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Sample records for cardiac failure caused

  1. Giant cardiac fibroma: an unusual cause of failure to thrive.

    Science.gov (United States)

    Navarini, Susanne; Latzin, Philipp; Kadner, Alexander; Carrel, Thierry; Hutter, Damian

    2013-06-01

    Cardiac fibromas are extremely rare in the general pediatric population and may present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 14-month-old boy who presented with failure to thrive as the only symptom. Echocardiography showed a large cardiac fibroma in the right ventricle. Cardiac magnetic resonance imaging confirmed the diagnosis. After complete surgical tumor resection, the boy showed normal catch-up growth. This case underlines the diversity of clinical features of cardiac tumors, which implies that they should be considered early in the differential diagnosis of infants with failure to thrive.

  2. Systemic arteriovenous malformations as a cause of cardiac failure: Treatment with embolization

    International Nuclear Information System (INIS)

    Smith, E.J.; Hemingway, A.P.; Allison, D.J.

    1987-01-01

    Massive cogenital systemic arteriovenous malformations (AVMs) present considerable management problems for clinicians. Their size, position, and vascularity make successful surgical reaction impossible. Attempts at resection produce only temporary relief of symptoms and cause further disfigurement. Large AVMs give rise to pain, swelling, and distal ischaemia, can erode bone, and give rise to life-threatening hemorrhage, and a massive left or right shunt causes high-output cardiac failure and death. Ten patients (age range, 5-50 years; mean 26 years) have massive AVMs giving rise to high-output cardiac failure (26-28 liters). These patients (seven male, three female), have undergone a total of 43 embolization procedures. The advent of nonionic contrast media, digital subtraction angiography, steel coils, and balloons allows us to successfully treat these patients who until recently were condemned to die in high-output cardiac failure

  3. Identification of cellular targets involved in cardiac failure caused by PKI in oncology: an approach combining pharmacovigilance and pharmacodynamics.

    Science.gov (United States)

    Patras de Campaigno, Emilie; Bondon-Guitton, Emmanuelle; Laurent, Guy; Montastruc, Francois; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse; Despas, Fabien

    2017-07-01

    The aims of the present study were to evaluate the risk of cardiac failure (CF) associated with 15 anticancer protein kinase inhibitors (PKIs) through a case/noncase analysis and to identify which PK(s) and pathways are involved in PKI-induced CF. In order to evaluate the risk of CF, adjusted reporting odds ratios (aRORs) were calculated for the 15 anticancer PKIs in the World Health Organization safety report database (VigiBase®). We realised a literature review to identify 21 protein kinases (PKs) that were possibly involved in CF caused by PKIs. Pearson correlation coefficients (r) between aRORs and affinity data of the 15 PKIs for the 21 PKs were calculated to identify the cellular target most likely to be involved in PKI-induced CF. A total of 141 601 individual case safety reports (ICSRs) were extracted from VigiBase® for the following PKIs: afatinib, axitinib, bosutinib, crizotinib, dasatinib, erlotinib, gefitinib, imatinib, lapatinib, nilotinib, pazopanib, ruxolitinib, sorafenib, sunitinib and vandetanib. Among them, 2594 ICSRs concerned CF. The disproportionality analysis revealed that, for dasatinib, imatinib, bosutinib, sunitinib and nilotinib, disproportionality for CF was significantly higher than for other PKIs, with aRORs of 2.52 [95% CI 2.26, 2.82], 1.79 (95% CI 1.57, 2.03), 1.73 (95% CI 1.18, 2.54), 1.67 (95% CI 1.51, 1.84) and 1.38 (95% CI 1.18, 1.61), respectively. Significant values for correlation coefficients between the product of dissociation constant (pKd) and aROR were observed for two non-receptor protein kinases: ABL1 (non-phosphorylated and phosphorylated forms) and ABL2 protein kinases, with values of r = 0.83 (P = 0.0001), r = 0.75 (P = 0.0014) and r = 0.78 (P = 0.0006), respectively. We observed a higher disproportionality for CF with dasatinib, imatinib, bosutinib, sunitinib and nilotinib than with other PKIs. In addition, the study highlighted the role of ABL tyrosine kinases in CF caused by anticancer PKIs. © 2017 The British

  4. [Acute cardiac failure in pheochromocytoma.

    DEFF Research Database (Denmark)

    Jønler, Morten; Munk, Kim

    2008-01-01

    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...

  5. Heart failure and sudden cardiac death in heritable thoracic aortic disease caused by pathogenic variants in the SMAD3 gene.

    Science.gov (United States)

    Backer, Julie De; Braverman, Alan C

    2018-05-01

    Predominant cardiovascular manifestations in the spectrum of Heritable Thoracic Aortic Disease include by default aortic root aneurysms- and dissections, which may be associated with aortic valve disease. Mitral- and tricuspid valve prolapse are other commonly recognized features. Myocardial disease, characterized by heart failure and/or malignant arrhythmias has been reported in humans and in animal models harboring pathogenic variants in the Fibrillin1 gene. Description of clinical history of three cases from one family in Ghent (Belgium) and one family in St. Louis (US). We report on three cases from two families presenting end-stage heart failure (in two) and lethal arrhythmias associated with moderate left ventricular dilatation (in one). All three cases harbor a pathogenic variant in the SMAD3 gene, known to cause aneurysm osteoarthritis syndrome, Loeys-Dietz syndrome type 3 or isolated Heritable Thoracic Aortic Disease. These unusual presentations warrant awareness for myocardial disease in patients harboring pathogenic variants in genes causing Heritable Thoracic Aortic Disease and indicate the need for prospective studies in larger cohorts. © 2018 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

  6. Cardiac Arrythmias in Acute and Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Ali A. Handjani

    1966-01-01

    Full Text Available Cardiac arrythmias are frequent complications in acute and chronic renal failure and they may well account for sudden unexplained death in these patients. Based upon our recent study, we strongly believe that among other causative factors, focal degeneration of myocardium is the commonest and the most potentially dangerous cause of cardiac arrythmias. We suggest in emergency instances, ouabain to be used instead of digitalis which appears to be quite safe with dramatic results in cardiac arrythmias of these group.

  7. Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study

    Directory of Open Access Journals (Sweden)

    Dimitrios Doulgerakis

    2017-07-01

    Discussion: Age and presence of CAN are independent predictors of all-cause and CV mortality in patients with ESRF. The functionality of the cardiac autonomic nervous system activity can be used for the risk stratification in patients with ESRF.

  8. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick

    2012-02-03

    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.

  9. Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure

    International Nuclear Information System (INIS)

    Khan, M.A.; Mohammad, J.; Hussain, M.

    2004-01-01

    Objective: To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Subject: Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Results: Out of fifty patients admitted with cardiac failure 27 (54%) cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 (24%), 8 (16%) and 3 (6%) cases respectively. Conclusion: Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure. (author)

  10. Can cardiac surgery cause hypopituitarism?

    Science.gov (United States)

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

    2012-03-01

    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.

  11. Governing of common cause failures

    International Nuclear Information System (INIS)

    Bock, H.W.

    1998-01-01

    Agreed strategy is to govern common cause failures by the application of diversity, to assure that the overall plant safety objectives are met even in the case that a common cause failure of a system with all redundant trains is assumed. The presented strategy aims on the application of functional diversity without the implementation of equipment diversity. In the focus are the design criteria which have to be met for the design of independent systems in such a way that the time-correlated failure of such independent systems according a common cause can be excluded deterministically. (author)

  12. Coordination failure caused by sunspots

    DEFF Research Database (Denmark)

    Beugnot, Julie; Gürgüç, Zeynep; Øvlisen, Frederik Roose

    2012-01-01

    on the efficient equilibrium, we consider sunspots as a potential reason for coordination failure. We conduct an experiment with a three player 2x2x2 game in which coordination on the efficient equilibrium is easy and should normally occur. In the control session, we find almost perfect coordination on the payoff......-dominant equilibrium, but in the sunspot treatment, dis-coordination is frequent. Sunspots lead to significant inefficiency, and we conclude that sunspots can indeed cause coordination failure....

  13. Exercise training restores cardiac protein quality control in heart failure.

    Directory of Open Access Journals (Sweden)

    Juliane C Campos

    Full Text Available Exercise training is a well-known coadjuvant in heart failure treatment; however, the molecular mechanisms underlying its beneficial effects remain elusive. Despite the primary cause, heart failure is often preceded by two distinct phenomena: mitochondria dysfunction and cytosolic protein quality control disruption. The objective of the study was to determine the contribution of exercise training in regulating cardiac mitochondria metabolism and cytosolic protein quality control in a post-myocardial infarction-induced heart failure (MI-HF animal model. Our data demonstrated that isolated cardiac mitochondria from MI-HF rats displayed decreased oxygen consumption, reduced maximum calcium uptake and elevated H₂O₂ release. These changes were accompanied by exacerbated cardiac oxidative stress and proteasomal insufficiency. Declined proteasomal activity contributes to cardiac protein quality control disruption in our MI-HF model. Using cultured neonatal cardiomyocytes, we showed that either antimycin A or H₂O₂ resulted in inactivation of proteasomal peptidase activity, accumulation of oxidized proteins and cell death, recapitulating our in vivo model. Of interest, eight weeks of exercise training improved cardiac function, peak oxygen uptake and exercise tolerance in MI-HF rats. Moreover, exercise training restored mitochondrial oxygen consumption, increased Ca²⁺-induced permeability transition and reduced H₂O₂ release in MI-HF rats. These changes were followed by reduced oxidative stress and better cardiac protein quality control. Taken together, our findings uncover the potential contribution of mitochondrial dysfunction and cytosolic protein quality control disruption to heart failure and highlight the positive effects of exercise training in re-establishing cardiac mitochondrial physiology and protein quality control, reinforcing the importance of this intervention as a non-pharmacological tool for heart failure therapy.

  14. Bone Morphogenetic Protein 9 Reduces Cardiac Fibrosis and Improves Cardiac Function in Heart Failure.

    Science.gov (United States)

    Morine, Kevin J; Qiao, Xiaoying; York, Sam; Natov, Peter S; Paruchuri, Vikram; Zhang, Yali; Aronovitz, Mark J; Karas, Richard H; Kapur, Navin K

    2018-02-27

    Background -Heart failure is a growing cause of morbidity and mortality worldwide. Transforming growth factor beta (TGF-β1) promotes cardiac fibrosis, but also activates counter-regulatory pathways that serve to regulate TGF-β1 activity in heart failure. Bone morphogenetic protein 9 (BMP9) is a member of the TGFβ family of cytokines and signals via the downstream effector protein Smad1. Endoglin is a TGFβ co-receptor that promotes TGF-β1 signaling via Smad3 and binds BMP9 with high affinity. We hypothesized that BMP9 limits cardiac fibrosis by activating Smad1 and attenuating Smad3 and further that neutralizing endoglin activity promotes BMP9 activity. Methods -We examined BMP9 expression and signaling in human cardiac fibroblasts and human subjects with heart failure. We utilized the thoracic aortic constriction (TAC) induced model of heart failure to evaluate the functional effect of BMP9 signaling on cardiac remodeling. Results -BMP9 expression is increased in the circulation and left ventricle (LV) of human subjects with heart failure and is expressed by cardiac fibroblasts. Next, we observed that BMP9 attenuates Type I collagen synthesis in human cardiac fibroblasts using recombinant human BMP9 and an siRNA approach. In BMP9 -/- mice subjected to TAC, loss of BMP9 activity promotes cardiac fibrosis, impairs LV function, and increases LV levels of phosphorylated Smad3 (pSmad3), not pSmad1. In contrast, treatment of wild-type mice subjected to TAC with recombinant BMP9 limits progression of cardiac fibrosis, improves LV function, enhances myocardial capillary density, and increases LV levels of pSmad1, not pSmad3 compared to vehicle treated controls. Since endoglin binds BMP9 with high affinity, we explored the effect of reduced endoglin activity on BMP9 activity. Neutralizing endoglin activity in human cardiac fibroblasts or in wild-type mice subjected to TAC induced heart failure limits collagen production, increases BMP9 protein levels, and increases

  15. Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

    Directory of Open Access Journals (Sweden)

    Nao Okuda

    2012-01-01

    Full Text Available Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy.

