tissues to produce a desired temperature profile therein at tissue depths sufficient for thermally ablating arrhythmogenic cardiac tissue while preventing excessive heating of surrounding tissues, organs, and blood. A wide bandwidth double-disk antenna is effective for this purpose over a bandwidth of about six gigahertz. A computer simulation provides initial screening capabilities for an antenna such as antenna, frequency, power level, and power application duration. The simulation also allows optimization of techniques for specific patients or conditions. In comparison with other methods that involve direct-current pulses or radio frequencies below 1 GHz, this method may prove more effective in treating ventricular tachycardia. This is because the present method provides for greater control of the location, cross-sectional area, and depth of a lesion via selection of the location and design of the antenna and the choice of microwave power and frequency.

  20. Functional and morphological cardiac magnetic resonance imaging of mice using a cryogenic quadrature radiofrequency coil.

    Directory of Open Access Journals (Sweden)

    Babette Wagenhaus

    Full Text Available Cardiac morphology and function assessment by magnetic resonance imaging is of increasing interest for a variety of mouse models in pre-clinical cardiac research, such as myocardial infarction models or myocardial injury/remodeling in genetically or pharmacologically induced hypertension. Signal-to-noise ratio (SNR constraints, however, limit image quality and blood myocardium delineation, which crucially depend on high spatial resolution. Significant gains in SNR with a cryogenically cooled RF probe have been shown for mouse brain MRI, yet the potential of applying cryogenic RF coils for cardiac MR (CMR in mice is, as of yet, untapped. This study examines the feasibility and potential benefits of CMR in mice employing a 400 MHz cryogenic RF surface coil, compared with a conventional mouse heart coil array operating at room temperature. The cryogenic RF coil affords SNR gains of 3.0 to 5.0 versus the conventional approach and hence enables an enhanced spatial resolution. This markedly improved image quality--by better deliniation of myocardial borders and enhanced depiction of papillary muscles and trabeculae--and facilitated a more accurate cardiac chamber quantification, due to reduced intraobserver variability. In summary the use of a cryogenically cooled RF probe represents a valuable means of enhancing the capabilities of CMR of mice.