  16. Causes and prevention of sudden cardiac death in the elderly.

    Science.gov (United States)

    Tung, Patricia; Albert, Christine M

    2013-03-01

    Sudden cardiac death (SCD) is a major cause of mortality in elderly individuals owing to a high prevalence of coronary heart disease, systolic dysfunction, and congestive heart failure (CHF). Although the incidence of SCD increases with age, the proportion of cardiac deaths that are sudden decreases owing to high numbers of other cardiac causes of death in elderly individuals. Implantable cardioverter-defibrillator (ICD) therapy has been demonstrated to improve survival and prevent SCD in selected patients with systolic dysfunction and CHF. However, ICD therapy in elderly patients might not be effective because of a greater rate of pulseless electrical activity underlying SCD and other competing nonarrhythmic causes of death in this population. Although under-represented in randomized trials of ICD use, elderly patients comprise a substantial proportion of the population that qualifies for and receives an ICD for primary prevention under current guidelines. Cardiac resynchronization therapy (CRT), which has been demonstrated to reduce mortality in selected populations with heart failure, is also more commonly used in this group of patients than in younger individuals. In this Review, we examine the causes of SCD in elderly individuals, and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.

  17. Hemorrhagic Stroke Associated with Pulmonary Edema and Catastrophic Cardiac Failure

    Directory of Open Access Journals (Sweden)

    Jiun-Chang Lee

    2008-06-01

    Full Text Available Cerebral arteriovenous fistula (AVF is a vascular malformation that is rare in the pediatric population. Older children with cerebral AVF tend to present with neurologic problems related to intracranial venous hypertension or intracranial hemorrhage. Cardiac and pulmonary complications following acute neurologic injury such as subarachnoid hemorrhage are common in adults, but are rarely reported in children. However, complications have been reported in cases of enterovirus 71 rhombencephalitis in infants and children and can cause high morbidity and mortality. Here, we report a 14-year-old boy who presented with cardiac failure associated with pulmonary edema following cerebral hemorrhagic stroke due to AVF. After aggressive investigation and management, we intervened before significant hypoxia and hypotension developed, potentially reducing the risk of long-term adverse neurologic consequences in this patient.

  18. Common cause failures of reactor pressure components

    International Nuclear Information System (INIS)

    Mankamo, T.

    1978-01-01

    The common cause failure is defined as a multiple failure event due to a common cause. The existence of common failure causes may ruin the potential advantages of applying redundancy for reliability improvement. Examples relevant to large mechanical components are presented. Preventive measures against common cause failures, such as physical separation, equipment diversity, quality assurance, and feedback from experience are discussed. Despite the large number of potential interdependencies, the analysis of common cause failures can be done within the framework of conventional reliability analysis, utilizing, for example, the method of deriving minimal cut sets from a system fault tree. Tools for the description and evaluation of dependencies between components are discussed: these include the model of conditional failure causes that are common to many components, and evaluation of the reliability of redundant components subjected to a common load. (author)

  19. Data needs for common cause failure analysis

    International Nuclear Information System (INIS)

    Parry, G.W.; Paula, H.M.; Rasmuson, D.; Whitehead, D.

    1990-01-01

    The procedures guide for common cause failure analysis published jointly by USNRC and EPRI requires a detailed historical event analysis. Recent work on the further development of the cause-defense picture of common cause failures introduced in that guide identified the information that is necessary to perform the detailed analysis in an objective manner. This paper summarizes these information needs

  20. Increased in vivo mitochondrial oxygenation with right ventricular failure induced by pulmonary arterial hypertension: Mitochondrial inhibition as driver of cardiac failure?

    NARCIS (Netherlands)

    G. Balestra (Gianmarco); E.G. Mik (Egbert); O. Eerbeek (Otto); P. Specht (Patricia); W.J. van der Laarse (Willem J.); C.J. Zuurbier (Coert J.)

    2015-01-01

    textabstractBackground: The leading cause of mortality due to pulmonary arterial hypertension (PAH) is failure of the cardiac right ventricle. It has long been hypothesized that during the development of chronic cardiac failure the heart becomes energy deprived, possibly due to shortage of oxygen at

  1. Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Lynge, Thomas Hadberg; Risgaard, Bjarke; Jabbari, Reza

    2016-01-01

    AIMS: Hypertrophic cardiomyopathy (HCM) is a frequent cause of sudden cardiac death (SCD) among the young (SCDY). The aim of this study was to characterize symptoms before SCDY due to HCM. METHODS AND RESULTS: Through review of all death certificates, we identified all SCDs in Danes aged 1-35 years...... in 2000-2009. Nationwide we included all deaths (n = 8756) and identified 431 autopsied SCDYs. All available records from hospitals and general practitioners were retrieved. To compare symptoms, we included a control groups consisting of traffic accident victims (n = 74). In the 10-year study period, 431...... autopsied SCDY cases were reviewed and 38 cases (9%) were included, of which 22 (58%) had morphologic findings diagnostic of HCM and 16 (42%) had findings suggestive, but not diagnostic, of HCM ('possible HCM'). Cardiac symptoms >1 h prior to death were reported in 21 (55%) of cases, and 16 (42%) sought...

  2. Macrophage microRNA-155 promotes cardiac hypertrophy and failure

    NARCIS (Netherlands)

    Heymans, Stephane; Corsten, Maarten F.; Verhesen, Wouter; Carai, Paolo; van Leeuwen, Rick E. W.; Custers, Kevin; Peters, Tim; Hazebroek, Mark; Stöger, Lauran; Wijnands, Erwin; Janssen, Ben J.; Creemers, Esther E.; Pinto, Yigal M.; Grimm, Dirk; Schürmann, Nina; Vigorito, Elena; Thum, Thomas; Stassen, Frank; Yin, Xiaoke; Mayr, Manuel; de Windt, Leon J.; Lutgens, Esther; Wouters, Kristiaan; de Winther, Menno P. J.; Zacchigna, Serena; Giacca, Mauro; van Bilsen, Marc; Papageorgiou, Anna-Pia; Schroen, Blanche

    2013-01-01

    Cardiac hypertrophy and subsequent heart failure triggered by chronic hypertension represent major challenges for cardiovascular research. Beyond neurohormonal and myocyte signaling pathways, growing evidence suggests inflammatory signaling pathways as therapeutically targetable contributors to this

  3. Intrinsic cardiac nervous system in tachycardia induced heart failure.

    Science.gov (United States)

    Arora, Rakesh C; Cardinal, Rene; Smith, Frank M; Ardell, Jeffrey L; Dell'Italia, Louis J; Armour, J Andrew

    2003-11-01

    The purpose of this study was to test the hypothesis that early-stage heart failure differentially affects the intrinsic cardiac nervous system's capacity to regulate cardiac function. After 2 wk of rapid ventricular pacing in nine anesthetized canines, cardiac and right atrial neuronal function were evaluated in situ in response to enhanced cardiac sensory inputs, stimulation of extracardiac autonomic efferent neuronal inputs, and close coronary arterial administration of neurochemicals that included nicotine. Right atrial neuronal intracellular electrophysiological properties were then evaluated in vitro in response to synaptic activation and nicotine. Intrinsic cardiac nicotine-sensitive, neuronally induced cardiac responses were also evaluated in eight sham-operated, unpaced animals. Two weeks of rapid ventricular pacing reduced the cardiac index by 54%. Intrinsic cardiac neurons of paced hearts maintained their cardiac mechano- and chemosensory transduction properties in vivo. They also responded normally to sympathetic and parasympathetic preganglionic efferent neuronal inputs, as well as to locally administered alpha-or beta-adrenergic agonists or angiotensin II. The dose of nicotine needed to modify intrinsic cardiac neurons was 50 times greater in failure compared with normal preparations. That dose failed to alter monitored cardiovascular indexes in failing preparations. Phasic and accommodating neurons identified in vitro displayed altered intracellular membrane properties compared with control, including decreased membrane resistance, indicative of reduced excitability. Early-stage heart failure differentially affects the intrinsic cardiac nervous system's capacity to regulate cardiodynamics. While maintaining its capacity to transduce cardiac mechano- and chemosensory inputs, as well as inputs from extracardiac autonomic efferent neurons, intrinsic cardiac nicotine-sensitive, local-circuit neurons differentially remodel such that their capacity to

  4. Atrial Fibrillation and Heart Failure - Cause or Effect?

    Science.gov (United States)

    Prabhu, Sandeep; Voskoboinik, Aleksandr; Kaye, David M; Kistler, Peter M

    2017-09-01

    There are emerging epidemics of atrial fibrillation (AF) and heart failure in most developed countries, with a significant health burden. Due to many shared pathophysiological mechanisms, which facilitate the maintenance of each condition, AF and heart failure co-exist in up to 30% of patients. In the circumstance where known structural causes of heart failure (such as myocardial infarction) are absent, patients presenting with both conditions present a unique challenge, particularly as the temporal relationship of each condition can often remain elusive from the clinical history. The question of whether the AF is driving, or significantly contributing to the left ventricular (LV) dysfunction, rather than merely a consequence of heart failure, has become ever more pertinent, especially as catheter ablation now offers a significant advancement over existing rhythm control strategies. This paper will review the inter-related physiological drivers of AF and heart failure before considering the implications from the outcomes of recent clinical trials in patients with AF and heart failure. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  5. Structures for common-cause failure analysis

    International Nuclear Information System (INIS)

    Vaurio, J.K.

    1981-01-01

    Common-cause failure methodology and terminology have been reviewed and structured to provide a systematical basis for addressing and developing models and methods for quantification. The structure is based on (1) a specific set of definitions, (2) categories based on the way faults are attributable to a common cause, and (3) classes based on the time of entry and the time of elimination of the faults. The failure events are then characterized by their likelihood or frequency and the average residence time. The structure provides a basis for selecting computational models, collecting and evaluating data and assessing the importance of various failure types, and for developing effective defences against common-cause failure. The relationships of this and several other structures are described

  6. Cardiac failure due to arteriovenous fistula with brachiocephalic stenosis: a gated heart case study

    International Nuclear Information System (INIS)

    Abel, G.; Irish, A.; Henderson, A.; Lenzo, N.

    2003-01-01

    Full text: There are numerous causes of cardiac failure of which the commonest in our community include ischaemic cardiomyopathy, post-viral cardiomyopathy, alcohol-induced cardiomyopathy and drug-induced cardiomyopathy. All these entities cause low output cardiac failure however high output cardiac failure is also well recognised. This includes heart failure related to such conditions as hyperthyroidism, anaemia, pregnancy, beri-beri, and Paget's disease. A rare cause of high output cardiac failure is an arteriovenous fistula. We present an unusual case of a patient with end-stage renal failure on haemodialysis who developed extensive dilatation of their left arm arteriovenous fistula secondary to bachiocephalic vein stenosis. The labelled red blood cell gated heart blood pool study demonstrated decreased left ventricular function and extensive pooling of blood within the tortuous dilated left arm vessels. A follow-up study post-ligation of the arteriovenous fistula showed improvement of the left ventricular ejection fraction. The associated contrast venography findings are also demonstrated. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  7. Common cause failures - a dilemma in perspective

    International Nuclear Information System (INIS)

    Smith, A.M.; Watson, I.A.

    1980-01-01

    This paper identifies the broad spectrum of common cause failure (CCF) definitions used by various authors. These definitions, as applied to real aircraft and nuclear reactor failure events, lead to a divergence of interpretation and a resultant confusion that obscures meaningful progress in CCF analysis. A new definition is proposed, explained, and tested against the examples. Technical as well as administrative practices are cited as ways to control or eliminate the product defects that lead to CCF. (author)

  8. Common cause failure analysis methodology for complex systems

    International Nuclear Information System (INIS)

    Wagner, D.P.; Cate, C.L.; Fussell, J.B.

    1977-01-01

    Common cause failure analysis, also called common mode failure analysis, is an integral part of a complex system reliability analysis. This paper extends existing methods of computer aided common cause failure analysis by allowing analysis of the complex systems often encountered in practice. The methods presented here aid in identifying potential common cause failures and also address quantitative common cause failure analysis

  9. Practolol in Hyperthyroid Cardiac Failure | Epstein | South African ...

    African Journals Online (AJOL)

    Practolol (Eraldint), a recently developed beta-adrenergic blocking agent, has been found useful in conjunction with digitalis and diuretics in 6 patients with thyrocardiac disease who had been refractory to therapy. In all cases cardiac failure improved dramatically, suggesting better myocardial efficiency and a return of ...

  10. Congestive Cardiac Failure in a patient with Systemic Sclerosis ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    disease(ILD) and cardiac function ... failure symptoms, in order to avoid a ... were a few blood vessels with thickened wall .... mean left atrial diameter, a smaller LV ejection ... resistance to flow is at the level of the ... 8The finding of mitral valve.

  11. Home-based cardiac rehabilitation for people with heart failure

    DEFF Research Database (Denmark)

    Zwisler, Ann Dorthe Olsen; Norten, RJ; Dean, SG

    2016-01-01

    AIMS: To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. METHODS: Randomised...

  12. Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

    Directory of Open Access Journals (Sweden)

    Acker Michael A

    2008-05-01

    Full Text Available Abstract Background Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated. Methods 709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%. A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function. Results Etiology of primary graft failure included transplant arteriopathy (n = 10, acute rejection (n = 3, hyperacute rejection (n = 1, and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1. Mean age at retransplantation was 45.5 ± 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 ± 12.2% at a mean follow-up of 32.6 ± 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 ± 95.7 mos post-transplant. Conclusion Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.

  13. Importance analysis for the systems with common cause failures

    International Nuclear Information System (INIS)

    Pan Zhijie; Nonaka, Yasuo

    1995-01-01

    This paper extends the importance analysis technique to the research field of common cause failures to evaluate the structure importance, probability importance, and β-importance for the systems with common cause failures. These importance measures would help reliability analysts to limit the common cause failure analysis framework and find efficient defence strategies against common cause failures

  14. Mutations in calmodulin cause ventricular tachycardia and sudden cardiac death

    DEFF Research Database (Denmark)

    Nyegaard, Mette; Overgaard, Michael Toft; Sondergaard, M.T.

    2012-01-01

    a substantial part of sudden cardiac deaths in young individuals. Mutations in RYR2, encoding the cardiac sarcoplasmic calcium channel, have been identified as causative in approximately half of all dominantly inherited CPVT cases. Applying a genome-wide linkage analysis in a large Swedish family with a severe......Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating inherited disorder characterized by episodic syncope and/or sudden cardiac arrest during exercise or acute emotion in individuals without structural cardiac abnormalities. Although rare, CPVT is suspected to cause...... calmodulin-binding-domain peptide at low calcium concentrations. We conclude that calmodulin mutations can cause severe cardiac arrhythmia and that the calmodulin genes are candidates for genetic screening of individual cases and families with idiopathic ventricular tachycardia and unexplained sudden cardiac...

  15. Deranged Cardiac Metabolism and the Pathogenesis of Heart Failure

    Science.gov (United States)

    2016-01-01

    Activation of the neuro-hormonal system is a pathophysiological consequence of heart failure. Neuro-hormonal activation promotes metabolic changes, such as insulin resistance, and determines an increased use of non-carbohydrate substrates for energy production. Fasting blood ketone bodies as well as fat oxidation are increased in patients with heart failure, yielding a state of metabolic inefficiency. The net result is additional depletion of myocardial adenosine triphosphate, phosphocreatine and creatine kinase levels with further decreased efficiency of mechanical work. In this context, manipulation of cardiac energy metabolism by modification of substrate use by the failing heart has produced positive clinical results. The results of current research support the concept that shifting the energy substrate preference away from fatty acid metabolism and towards glucose metabolism could be an effective adjunctive treatment in patients with heart failure. The additional use of drugs able to partially inhibit fatty acids oxidation in patients with heart failure may therefore yield a significant protective effect for clinical symptoms and cardiac function improvement, and simultaneously ameliorate left ventricular remodelling. Certainly, to clarify the exact therapeutic role of metabolic therapy in heart failure, a large multicentre, randomised controlled trial should be performed. PMID:28785448

  16. A sodium-channel mutation causes isolated cardiac conduction disease

    NARCIS (Netherlands)

    Tan, HL; Bink-Boelkens, MTE; Bezzina, CR; Viswanathan, PC; Beaufort-Krol, GCM; van Tintelen, PJ; van den Berg, MP; Wilde, AAM; Balser, [No Value

    2001-01-01

    Cardiac conduction disorders slow the heart rhythm and cause disability in millions of people worldwide. Inherited mutations in SCN5A, the gene encoding the human cardiac sodium (Na+) channel, have been associated with rapid heart rhythms that occur suddenly and are life-threatening(1-3); however, a

  17. A sodium-channel mutation causes isolated cardiac conduction disease

    NARCIS (Netherlands)

    Tan, H. L.; Bink-Boelkens, M. T.; Bezzina, C. R.; Viswanathan, P. C.; Beaufort-Krol, G. C.; van Tintelen, P. J.; van den Berg, M. P.; Wilde, A. A.; Balser, J. R.

    2001-01-01

    Cardiac conduction disorders slow the heart rhythm and cause disability in millions of people worldwide. Inherited mutations in SCN5A, the gene encoding the human cardiac sodium (Na+) channel, have been associated with rapid heart rhythms that occur suddenly and are life-threatening; however, a

  18. Primary Cardiac Leiomyoma Causing Right Ventricular Obstruction and Tricuspid Regurgitation.

    Science.gov (United States)

    Careddu, Lucio; Foà, Alberto; Leone, Ornella; Agostini, Valentina; Gargiulo, Gaetano Domenico; Rapezzi, Claudio; Di Bartolomeo, Roberto; Pacini, Davide

    2017-09-01

    We report the unique case of a primary cardiac leiomyoma originating from the right ventricle and involving the tricuspid valve in a 43-year-old woman. Echocardiography showed a giant mass causing severe pulmonary stenosis and tricuspid valve regurgitation. The patient underwent surgical excision and histologic examination revealed a primary cardiac leiomyoma. To the best of our knowledge only three cases of primary cardiac leiomyoma have so far been reported, and this is the first case of primary cardiac leiomyoma involving the tricuspid valve apparatus. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Early dystrophin loss is coincident with the transition of compensated cardiac hypertrophy to heart failure.

    Directory of Open Access Journals (Sweden)

    Fernanda P Prado

    Full Text Available Hypertension causes cardiac hypertrophy, one of the most important risk factors for heart failure (HF. Despite the importance of cardiac hypertrophy as a risk factor for the development of HF, not all hypertrophied hearts will ultimately fail. Alterations of cytoskeletal and sarcolemma-associated proteins are considered markers cardiac remodeling during HF. Dystrophin provides mechanical stability to the plasma membrane through its interactions with the actin cytoskeleton and, indirectly, to extracellular matrix proteins. This study was undertaken to evaluate dystrophin and calpain-1 in the transition from compensated cardiac hypertrophy to HF. Wistar rats were subjected to abdominal aorta constriction and killed at 30, 60 and 90 days post surgery (dps. Cardiac function and blood pressure were evaluated. The hearts were collected and Western blotting and immunofluorescence performed for dystrophin, calpain-1, alpha-fodrin and calpastatin. Statistical analyses were performed and considered significant when p<0.05. After 90 dps, 70% of the animals showed hypertrophic hearts (HH and 30% hypertrophic+dilated hearts (HD. Systolic and diastolic functions were preserved at 30 and 60 dps, however, decreased in the HD group. Blood pressure, cardiomyocyte diameter and collagen content were increased at all time points. Dystrophin expression was lightly increased at 30 and 60 dps and HH group. HD group showed decreased expression of dystrophin and calpastatin and increased expression of calpain-1 and alpha-fodrin fragments. The first signals of dystrophin reduction were observed as early as 60 dps. In conclusion, some hearts present a distinct molecular pattern at an early stage of the disease; this pattern could provide an opportunity to identify these failure-prone hearts during the development of the cardiac disease. We showed that decreased expression of dystrophin and increased expression of calpains are coincident and could work as possible

  20. Novel protective role of endogenous cardiac myocyte P2X4 receptors in heart failure.

    Science.gov (United States)

    Yang, Tiehong; Shen, Jian-bing; Yang, Ronghua; Redden, John; Dodge-Kafka, Kimberly; Grady, James; Jacobson, Kenneth A; Liang, Bruce T

    2014-05-01

    Heart failure (HF), despite continuing progress, remains a leading cause of mortality and morbidity. P2X4 receptors (P2X4R) have emerged as potentially important molecules in regulating cardiac function and as potential targets for HF therapy. Transgenic P2X4R overexpression can protect against HF, but this does not explain the role of native cardiac P2X4R. Our goal is to define the physiological role of endogenous cardiac myocyte P2X4R under basal conditions and during HF induced by myocardial infarction or pressure overload. Mice established with conditional cardiac-specific P2X4R knockout were subjected to left anterior descending coronary artery ligation-induced postinfarct or transverse aorta constriction-induced pressure overload HF. Knockout cardiac myocytes did not show P2X4R by immunoblotting or by any response to the P2X4R-specific allosteric enhancer ivermectin. Knockout hearts showed normal basal cardiac function but depressed contractile performance in postinfarct and pressure overload models of HF by in vivo echocardiography and ex vivo isolated working heart parameters. P2X4R coimmunoprecipitated and colocalized with nitric oxide synthase 3 (eNOS) in wild-type cardiac myocytes. Mice with cardiac-specific P2X4R overexpression had increased S-nitrosylation, cyclic GMP, NO formation, and were protected from postinfarct and pressure overload HF. Inhibitor of eNOS, L-N(5)-(1-iminoethyl)ornithine hydrochloride, blocked the salutary effect of cardiac P2X4R overexpression in postinfarct and pressure overload HF as did eNOS knockout. This study establishes a new protective role for endogenous cardiac myocyte P2X4R in HF and is the first to demonstrate a physical interaction between the myocyte receptor and eNOS, a mediator of HF protection. © 2014 American Heart Association, Inc.

  1. Galen's vein aneurysm as cause of heart failure

    International Nuclear Information System (INIS)

    Echeverria, Claudia; Cassalett, Gabriel; Franco, Jaime; Carrillo, Gustavo

    2005-01-01

    We present the case of a newborn admitted to the intensive care unit with a heart failure of difficult medical management. A large ductus arteriosus was found. It was surgically corrected, but the heart failure persisted and did not improve with medical treatment. Incidentally, a big Galen's vein aneurysm was found. Galen's vein aneurysm is a rare congenital pathology, originated by a fusion defect of the internal cerebral veins. Due to its low resistance, it produces a picture of high-output heart failure. Large defects may contain 50% to 60% of cardiac output. An aneurysm may be suspected in each newborn or infant with clinical picture of heart failure and right cardiac chamber dilation without any evidence of structural cardiac anomaly

  2. Electrical failure analysis for root-cause determination

    International Nuclear Information System (INIS)

    Riddle, J.

    1990-01-01

    This paper outlines a practical failure analysis sequence. Several technical definitions are required. A failure is defined as a component that was operating in a system where the system malfunctioned and the replacement of the device restored system functionality. The failure mode is the malfunctioning behavior of the device. The failure mechanism is the underlying cause or source of the failure mode. The failure mechanism is the root cause of the failure mode. The failure analysis procedure needs to be adequately refined to result in the determination of the cause of failure to the degree that corrective action or design changes will prevent recurrence of the failure mode or mechanism. An example of a root-cause determination analysis performed for a nuclear power industry customer serves to illustrate the analysis methodology

  3. Cardiac Depression Scale: Mokken scaling in heart failure patients

    Directory of Open Access Journals (Sweden)

    Ski Chantal F

    2012-11-01

    Full Text Available Abstract Background There is a high prevalence of depression in patients with heart failure (HF that is associated with worsening prognosis. The value of using a reliable and valid instrument to measure depression in this population is therefore essential. We validated the Cardiac Depression Scale (CDS in heart failure patients using a model of ordinal unidimensional measurement known as Mokken scaling. Findings We administered in face-to-face interviews the CDS to 603 patients with HF. Data were analysed using Mokken scale analysis. Items of the CDS formed a statistically significant unidimensional Mokken scale of low strength (H0.8. Conclusions The CDS has a hierarchy of items which can be interpreted in terms of the increasingly serious effects of depression occurring as a result of HF. Identifying an appropriate instrument to measure depression in patients with HF allows for early identification and better medical management.

  4. Associations between cardiac pathology and clinical, echocardiographic and electrocardiographic findings in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Falk, Bo Torkel; Jönsson, Lennart; Olsen, Lisbeth Høier

    2010-01-01

    The objective of this study was to correlate defined pathological features with clinical findings in dogs with naturally occurring congestive heart failure (CHF). Fifty-eight dogs with CHF were examined clinically and using echocardiography and electrocardiography. Detailed cardiac post...... such as MMVD, myocardial atrophy and fibrosis, and by arteriosclerosis. Further, more extensive research will be required to establish cause-effect relationships between these cardiac lesions and the pathophysiology of CHF in dogs....

  5. Sudden cardiac death in adults: causes, incidence and interventions.

    Science.gov (United States)

    Walker, Wendy Marina

    Many nurses will be familiar with the unexpected death of an adult patient following a sudden, life-threatening cardiac event. It is a situation that demands sensitive nursing care and skilled interventions to provide a foundation for recovery and promote healthy bereavement. This article examines the causes and incidence of sudden cardiac death in adults. Possible reactions of those who are suddenly bereaved are described and immediate care interventions aimed at dealing with the grief process are discussed. The article concludes by identifying ways in which the incidence of sudden cardiac death may be reduced.

  6. Paradoxical euthyroid hormone profile in a case of Graves' disease with cardiac failure

    Directory of Open Access Journals (Sweden)

    Kapoor Aditya

    2011-07-01

    Full Text Available Abstract Cardiac failure is an uncommon complication of juvenile hyperthyroidism. We describe an adolescent boy with Graves' disease who developed manifestations of heart failure while on antithyroid medications. There was no evidence of any underlying cardiac disease. He had paradoxical euthyroid hormone profile which rose to hyperthyroid range when the manifestations of the cardiac failure subsided. The case highlights several unusual features of Graves' disease.

  7. Brain renin angiotensin system in cardiac hypertrophy and failure

    Directory of Open Access Journals (Sweden)

    Luciana eCampos

    2012-01-01

    Full Text Available Brain renin-angiotensin system (RAS is significantly involved in the roles of the endocrine RAS in cardiovascular regulation. Our studies indicate that the brain RAS participates in the development of cardiac hypertrophy and fibrosis through sympathetic activation. Inhibition of sympathetic hyperactivity after myocardial infarction through suppression of the brain RAS appears beneficial. The brain RAS is involved in the modulation of circadian rhythms of arterial pressure, contributing to nondipping hypertension. We conclude that the brain RAS in pathophysiological states interacts synergistically with the chronically overactive RAS through a positive biofeedback in order to maintain a state of alert diseased conditions, such as cardiac hypertrophy and failure. Therefore, targeting brain RAS with drugs such as angiotensin converting inhibitors or receptor blockers having increased brain penetrability could be of advantage. These RAS-targeting drugs are first-line therapy for all heart failure patients. Since the RAS has both endocrine and local tissue components, RAS drugs are being developed to attain increased tissue penetrability and volume of distribution and consequently an efficient inhibition of both RAS components.

  8. [A rare cause of heart failure].

    Science.gov (United States)

    Gutersohn, Andreas; Oestmann, Andreas

    2014-12-10

    We report the case of a 52 years old patient with dilated cardiomyopathy. Ischemic heart disease was excluded by coronary angiography. However, bilateral hilar lymphadenopathy was present on plain chest radiography. Transbronchial biopsy showed non-necrotizing, epitheloid cell granulomas and thus sarcoidosis was diagnosed. A MRI of the heart confirmed the cardiac involvement by the sarcoidosis with corresponding structural changes.

  9. BACFIRE, Minimal Cut Sets Common Cause Failure Fault Tree Analysis

    International Nuclear Information System (INIS)

    Fussell, J.B.

    1983-01-01

    1 - Description of problem or function: BACFIRE, designed to aid in common cause failure analysis, searches among the basic events of a minimal cut set of the system logic model for common potential causes of failure. The potential cause of failure is called a qualitative failure characteristics. The algorithm searches qualitative failure characteristics (that are part of the program input) of the basic events contained in a set to find those characteristics common to all basic events. This search is repeated for all cut sets input to the program. Common cause failure analysis is thereby performed without inclusion of secondary failure in the system logic model. By using BACFIRE, a common cause failure analysis can be added to an existing system safety and reliability analysis. 2 - Method of solution: BACFIRE searches the qualitative failure characteristics of the basic events contained in the fault tree minimal cut set to find those characteristics common to all basic events by either of two criteria. The first criterion can be met if all the basic events in a minimal cut set are associated by a condition which alone may increase the probability of multiple component malfunction. The second criterion is met if all the basic events in a minimal cut set are susceptible to the same secondary failure cause and are located in the same domain for that cause of secondary failure. 3 - Restrictions on the complexity of the problem - Maxima of: 1001 secondary failure maps, 101 basic events, 10 cut sets

  10. Acromegaly Presenting as Cardiac Failure - A Case Report

    Directory of Open Access Journals (Sweden)

    Shohael Mahmud Arafat

    2011-09-01

    Full Text Available Acromegaly is characterized by chronic hypersecretion of growth hormone (GH and is associated with increased mortality rate because of the potential complications such as cardiovascular disease, respiratory disease, or malignancy, which are probably caused by the long-term exposure of tissues to excess GH, for at least 10 years, before diagnosis and treatment. Here we are reporting a case of acromegaly who initially presented with features of left ventricular failure for which she got herself admitted in CCU and was treated conservatively. Later on, after clinical examination and investigations she was diagnosed as a case of mitral regurgitation due to cardiomyopathy caused by acromegaly. After the successful transsphenoidal resection of the pituitary microadenoma, the level of GH was normalized and heart failure improved. Key words: acromegaly; heart failure; Pituitary microadenoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8644 BSMMU J 2011; 4(2:122-124

  11. Operational Failures Caused by Arrogant Leaders

    National Research Council Canada - National Science Library

    Parrington, James R

    2008-01-01

    .... The failures of the Japanese and U.S. militaries directly resulted from the professional arrogance exhibited by Admiral Yamamoto and Secretary Rumsfeld as they deliberately limited the scope of their strategic thinking to how their...

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

    International Nuclear Information System (INIS)

    Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B.; Screaton, Nicholas J.

    2009-01-01

    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.)

  13. 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)

    2009-11-15

    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.)

  14. Oxidized CaMKII causes cardiac sinus node dysfunction in mice

    OpenAIRE

    Swaminathan, Paari Dominic; Purohit, Anil; Soni, Siddarth; Voigt, Niels; Singh, Madhu V.; Glukhov, Alexey V.; Gao, Zhan; He, B. Julie; Luczak, Elizabeth D.; Joiner, Mei-ling A.; Kutschke, William; Yang, Jinying; Donahue, J. Kevin; Weiss, Robert M.; Grumbach, Isabella M.

    2011-01-01

    Sinus node dysfunction (SND) is a major public health problem that is associated with sudden cardiac death and requires surgical implantation of artificial pacemakers. However, little is known about the molecular and cellular mechanisms that cause SND. Most SND occurs in the setting of heart failure and hypertension, conditions that are marked by elevated circulating angiotensin II (Ang II) and increased oxidant stress. Here, we show that oxidized calmodulin kinase II (ox-CaMKII) is a biomark...

  15. Cardiac Hydatid Cyst: An Unusual Cause of Chest Pain

    Directory of Open Access Journals (Sweden)

    Esref Tuncer

    2013-12-01

    Full Text Available Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus. Cardiac involvement in hydatid disease is uncommon, constituting only 0.5 - 2% of all cases of hydatidosis. Most patients with cardiac echinococcosis are asymptomatic, and the disease is often latent because a hydatid cyst in the heart grows very slowly. Only approximately 10 % of patients, especially those with large hydatid cysts, have clinical manifestations. Precordial pain is the one of the common symptoms and is most often vague and does not resemble angina pectoris.

  16. High-Resolution Mapping of Chromatin Conformation in Cardiac Myocytes Reveals Structural Remodeling of the Epigenome in Heart Failure.

    Science.gov (United States)

    Rosa-Garrido, Manuel; Chapski, Douglas J; Schmitt, Anthony D; Kimball, Todd H; Karbassi, Elaheh; Monte, Emma; Balderas, Enrique; Pellegrini, Matteo; Shih, Tsai-Ting; Soehalim, Elizabeth; Liem, David; Ping, Peipei; Galjart, Niels J; Ren, Shuxun; Wang, Yibin; Ren, Bing; Vondriska, Thomas M

    2017-10-24

    Cardiovascular disease is associated with epigenomic changes in the heart; however, the endogenous structure of cardiac myocyte chromatin has never been determined. To investigate the mechanisms of epigenomic function in the heart, genome-wide chromatin conformation capture (Hi-C) and DNA sequencing were performed in adult cardiac myocytes following development of pressure overload-induced hypertrophy. Mice with cardiac-specific deletion of CTCF (a ubiquitous chromatin structural protein) were generated to explore the role of this protein in chromatin structure and cardiac phenotype. Transcriptome analyses by RNA-seq were conducted as a functional readout of the epigenomic structural changes. Depletion of CTCF was sufficient to induce heart failure in mice, and human patients with heart failure receiving mechanical unloading via left ventricular assist devices show increased CTCF abundance. Chromatin structural analyses revealed interactions within the cardiac myocyte genome at 5-kb resolution, enabling examination of intra- and interchromosomal events, and providing a resource for future cardiac epigenomic investigations. Pressure overload or CTCF depletion selectively altered boundary strength between topologically associating domains and A/B compartmentalization, measurements of genome accessibility. Heart failure involved decreased stability of chromatin interactions around disease-causing genes. In addition, pressure overload or CTCF depletion remodeled long-range interactions of cardiac enhancers, resulting in a significant decrease in local chromatin interactions around these functional elements. These findings provide a high-resolution chromatin architecture resource for cardiac epigenomic investigations and demonstrate that global structural remodeling of chromatin underpins heart failure. The newly identified principles of endogenous chromatin structure have key implications for epigenetic therapy. © 2017 The Authors.

  17. Evaluation of Causes of Retaining Wall Failure

    Directory of Open Access Journals (Sweden)

    Mu'azu Mohammed ABDULLAHI

    2009-07-01

    Full Text Available Retaining structures are vital geotechnical structure, because the topography of the earth surface is a combination of plain, sloppy and undulating terrain. The retaining wall resists thrust of a bank of earth as well as providing soil stability of a change of ground elevation. Earth pressures on retaining wall are designed from theories of Soil Mechanics, but unfortunately the engineers using them do not always realize the significance of the assumption in their development. This is usually accompanied by with failure and partial failures because of designed based on rules and formulae that fit only limited conditions. In addition there are also problems of using bad backfill materials without taking precautionary measures against built–up of hydrostatic pressure by provision of drainage and also poor workmanship.

  18. The Role of Nrf2-Mediated Pathway in Cardiac Remodeling and Heart Failure

    Directory of Open Access Journals (Sweden)

    Shanshan Zhou

    2014-01-01

    Full Text Available Heart failure (HF is frequently the consequence of sustained, abnormal neurohormonal, and mechanical stress and remains a leading cause of death worldwide. The key pathophysiological process leading to HF is cardiac remodeling, a term referring to maladaptation to cardiac stress at the molecular, cellular, tissue, and organ levels. HF and many of the conditions that predispose one to HF are associated with oxidative stress. Increased generation of reactive oxygen species (ROS in the heart can directly lead to increased necrosis and apoptosis of cardiomyocytes which subsequently induce cardiac remodeling and dysfunction. Nuclear factor-erythroid-2- (NF-E2- related factor 2 (Nrf2 is a transcription factor that controls the basal and inducible expression of a battery of antioxidant genes and other cytoprotective phase II detoxifying enzymes that are ubiquitously expressed in the cardiovascular system. Emerging evidence has revealed that Nrf2 and its target genes are critical regulators of cardiovascular homeostasis via the suppression of oxidative stress, which is the key player in the development and progression of HF. The purpose of this review is to summarize evidence that activation of Nrf2 enhances endogenous antioxidant defenses and counteracts oxidative stress-associated cardiac remodeling and HF.

  19. FIASCO II failure to achieve a satisfactory cardiac outcome study: the elimination of system errors.

    Science.gov (United States)

    Farid, Shakil; Page, Aravinda; Jenkins, David; Jones, Mark T; Freed, Darren; Nashef, Samer A M

    2013-07-01

    Death in low-risk cardiac surgical patients provides a simple and accessible method by which modifiable causes of death can be identified. In the first FIASCO study published in 2009, local potentially modifiable causes of preventable death in low-risk patients with a logistic EuroSCORE of 0-2 undergoing cardiac surgery were inadequate myocardial protection and lack of clarity in the chain of responsibility. As a result, myocardial protection was improved, and a formalized system introduced to ensure clarity of the chain of responsibility in the care of all cardiac surgical patients. The purpose of the current study was to re-audit outcomes in low-risk patients to see if improvements have been achieved. Patients with a logistic EuroSCORE of 0-2 who had cardiac surgery from January 2006 to August 2012 were included. Data were prospectively collected and retrospectively analysed. The case notes of patients who died in hospital were subject to internal and external review and classified according to preventability. Two thousand five hundred and forty-nine patients with a logistic EuroSCORE of 0-2 underwent cardiac surgery during the study period. Seven deaths occurred in truly low-risk patients, giving a mortality of 0.27%. Of the seven, three were considered preventable and four non-preventable. Mortality was marginally lower than in our previous study (0.37%), and no death occurred as a result of inadequate myocardial protection or communication failures. We postulate that the regular study of such events in all institutions may unmask systemic errors that can be remedied to prevent or reduce future occurrences. We encourage all units to use this methodology to detect any similarly modifiable factors in their practice.

  20. Estimating flood inundation caused by dam failures

    Energy Technology Data Exchange (ETDEWEB)

    Mocan, N. [Crozier and Associates Inc., Collingwood, ON (Canada); Joy, D.M. [Guelph Univ., ON (Canada). School of Engineering; Rungis, G. [Grand River Conservation Authority, Cambridge, ON (Canada)

    2006-01-15

    Recent advancements in modelling inundation due to dam failures have allowed easier and more illustrative analyses of potential outcomes. This paper described new model and mapping capabilities available using the HEC-RAS hydraulic model in concert with geographic information systems (GIS). The study area was the upper reaches of Canagagigue Creek and the Woolwich Dam near Elmira, Ontario. A hydraulic analysis of a hypothetical dam failure was developed based on the summer probable maximum flood (PMF) event. Limits extended from Woolwich Dam to downstream of the Town of Elmira. An incoming summer PMF hydrograph was set as the upstream boundary condition in the upstream model. Simulation parameters include simulation time-step; implicit weighting factor; water surface calculation tolerance; and output calculation interval. Peak flows were presented, as well as corresponding flood inundation results through the Town of Elmira. The hydraulic model results were exported to a GIS in order to develop inundation maps for emergency management planning. Results from post-processing included inundation maps for each of the simulated time-steps as well as an inundation animation for the duration of the dam breach. It was concluded that the modelling tools presented in the study can be applied to other dam safety assessment projects in order to develop effective and efficient emergency preparedness plans through public consultation and the establishment of impact zones. 1 tab., 2 figs.

  1. Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted?

    Science.gov (United States)

    Irzmański, Robert; Kapusta, Joanna; Obrębska-Stefaniak, Agnieszka; Urzędowicz, Beata; Kowalski, Jan

    2017-07-01

    The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients. The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR 10 × 103/μl; platelets (PLTs) failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index. Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of

  2. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences

    OpenAIRE

    Lorenzi-Filho,Geraldo; Genta,Pedro R; Figueiredo,Adelaide C.; Inoue,Daniel

    2005-01-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac outpu...

  3. Transcriptional profile of isoproterenol-induced cardiomyopathy and comparison to exercise-induced cardiac hypertrophy and human cardiac failure

    Directory of Open Access Journals (Sweden)

    McIver Lauren J

    2009-12-01

    Full Text Available Abstract Background Isoproterenol-induced cardiac hypertrophy in mice has been used in a number of studies to model human cardiac disease. In this study, we compared the transcriptional response of the heart in this model to other animal models of heart failure, as well as to the transcriptional response of human hearts suffering heart failure. Results We performed microarray analyses on RNA from mice with isoproterenol-induced cardiac hypertrophy and mice with exercise-induced physiological hypertrophy and identified 865 and 2,534 genes that were significantly altered in pathological and physiological cardiac hypertrophy models, respectively. We compared our results to 18 different microarray data sets (318 individual arrays representing various other animal models and four human cardiac diseases and identified a canonical set of 64 genes that are generally altered in failing hearts. We also produced a pairwise similarity matrix to illustrate relatedness of animal models with human heart disease and identified ischemia as the human condition that most resembles isoproterenol treatment. Conclusion The overall patterns of gene expression are consistent with observed structural and molecular differences between normal and maladaptive cardiac hypertrophy and support a role for the immune system (or immune cell infiltration in the pathology of stress-induced hypertrophy. Cross-study comparisons such as the results presented here provide targets for further research of cardiac disease that might generally apply to maladaptive cardiac stresses and are also a means of identifying which animal models best recapitulate human disease at the transcriptional level.

  4. Common-Cause Failure Analysis in Event Assessment

    International Nuclear Information System (INIS)

    Rasmuson, D.M.; Kelly, D.L.

    2008-01-01

    This paper reviews the basic concepts of modeling common-cause failures (CCFs) in reliability and risk studies and then applies these concepts to the treatment of CCF in event assessment. The cases of a failed component (with and without shared CCF potential) and a component being unavailable due to preventive maintenance or testing are addressed. The treatment of two related failure modes (e.g. failure to start and failure to run) is a new feature of this paper, as is the treatment of asymmetry within a common-cause component group

  5. The Cardiac MR Images and Causes of Paradoxical Septal Motion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Choi, Sang Il; Chun, Eun Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Choi, Sung Hun [Ulsan University Hospital, Ulsan (Korea, Republic of); Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of)

    2010-10-15

    Real-time cine MRI studies using the steady-state free precession (SSFP) technique are very useful for evaluating cardiac and septal motion. During diastole, the septum acts as a compliant membrane between the two ventricles, and its position and geometry respond to even small alterations in the trans-septal pressure gradients. Abnormal septal motion can be caused by an overload of the right ventricle, delayed ventricular filling and abnormal conduction. In this study, we illustrate, based on our experiences, the causes of abnormal septal motion such as corrective surgery for tetralogy of Fallot, an atrial septal defect, pulmonary thromboembolism, mitral stenosis, constrictive pericarditis and left bundle branch block. In addition, we discuss the significance of paradoxical septal motion in the context of cardiac MR imaging.

  6. The Cardiac MR Images and Causes of Paradoxical Septal Motion

    International Nuclear Information System (INIS)

    Kim, Dong Hun; Choi, Sang Il; Chun, Eun Ju; Choi, Sung Hun; Park, Jae Hyung

    2010-01-01

    Real-time cine MRI studies using the steady-state free precession (SSFP) technique are very useful for evaluating cardiac and septal motion. During diastole, the septum acts as a compliant membrane between the two ventricles, and its position and geometry respond to even small alterations in the trans-septal pressure gradients. Abnormal septal motion can be caused by an overload of the right ventricle, delayed ventricular filling and abnormal conduction. In this study, we illustrate, based on our experiences, the causes of abnormal septal motion such as corrective surgery for tetralogy of Fallot, an atrial septal defect, pulmonary thromboembolism, mitral stenosis, constrictive pericarditis and left bundle branch block. In addition, we discuss the significance of paradoxical septal motion in the context of cardiac MR imaging

  7. Data analysis using the Binomial Failure Rate common cause model

    International Nuclear Information System (INIS)

    Atwood, C.L.

    1983-09-01

    This report explains how to use the Binomial Failure Rate (BFR) method to estimate common cause failure rates. The entire method is described, beginning with the conceptual model, and covering practical issues of data preparation, treatment of variation in the failure rates, Bayesian estimation of the quantities of interest, checking the model assumptions for lack of fit to the data, and the ultimate application of the answers

  8. Root cause of failure analysis and the system engineer

    International Nuclear Information System (INIS)

    Coppock, M.S.; Hartwig, A.W.

    1990-01-01

    In an industry where ever-increasing emphasis is being placed on root cause of failure determination, it is imperative that a successful nuclear utility have an effective means of identifying failures and performing the necessary analyses. The current Institute of Nuclear Power Operations (INPO) good practice, OE-907, root-cause analysis, gives references to methodology that will help determine breakdowns in procedures, programs, or design but gives very little guidance on how or when to perform component root cause of failure analyses. The system engineers of nuclear utilities are considered the focal point for their respective systems and are required by most programs to investigate component failures. The problem that the system engineer faces in determining a component root cause of failures lies in acquisition of the necessary data to identify the need to perform the analysis and in having the techniques and equipment available to perform it. The system engineers at the Palo Verde nuclear generating station routinely perform detailed component root cause of failure analyses. The Palo Verde program provides the system engineers with the information necessary to identify when a component root cause of failure is required. Palo Verde also has the necessary equipment on-site to perform the analyses

  9. High-output cardiac failure secondary to multiple vascular malformations in the liver: case report

    International Nuclear Information System (INIS)

    Spaner, S.; Demeter, S.; Lien, D.; Shapiro, J.; McCarthy, M.; Raymond, G.

    2001-01-01

    High-output cardiac failure is associated with several systemic illnesses, including hyperthyroidism, thiamine deficiency, severe anemia, multiple myeloma, Paget's disease of bone and Osler-Weber-Rendu syndrome. We present an unusual case of a woman with high-output cardiac failure as a result of multiple arteriovenous fistulas in the liver, most likely representing an unusual variant of Osler-Weber-Rendu syndrome (i.e., no other telangiectasias or a family history of vascular malformations was demonstrated). (author)

  10. Influence of the timing of cardiac catheterization and amount of contrast media on acute renal failure after cardiac surgery.

    Science.gov (United States)

    Sadeghi, Mohsen Mirmohammad; Gharipour, Mojgan; Nilforoush, Peiman; Shamsolkotabi, Hamid; Sadeghi, Hamid Mirmohammad; Kiani, Amjad; Sadeghi, Pouya Mirmohammad; Farahmand, Niloufar

    2011-04-01

    There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated. Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression. The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI = 1.613-15.355 and p = 0.002), followed by intra-aortic balloon pump insertion (OR: 6.890, CI = 1.482-32.032 and p = 0.009) and usage of higher doses of contrast media agent (OR: 1.446, CI = 1.033-2.025 and p = 0.031). Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.

  11. A huge bladder calculus causing acute renal failure.

    Science.gov (United States)

    Komeya, Mitsuru; Sahoda, Tamami; Sugiura, Shinpei; Sawada, Takuto; Kitami, Kazuo

    2013-02-01

    A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

  12. Common cause failure investigations using the European Reliability Data System

    International Nuclear Information System (INIS)

    Games, A.M.; Breewood, M.; Amendola, A.; Keller, A.Z.

    1984-01-01

    The European Reliability Data System (ERDS) has provided data for use in investigations into common cause failures (CCFs) in nuclear power plants. These investigations have been made on two levels, at a system and inter-system level. Data have been used from the Component Event Data Bank and from the Licensee Event Report Files, both part of the ERDS. The two studies required different methodologies although both commenced with a temporal sorting procedure for the failure events. The studies demonstrated that different types of common cause failure necessitate different search algorithms, and thus a data search must be closely related to an appropriate CCF classification system, which in the first instance would not be based on causes of failure. (author)

  13. Hypertrophy of neurons within cardiac ganglia in human, canine, and rat heart failure: the potential role of nerve growth factor.

    Science.gov (United States)

    Singh, Sanjay; Sayers, Scott; Walter, James S; Thomas, Donald; Dieter, Robert S; Nee, Lisa M; Wurster, Robert D

    2013-08-19

    Autonomic imbalances including parasympathetic withdrawal and sympathetic overactivity are cardinal features of heart failure regardless of etiology; however, mechanisms underlying these imbalances remain unknown. Animal model studies of heart and visceral organ hypertrophy predict that nerve growth factor levels should be elevated in heart failure; whether this is so in human heart failure, though, remains unclear. We tested the hypotheses that neurons in cardiac ganglia are hypertrophied in human, canine, and rat heart failure and that nerve growth factor, which we hypothesize is elevated in the failing heart, contributes to this neuronal hypertrophy. Somal morphology of neurons from human (579.54±14.34 versus 327.45±9.17 μm(2); Phearts (767.80±18.37 versus 650.23±9.84 μm(2); Pneurons from spontaneously hypertensive rat hearts (327.98±3.15 versus 271.29±2.79 μm(2); Pneurons in cardiac ganglia compared with controls. Western blot analysis shows that nerve growth factor levels in the explanted, failing human heart are 250% greater than levels in healthy donor hearts. Neurons from cardiac ganglia cultured with nerve growth factor are significantly larger and have greater dendritic arborization than neurons in control cultures. Hypertrophied neurons are significantly less excitable than smaller ones; thus, hypertrophy of vagal postganglionic neurons in cardiac ganglia would help to explain the parasympathetic withdrawal that accompanies heart failure. Furthermore, our observations suggest that nerve growth factor, which is elevated in the failing human heart, causes hypertrophy of neurons in cardiac ganglia.

  14. Pathophysiology of cardiac hypertrophy and heart failure: signaling pathways and novel therapeutic targets.

    Science.gov (United States)

    Tham, Yow Keat; Bernardo, Bianca C; Ooi, Jenny Y Y; Weeks, Kate L; McMullen, Julie R

    2015-09-01

    The onset of heart failure is typically preceded by cardiac hypertrophy, a response of the heart to increased workload, a cardiac insult such as a heart attack or genetic mutation. Cardiac hypertrophy is usually characterized by an increase in cardiomyocyte size and thickening of ventricular walls. Initially, such growth is an adaptive response to maintain cardiac function; however, in settings of sustained stress and as time progresses, these changes become maladaptive and the heart ultimately fails. In this review, we discuss the key features of pathological cardiac hypertrophy and the numerous mediators that have been found to be involved in the pathogenesis of cardiac hypertrophy affecting gene transcription, calcium handling, protein synthesis, metabolism, autophagy, oxidative stress and inflammation. We also discuss new mediators including signaling proteins, microRNAs, long noncoding RNAs and new findings related to the role of calcineurin and calcium-/calmodulin-dependent protein kinases. We also highlight mediators and processes which contribute to the transition from adaptive cardiac remodeling to maladaptive remodeling and heart failure. Treatment strategies for heart failure commonly include diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and β-blockers; however, mortality rates remain high. Here, we discuss new therapeutic approaches (e.g., RNA-based therapies, dietary supplementation, small molecules) either entering clinical trials or in preclinical development. Finally, we address the challenges that remain in translating these discoveries to new and approved therapies for heart failure.

  15. Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure.

    Science.gov (United States)

    Paolillo, S; Rengo, G; Pellegrino, T; Formisano, R; Pagano, G; Gargiulo, P; Savarese, G; Carotenuto, R; Petraglia, L; Rapacciuolo, A; Perrino, C; Piscitelli, S; Attena, E; Del Guercio, L; Leosco, D; Trimarco, B; Cuocolo, A; Perrone-Filardi, P

    2015-10-01

    Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational study was to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients. One hundred and fifteen patients (87% males; 65 ± 11.3 years) with severe-to-moderate HF (ejection fraction 32.5 ± 9.1%) underwent iodine-123 meta-iodobenzylguanidine ((123)I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From (123)I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR. Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  16. Subclinical Atherosclerosis, Cardiac and Kidney Function, Heart Failure, and Dementia in the Very Elderly.

    Science.gov (United States)

    Kuller, Lewis H; Lopez, Oscar L; Gottdiener, John S; Kitzman, Dalane W; Becker, James T; Chang, Yuefang; Newman, Anne B

    2017-07-22

    Heart failure (HF) and dementia are major causes of disability and death among older individuals. Risk factors and biomarkers of HF may be determinants of dementia in the elderly. We evaluated the relationship between biomarkers of cardiovascular disease and HF and risk of dementia and death. Three hypotheses were tested: (1) higher levels of high-sensitivity cardiac troponin T, N-terminal of prohormone brain natriuretic peptide, and cystatin C predict risk of death, cardiovascular disease, HF, and dementia; (2) higher levels of cardiovascular disease biomarkers are associated with increased risk of HF and then secondary increased risk of dementia; and (3) risk of dementia is lower among participants with a combination of lower coronary artery calcium, atherosclerosis, and lower high-sensitivity cardiac troponin T (myocardial injury). The Cardiovascular Health Study Cognition Study was a continuation of the Cardiovascular Health Study limited to the Pittsburgh, PA, center from 1998-1999 to 2014. In 1992-1994, 924 participants underwent magnetic resonance imaging of the brain. There were 199 deaths and 116 developed dementia before 1998-1999. Of the 609 participants eligible for the Pittsburgh Cardiovascular Health Study Cognition Study, 87.5% (n=532) were included in the study. There were 120 incident HF cases and 72% had dementia. In 80 of 87, dementia preceded HF. A combination of low coronary artery calcium score and low high-sensitivity cardiac troponin T was significantly associated with reduced risk of dementia and HF. Most participants with HF had dementia but with onset before HF. Lower high-sensitivity cardiac troponin T and coronary artery calcium was associated with low risk of dementia based on a small number of events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  17. Impact of KChIP2 on Cardiac Electrophysiology and the Progression of Heart Failure

    DEFF Research Database (Denmark)

    Grubb, Søren; Callø, Kirstine; Thomsen, Morten B

    2012-01-01

    Electrophysiological remodeling of cardiac potassium ion channels is important in the progression of heart failure. A reduction of the transient outward potassium current (I(to)) in mammalian heart failure is consistent with a reduced expression of potassium channel interacting protein 2 (KChIP2...

  18. The most common cause of sudden cardiac death in athletes

    Directory of Open Access Journals (Sweden)

    Topalović Nikola

    2016-01-01

    Full Text Available The positive impact of exercise on cardiovascular health is well known. Athletes, who are constantly physically active, are considered to be the healthiest members of our society. That is why their sudden death, during the training or competition, attracts the attention of the general public. Rarely, tragic events of sudden cardiac death (SCD are the reason for questioning if by many positive there are also negative impact of physical exercise. The first case of SCD is recorded as far back as the year 490 BC, when the Greek soldier Pheidippides died after he conveyed news of the great victory of the Greeks over the Persians. Risk of SCD is recognized in the middle of the twentieth century. In our region, discussion about this issue began after the World Basketball Championship, which was held in Ljubljana in 1970, because of the sudden death of the national team member Trajko Rajkovic. One of the important goals of modern sports medicine is to reduce the risk of SCD in athletes to 'inevitable rarity'. Definition of SCD is considered to be any unexpected death due to sudden cardiac arrest. Pedo (Pedoe has divided all causes of SCD in the sport into three categories: Commotio cordis (agitation of the heart, which results from blunt impact to the athletes chest with consequent fatal disorder of heart rhythm; SCD of athletes under the age of 35 because of structural, congenital and inflammatory heart disease, which includes hypertrophic cardiomyopathy as the most important cause of sudden cardiac death, congenital anomalies of the coronary arteries, arrhythmogenic right ventricular cardiomyopathy, myocarditis and other; SCD of athletes older than 35 years which is most common due coronary artery disease - atherosclerosis (the dominant risk in the marathon and half-marathon. .

  19. Late Causes of Death After Pediatric Cardiac Surgery: A 60-Year Population-Based Study.

    Science.gov (United States)

    Raissadati, Alireza; Nieminen, Heta; Haukka, Jari; Sairanen, Heikki; Jokinen, Eero

    2016-08-02

    Comprehensive information regarding causes of late post-operative death following pediatric congenital cardiac surgery is lacking. The study sought to analyze late causes of death after congenital cardiac surgery by era and defect severity. We obtained data from a nationwide pediatric cardiac surgery database and Finnish population registry regarding patients who underwent cardiac surgery at Causes of death were determined using International Classification of Diseases diagnostic codes. Deaths among the study population were compared to a matched control population. Overall, 10,964 patients underwent 14,079 operations, with 98% follow-up. Early mortality (death rates correlated with defect severity. Heart failure was the most common mode of CHD-related death, but decreased after surgeries performed between 1990 and 2009. Sudden death after surgery for atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition of the great arteries decreased to zero following operations from 1990 to 2009. Deaths from neoplasms, respiratory, neurological, and infectious disease were significantly more common among study patients than controls. Pneumonia caused the majority of non-CHD-related deaths among the study population. CHD-related deaths have decreased markedly but remain a challenge after surgery for severe cardiac defects. Premature deaths are generally more common among patients than the control population, warranting long-term follow-up after congenital cardiac surgery. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients.

    Science.gov (United States)

    Denardo, Scott J; Vock, David M; Schmalfuss, Carsten M; Young, Gregory D; Tcheng, James E; O'Connor, Christopher M

    2016-07-01

    Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (Pcontrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02). In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and

  1. Impaired cardiac uptake of meta-[123I]iodobenzylguanidine in Parkinson's disease with autonomic failure

    International Nuclear Information System (INIS)

    Braune, S.; Luecking, C.H.; Reinhardt, M.; Bathmann, J.; Krause, T.; Lehmann, M.

    1998-01-01

    Objective - To selectively investigate postganglionic sympathetic cardiac neurons in patients with Parkinson's disease and autonomic failure. Material and methods - Metaiodobenzylguanidine (MIBG) is a pharmacologically inactive analogue of noradrenaline, which is similarly metabolized in noradrenergic neurons. Therefore the uptake of radiolabelled MIBG represents not only the localization of postganglionic sympathetic neurons but also their functional integrity. Ten patients with Parkinson's disease and autonomic failure underwent standardized autonomic testing, assessment of catecholamine plasma levels and scintigraphy with [ 123 I]MIGB. Results - The cardiac uptake of MIBG, as demonstrated by the heart/mediastinum ratio, was significantly lower in patients in comparison with controls. Scintigraphy with MIBG allowed the selective in-vivo investigation of postganglionic sympathetic cardiac efferent in patients with autonomic failure, a procedure which was previously confined to post-mortem examination. Conclusion - These findings point to a relevant postganglionic pattern of involvement of the autonomic nervous system (ANS) in Parkinson's disease and autonomic failure. (au)

  2. Diesel Exhaust Inhalation Increases Cardiac Output, Bradyarrhythmias, and Parasympathetic Tone in Aged Heart Failure-Prone Rats

    Science.gov (United States)

    Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance...

  3. Estimation of common cause failure parameters for diesel generators

    International Nuclear Information System (INIS)

    Tirira, J.; Lanore, J.M.

    2002-10-01

    This paper presents a summary of some results concerning the feedback analysis of French Emergency diesel generator (EDG). The database of common cause failure for EDG has been updated. The data collected covers a period of 10 years. Several latent common cause failure (CCF) events counting in tens are identified. In fact, in this number of events collected, most are potential CCF. From events identified, 15% events are characterized as complete CCF. The database is organised following the structure proposed by 'International Common Cause Data Exchange' (ICDE project). Events collected are analyzed by failure mode and degree of failure. Qualitative analysis of root causes, coupling factors and corrective actions are studied. The exercise of quantitative analysis is in progress for evaluating CCF parameters taking into account the average impact vector and the rate of the independent failures. The interest of the average impact vector approach is that it makes it possible to take into account a wide experience feedback, not limited to complete CCF but including also many events related to partial or potential CCF. It has to be noted that there are no finalized quantitative conclusions yet to be drawn and analysis is in progress for evaluating diesel CCF parameters. In fact, the numerical coding CCF representation of the events uses a part of subjective analysis, which requests a complete and detailed event examination. (authors)

  4. The multi-class binomial failure rate model for the treatment of common-cause failures

    International Nuclear Information System (INIS)

    Hauptmanns, U.

    1995-01-01

    The impact of common cause failures (CCF) on PSA results for NPPs is in sharp contrast with the limited quality which can be achieved in their assessment. This is due to the dearth of observations and cannot be remedied in the short run. Therefore the methods employed for calculating failure rates should be devised such as to make the best use of the few available observations on CCF. The Multi-Class Binomial Failure Rate (MCBFR) Model achieves this by assigning observed failures to different classes according to their technical characteristics and applying the BFR formalism to each of these. The results are hence determined by a superposition of BFR type expressions for each class, each of them with its own coupling factor. The model thus obtained flexibly reproduces the dependence of CCF rates on failure multiplicity insinuated by the observed failure multiplicities. This is demonstrated by evaluating CCFs observed for combined impulse pilot valves in German NPPs. (orig.) [de

  5. A new method for explicit modelling of single failure event within different common cause failure groups

    International Nuclear Information System (INIS)

    Kančev, Duško; Čepin, Marko

    2012-01-01

    Redundancy and diversity are the main principles of the safety systems in the nuclear industry. Implementation of safety components redundancy has been acknowledged as an effective approach for assuring high levels of system reliability. The existence of redundant components, identical in most of the cases, implicates a probability of their simultaneous failure due to a shared cause—a common cause failure. This paper presents a new method for explicit modelling of single component failure event within multiple common cause failure groups simultaneously. The method is based on a modification of the frequently utilised Beta Factor parametric model. The motivation for development of this method lays in the fact that one of the most widespread softwares for fault tree and event tree modelling as part of the probabilistic safety assessment does not comprise the option for simultaneous assignment of single failure event to multiple common cause failure groups. In that sense, the proposed method can be seen as an advantage of the explicit modelling of common cause failures. A standard standby safety system is selected as a case study for application and study of the proposed methodology. The results and insights implicate improved, more transparent and more comprehensive models within probabilistic safety assessment.

  6. Relationship between quantitative cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Parker, Matthew W.; Sood, Nitesh [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Ahlberg, Alan W. [Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States); Heller, Gary V. [The Intersocietal Accreditation Commission, Ellicott City, MD (United States); Lundbye, Justin B. [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); The Hospital of Central Connecticut, Division of Cardiology, New Britain, CT (United States)

    2014-09-15

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between {sup 123}I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using {sup 123}I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  7. Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure

    International Nuclear Information System (INIS)

    Parker, Matthew W.; Sood, Nitesh; Ahlberg, Alan W.; Jacobson, Arnold F.; Heller, Gary V.; Lundbye, Justin B.

    2014-01-01

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by 123 I-meta-iodobenzylguanidine ( 123 I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between 123 I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using 123 I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

  8. An endogenously produced fragment of cardiac myosin-binding protein C is pathogenic and can lead to heart failure.

    Science.gov (United States)

    Razzaque, Md Abdur; Gupta, Manish; Osinska, Hanna; Gulick, James; Blaxall, Burns C; Robbins, Jeffrey

    2013-08-16

    A stable 40-kDa fragment is produced from cardiac myosin-binding protein C when the heart is stressed using a stimulus, such as ischemia-reperfusion injury. Elevated levels of the fragment can be detected in the diseased mouse and human heart, but its ability to interfere with normal cardiac function in the intact animal is unexplored. To understand the potential pathogenicity of the 40-kDa fragment in vivo and to investigate the molecular pathways that could be targeted for potential therapeutic intervention. We generated cardiac myocyte-specific transgenic mice using a Tet-Off inducible system to permit controlled expression of the 40-kDa fragment in cardiomyocytes. When expression of the 40-kDa protein is induced by crossing the responder animals with tetracycline transactivator mice under conditions in which substantial quantities approximating those observed in diseased hearts are reached, the double-transgenic mice subsequently experience development of sarcomere dysgenesis and altered cardiac geometry, and the heart fails between 12 and 17 weeks of age. The induced double-transgenic mice had development of cardiac hypertrophy with myofibrillar disarray and fibrosis, in addition to activation of pathogenic MEK-ERK pathways. Inhibition of MEK-ERK signaling was achieved by injection of the mitogen-activated protein kinase (MAPK)/ERK inhibitor U0126. The drug effectively improved cardiac function, normalized heart size, and increased probability of survival. These results suggest that the 40-kDa cardiac myosin-binding protein C fragment, which is produced at elevated levels during human cardiac disease, is a pathogenic fragment that is sufficient to cause hypertrophic cardiomyopathy and heart failure.

  9. Contribution of cardiac and extra-cardiac disease burden to risk of cardiovascular outcomes varies by ejection fraction in heart failure

    DEFF Research Database (Denmark)

    Wolsk, Emil; Claggett, Brian; Køber, Lars

    2018-01-01

    AIMS: Patients with heart failure (HF) often have multiple co-morbidities that contribute to the risk of adverse cardiovascular (CV) and non-CV outcomes. We assessed the relative contribution of cardiac and extra-cardiac disease burden and demographic factors to CV outcomes in HF patients...... Association class, systolic blood pressure, time since HF diagnosis, HF medication use), extra-cardiac (body mass index, creatinine, diabetes mellitus, chronic obstructive pulmonary disease, smoker), and demographic (age, gender) categories, and calculated subscores for each patient representing the burden......EF patients (PAR: 76% cardiac disease vs. 58% extra-cardiac disease, P vs. 49% extra-cardiac disease, P

  10. Computer aided approach to qualitative and quantitative common cause failure analysis for complex systems

    International Nuclear Information System (INIS)

    Cate, C.L.; Wagner, D.P.; Fussell, J.B.

    1977-01-01

    Common cause failure analysis, also called common mode failure analysis, is an integral part of a complete system reliability analysis. Existing methods of computer aided common cause failure analysis are extended by allowing analysis of the complex systems often encountered in practice. The methods aid in identifying potential common cause failures and also address quantitative common cause failure analysis

  11. Cardiac overexpression of Mammalian enabled (Mena) exacerbates heart failure in mice.

    Science.gov (United States)

    Belmonte, Stephen L; Ram, Rashmi; Mickelsen, Deanne M; Gertler, Frank B; Blaxall, Burns C

    2013-09-15

    Mammalian enabled (Mena) is a key regulator of cytoskeletal actin dynamics, which has been implicated in heart failure (HF). We have previously demonstrated that cardiac Mena deletion produced cardiac dysfunction with conduction abnormalities and hypertrophy. Moreover, elevated Mena expression correlates with HF in human and animal models, yet the precise role of Mena in cardiac pathophysiology is unclear. In these studies, we evaluated mice with cardiac myocyte-specific Mena overexpression (TTA/TgTetMena) comparable to that observed in cardiac pathology. We found that the hearts of TTA/TgTetMena mice were functionally and morphologically comparable to wild-type littermates, except for mildly increased heart mass in the transgenic mice. Interestingly, TTA/TgTetMena mice were particularly susceptible to cardiac injury, as these animals experienced pronounced decreases in ejection fraction and fractional shortening as well as heart dilatation and hypertrophy after transverse aortic constriction (TAC). By "turning off" Mena overexpression in TTA/TgTetMena mice either immediately prior to or immediately after TAC surgery, we discovered that normalizing Mena levels eliminated cardiac hypertrophy in TTA/TgTetMena animals but did not preclude post-TAC cardiac functional deterioration. These findings indicate that hearts with increased levels of Mena fare worse when subjected to cardiac injury and suggest that Mena contributes to HF pathophysiology.

  12. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia

    Directory of Open Access Journals (Sweden)

    Hak Ju Kim

    2016-08-01

    Full Text Available Cardiac resynchronization therapy (CRT is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D. After CRT-D, left ventricular ejection fraction improved from 22% to 4 4% a ssessed by e chocardiog ram 1 year p ostoperatively. On e lectrocardiog ram, Q RS d uration was shortened from 206 to 144 ms. The patient’s clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option.

  13. Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Han Soo Park

    2017-03-01

    Full Text Available Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF. A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

  14. Influence of the timing of cardiac catheterization and amount of contrast media on acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mohsen Mirmohammad Sadeghi

    2011-01-01

    Full Text Available Background: There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF. Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated. Methods: Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression. Results: The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05. Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57% and 6 (52.17% after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI = 1.613-15.355 and p = 0.002, followed by intra-aortic balloon pump insertion (OR: 6.890, CI = 1.482-32.032 and p = 0.009 and usage of higher doses of contrast media agent (OR: 1.446, CI = 1.033-2.025 and p = 0.031. Conclusions: Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have

  15. Toll-Like Receptor 9 Promotes Cardiac Inflammation and Heart Failure during Polymicrobial Sepsis

    Directory of Open Access Journals (Sweden)

    Ralph Lohner

    2013-01-01

    Full Text Available Background. Aim was to elucidate the role of toll-like receptor 9 (TLR9 in cardiac inflammation and septic heart failure in a murine model of polymicrobial sepsis. Methods. Sepsis was induced via colon ascendens stent peritonitis (CASP in C57BL/6 wild-type (WT and TLR9-deficient (TLR9-D mice. Bacterial load in the peritoneal cavity and cardiac expression of inflammatory mediators were determined at 6, 12, 18, 24, and 36 h. Eighteen hours after CASP cardiac function was monitored in vivo. Sarcomere length of isolated cardiomyocytes was measured at 0.5 to 10 Hz after incubation with heat-inactivated bacteria. Results. CASP led to continuous release of bacteria into the peritoneal cavity, an increase of cytokines, and differential regulation of receptors of innate immunity in the heart. Eighteen hours after CASP WT mice developed septic heart failure characterised by reduction of end-systolic pressure, stroke volume, cardiac output, and parameters of contractility. This coincided with reduced cardiomyocyte sarcomere shortening. TLR9 deficiency resulted in significant reduction of cardiac inflammation and a sustained heart function. This was consistent with reduced mortality in TLR9-D compared to WT mice. Conclusions. In polymicrobial sepsis TLR9 signalling is pivotal to cardiac inflammation and septic heart failure.

  16. Investigations of inter-system common cause failures

    International Nuclear Information System (INIS)

    Nonclerca, P.; Gallois, M.; Vasseur, D.

    2012-01-01

    Intra-system common-cause failures (CCF) are widely studied and addressed in existing PSA models, but the information and studies that incorporate the potential for inter-system CCF is limited. However, the French Safety Authority has requested that EDF investigate the possibility of common-cause failure across system boundaries for Flamanville 3 (an EPR design). Also, the modeling of inter-system CCF, or the proof that their impact is negligible, would satisfy Capability Category III for one of the requirements in the ASME/ANS PRA standard in the U.S. EDF and EPRI have been working on a method to assess when it is necessary to take into account inter-system CCF in a PSA model between 2008 and 2010. This method is based both on the likelihood of inter-system CCF and on its demonstrated potential impact on CDF (core damage frequency). This method was first applied on pumps in different systems of the 900 MWe series plants. The second application concerned the motor-operated valves across different systems, using the same PSA model. This second application helped us refine the method, which was not optimal when the number of concerned components is very large. Since then, the method has been successfully applied on the pumps and 10 kV breakers of the EPR power plant in Flamanville. This paper describes the method and the results obtained in some of these studies. All studies have shown either that components in different systems, when they were not already part of a common cause failure group in the model, are not susceptible to common causes of failure, or that the potential for inter-system common-cause failure is negligible regarding the overall risk. (authors)

  17. Climate change and the causes of dam failures in Australia

    International Nuclear Information System (INIS)

    Lewis, B.

    2007-01-01

    As a result of poor dam construction methods in Australia and significant droughts occurring over the past 60 years, there is a danger that mistakes made during previous droughts will be repeated. Dams were often built in soils of very low moisture content to ensure a properly compacted bank. As a result of these poor construction methods, the drought years have produced an unusually high number of dam failures. This paper discussed the causes of dam failures such as dispersive clays and defects in associated structures. The discussion on dispersive clays included cracking, piping, tunneling, and slides. Dispersive clays occur in soils whose clay minerals separate into single grains when placed in contact with water and are associated with high soil erodability and their distribution often coincides with the occurrence of erosion gullying, rilling and piping. Dispersive clays in a dam embankment can result in the leaching out of material from the embankment with consequent erosion and failure. Defects in associated structures that were discussed included spillway blockage and outlet pipe blockage. It was concluded that dam failures are seldom due to one particular cause but rather due to one weakness triggering another. It was concluded that failures are difficult and expensive to remedy. 9 refs., 4 figs

  18. Association of cardiac cachexia and atrial fibrillation in heart failure patients.

    Science.gov (United States)

    Arámbula-Garza, Estefanía; Castillo-Martínez, Lilia; González-Islas, Dulce; Orea-Tejeda, Arturo; Santellano-Juárez, Brenda; Keirns-Davies, Candace; Peláez-Hernández, Viridiana; Sánchez-Santillán, Rocío; Pineda-Juárez, Juan; Cintora-Martínez, Carlos; Pablo-Santiago, Ruth

    2016-11-15

    Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC). Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients. In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded. Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p<0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p<0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027). The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. A different management of saphenous vein graft failure related to cardiac tamponade following coronary surgery

    Directory of Open Access Journals (Sweden)

    Hamit Serdar Başbuğ

    2016-03-01

    Full Text Available Cardiac tamponade is a state of constriction of the heart with an excessive fluid or hematoma resulted from various conditions. Postoperative tamponade can occur after coronary bypass surgery. Despite it is uncommon, its results may have a high risk of mortality and morbidity. Acute postoperative cardiac tamponade reveals a vast spectrum of symptoms. Moreover, a compression over the saphenous vein graft is the worst complication that should be managed without delay. We report a rare case of saphenous vein graft failure due to the cardiac tamponade following a coronary surgery and its management with a practical measure.

  20. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins!

    Science.gov (United States)

    Aljizeeri, Ahmed; Sulaiman, Abdulbaset; Alhulaimi, Naji; Alsaileek, Ahmed; Al-Mallah, Mouaz H

    2017-07-01

    Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.

  1. Benchmark exercise of the European Community on common cause failure

    International Nuclear Information System (INIS)

    Doerre, P.

    1986-09-01

    This report summarizes experiences and results of the contractor's contribution to the 'Second Reliability Benchmark Exercise of the European Community on Common Cause Failure' (CCF-RBE). The choice of a method for the treatment of dependent failures in a given reliability analysis depends on the purpose and aim of this analysis as well as on quality and extent of the available data, which may also influence the necessary degree of detail of the analysis. When data are applied to a system with different degree of redundancy, two types of errors have to be avoided which lead to extremely pessimistic assessments. (orig.) With 20 refs., 3 tabs., 1 fig [de

  2. Myostatin from the heart: local and systemic actions in cardiac failure and muscle wasting

    Science.gov (United States)

    Breitbart, Astrid; Auger-Messier, Mannix; Molkentin, Jeffery D.

    2011-01-01

    A significant proportion of heart failure patients develop skeletal muscle wasting and cardiac cachexia, which is associated with a very poor prognosis. Recently, myostatin, a cytokine from the transforming growth factor-β (TGF-β) family and a known strong inhibitor of skeletal muscle growth, has been identified as a direct mediator of skeletal muscle atrophy in mice with heart failure. Myostatin is mainly expressed in skeletal muscle, although basal expression is also detectable in heart and adipose tissue. During pathological loading of the heart, the myocardium produces and secretes myostatin into the circulation where it inhibits skeletal muscle growth. Thus, genetic elimination of myostatin from the heart reduces skeletal muscle atrophy in mice with heart failure, whereas transgenic overexpression of myostatin in the heart is capable of inducing muscle wasting. In addition to its endocrine action on skeletal muscle, cardiac myostatin production also modestly inhibits cardiomyocyte growth under certain circumstances, as well as induces cardiac fibrosis and alterations in ventricular function. Interestingly, heart failure patients show elevated myostatin levels in their serum. To therapeutically influence skeletal muscle wasting, direct inhibition of myostatin was shown to positively impact skeletal muscle mass in heart failure, suggesting a promising strategy for the treatment of cardiac cachexia in the future. PMID:21421824

  3. Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

    Science.gov (United States)

    Compostella, Leonida; Compostella, Caterina; Russo, Nicola; Setzu, Tiziana; Iliceto, Sabino; Bellotto, Fabio

    2017-09-01

    During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

  4. Cardiac index and pulmonary arterial blood pressure during exercise in cases of suspected latent heart failure

    International Nuclear Information System (INIS)

    Agapov, A.A.; Berzak, N.V.; Vladimirov, S.S.

    1987-01-01

    The results studying hemodynamics during maximum physical load (veloeriometry when sitting) for 24 patients examined to avoid heart failure are presented. 19 patients were subjected to coronaroangiography and contrast ventriculography, and 12 patients - to myocardium scintigraphy with 99m Tc-pyrophosphate. It is shown that registration of diaslotic pressure in a pulmonary artery and in a cardiac index permits to diagnose failure in the miocardic function of patients with different heart diseases

  5. Aberrant Glycosylation in the Left Ventricle and Plasma of Rats with Cardiac Hypertrophy and Heart Failure.

    Directory of Open Access Journals (Sweden)

    Chiaki Nagai-Okatani

    Full Text Available Targeted proteomics focusing on post-translational modifications, including glycosylation, is a useful strategy for discovering novel biomarkers. To apply this strategy effectively to cardiac hypertrophy and resultant heart failure, we aimed to characterize glycosylation profiles in the left ventricle and plasma of rats with cardiac hypertrophy. Dahl salt-sensitive hypertensive rats, a model of hypertension-induced cardiac hypertrophy, were fed a high-salt (8% NaCl diet starting at 6 weeks. As a result, they exhibited cardiac hypertrophy at 12 weeks and partially impaired cardiac function at 16 weeks compared with control rats fed a low-salt (0.3% NaCl diet. Gene expression analysis revealed significant changes in the expression of genes encoding glycosyltransferases and glycosidases. Glycoproteome profiling using lectin microarrays indicated upregulation of mucin-type O-glycosylation, especially disialyl-T, and downregulation of core fucosylation on N-glycans, detected by specific interactions with Amaranthus caudatus and Aspergillus oryzae lectins, respectively. Upregulation of plasma α-l-fucosidase activity was identified as a biomarker candidate for cardiac hypertrophy, which is expected to support the existing marker, atrial natriuretic peptide and its related peptides. Proteomic analysis identified cysteine and glycine-rich protein 3, a master regulator of cardiac muscle function, as an O-glycosylated protein with altered glycosylation in the rats with cardiac hypertrophy, suggesting that alternations in O-glycosylation affect its oligomerization and function. In conclusion, our data provide evidence of significant changes in glycosylation pattern, specifically mucin-type O-glycosylation and core defucosylation, in the pathogenesis of cardiac hypertrophy and heart failure, suggesting that they are potential biomarkers for these diseases.

  6. Centrifuge model test of rock slope failure caused by seismic excitation. Plane failure of dip slope

    International Nuclear Information System (INIS)

    Ishimaru, Makoto; Kawai, Tadashi

    2008-01-01

    Recently, it is necessary to assess quantitatively seismic safety of critical facilities against the earthquake induced rock slope failure from the viewpoint of seismic PSA. Under these circumstances, it is essential to evaluate more accurately the possibilities of rock slope failure and the potential failure boundary, which are triggered by earthquake ground motions. The purpose of this study is to analyze dynamic failure characteristics of rock slopes by centrifuge model tests for verification and improvement of the analytical methods. We conducted a centrifuge model test using a dip slope model with discontinuities limitated by Teflon sheets. The centrifugal acceleration was 50G, and the acceleration amplitude of input sin waves increased gradually at every step. The test results were compared with safety factors of the stability analysis based on the limit equilibrium concept. Resultant conclusions are mainly as follows: (1) The slope model collapsed when it was excited by the sine wave of 400gal, which was converted to real field scale, (2) Artificial discontinuities were considerably concerned in the collapse, and the type of collapse was plane failure, (3) From response acceleration records observed at the slope model, we can say that tension cracks were generated near the top of the slope model during excitation, and that might be cause of the collapse, (4) By considering generation of the tension cracks in the stability analysis, correspondence of the analytical results and the experimental results improved. From the obtained results, we need to consider progressive failure in evaluating earthquake induced rock slope failure. (author)

  7. The clinical value of cardiac sympathetic imaging in heart failure

    DEFF Research Database (Denmark)

    Christensen, Thomas Emil; Kjaer, Andreas; Hasbak, Philip

    2014-01-01

    The autonomic nervous system plays an important role in the pathology of heart failure. The single-photon emission computed tomography tracer iodine-123-metaiodobenzylguanidine ((123) I-MIBG) can be used to investigate the activity of the predominant neurotransmitter of the sympathetic nervous...

  8. Chronic Cardiac-Targeted RNA Interference for the Treatment of Heart Failure Restores Cardiac Function and Reduces Pathological Hypertrophy

    Science.gov (United States)

    Suckau, Lennart; Fechner, Henry; Chemaly, Elie; Krohn, Stefanie; Hadri, Lahouaria; Kockskämper, Jens; Westermann, Dirk; Bisping, Egbert; Ly, Hung; Wang, Xiaomin; Kawase, Yoshiaki; Chen, Jiqiu; Liang, Lifan; Sipo, Isaac; Vetter, Roland; Weger, Stefan; Kurreck, Jens; Erdmann, Volker; Tschope, Carsten; Pieske, Burkert; Lebeche, Djamel; Schultheiss, Heinz-Peter; Hajjar, Roger J.; Poller, Wolfgang Ch.

    2009-01-01

    Background RNA interference (RNAi) has the potential to be a novel therapeutic strategy in diverse areas of medicine. We report on targeted RNAi for the treatment of heart failure (HF), an important disorder in humans resulting from multiple etiologies. Successful treatment of HF is demonstrated in a rat model of transaortic banding by RNAi targeting of phospholamban (PLB), a key regulator of cardiac Ca2+ homeostasis. Whereas gene therapy rests on recombinant protein expression as its basic principle, RNAi therapy employs regulatory RNAs to achieve its effect. Methods and Results We describe structural requirements to obtain high RNAi activity from adenoviral (AdV) and adeno-associated virus (AAV9) vectors and show that an AdV short hairpin RNA vector (AdV-shRNA) silenced PLB in cardiomyocytes (NRCMs) and improved hemodynamics in HF rats 1 month after aortic root injection. For simplified long-term therapy we developed a dimeric cardiotropic AAV vector (rAAV9-shPLB) delivering RNAi activity to the heart via intravenous injection. Cardiac PLB protein was reduced to 25% and SERCA2a suppression in the HF groups was rescued. In contrast to traditional vectors rAAV9 shows high affinity for myocardium, but low affinity for liver and other organs. rAAV9-shPLB therapy restored diastolic (LVEDP, dp/dtmin, Tau) and systolic (fractional shortening) functional parameters to normal range. The massive cardiac dilation was normalized and the cardiac hypertrophy, cardiomyocyte diameter and cardiac fibrosis significantly reduced. Importantly, there was no evidence of microRNA deregulation or hepatotoxicity during these RNAi therapies. Conclusion Our data show, for the first time, high efficacy of an RNAi therapeutic strategy in a cardiac disease. PMID:19237664

  9. Type D personality and cardiac mortality in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Smith, Otto R F; Pedersen, Susanne S.

    2010-01-01

    Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients....

  10. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  11. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R. J.; Staal, J. B.; van der Voort, S.; Kemps, H. M.; Koers, H.; Jongert, M. W. A.; Hendriks, E. J. M.

    2015-01-01

    To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. A systematic literature search was performed to formulate conclusions on the efficacy of

  12. Impact of Ejection Fraction on the Clinical Response to Cardiac Resynchronization Therapy in Mild Heart Failure

    DEFF Research Database (Denmark)

    Linde, Cecilia; Daubert, Claude; Abraham, William T

    2013-01-01

    Current guidelines recommend cardiac resynchronization therapy (CRT) in mild heart failure (HF) patients with QRS prolongation and ejection fraction (EF) ≤30%. To assess the effect of CRT in less severe systolic dysfunction, outcomes in the REsynchronization reVErses Remodeling in Systolic left v...

  13. Insights About Emergency Diesel Generator Failures from the USNRC's Common Cause Failure Database

    International Nuclear Information System (INIS)

    Mosleh, A.; Rasmuson, D.; Marshall, F.; Wierman, T.

    1999-01-01

    The US Nuclear Regulatory Commission has sponsored development of a database of common cause failure events for use in commercial nuclear power plant risk and reliability analyses. This paper presents a summary of the results from analysis of the emergency diesel generator data from the database. The presentation is limited to the overall insights, the design and manufacturing cause and the instrumentation and control sub-system

  14. Common Cause Failure Analysis for the Digital Plant Protection System

    International Nuclear Information System (INIS)

    Kagn, Hyun Gook; Jang, Seung Cheol

    2005-01-01

    Safety-critical systems such as nuclear power plants adopt the multiple-redundancy design in order to reduce the risk from the single component failure. The digitalized safety-signal generation system is also designed based on the multiple-redundancy strategy which consists of more redundant components. The level of the redundant design of digital systems is usually higher than those of conventional mechanical systems. This higher redundancy would clearly reduce the risk from the single failure of components, but raise the importance of the common cause failure (CCF) analysis. This research aims to develop the practical and realistic method for modeling the CCF in digital safety-critical systems. We propose a simple and practical framework for assessing the CCF probability of digital equipment. Higher level of redundancy causes the difficulty of CCF analysis because it results in impractically large number of CCF events in the fault tree model when we use conventional CCF modeling methods. We apply the simplified alpha-factor (SAF) method to the digital system CCF analysis. The precedent study has shown that SAF method is quite realistic but simple when we consider carefully system success criteria. The first step for using the SAF method is the analysis of target system for determining the function failure cases. That is, the success criteria of the system could be derived from the target system's function and configuration. Based on this analysis, we can calculate the probability of single CCF event which represents the CCF events resulting in the system failure. In addition to the application of SAF method, in order to accommodate the other characteristics of digital technology, we develop a simple concept and several equations for practical use

  15. Cardiac dysfunction in heart failure: the cardiologist's love affair with time.

    Science.gov (United States)

    Brutsaert, Dirk L

    2006-01-01

    Translating research into clinical practice has been a challenge throughout medical history. From the present review, it should be clear that this is particularly the case for heart failure. As a consequence, public awareness of this disease has been disillusionedly low, despite its prognosis being worse than that of most cancers and many other chronic diseases. We explore how over the past 150 years since Ludwig and Marey concepts about the evaluation of cardiac performance in patients with heart failure have emerged. From this historical-physiologic perspective, we have seen how 3 increasingly reductionist approaches or schools of thought have evolved in parallel, that is, an input-output approach, a hemodynamic pump approach, and a muscular pump approach. Each one of these has provided complementary insights into the pathophysiology of heart failure and has resulted in measurements or derived indices, some of which still being in use in present-day cardiology. From the third, most reductionist muscular pump approach, we have learned that myocardial and ventricular relaxation properties as well as temporal and spatial nonuniformities have been largely overlooked in the 2 other, input-output and hemodynamic pump, approaches. A key message from the present review is that relaxation and nonuniformities can be fully understood only from within the time-space continuum of cardiac pumping. As cyclicity and rhythm are, in some way, the most basic aspects of cardiac function, considerations of time should dominate over any measurement of cardiac performance as a muscular pump. Any measurement that is blind for the arrow of cardiac time should therefore be interpreted with caution. We have seen how the escape from the time domain-as with the calculation of LV ejection fraction-fascinating though as it may be, has undoubtedly served to hinder a rational scientific debate on the recent, so-called systolic-diastolic heart failure controversy. Lacking appreciation of early

  16. Effects of Common Cause Failure on Electrical Systems

    International Nuclear Information System (INIS)

    Pepper, Kevin

    2015-01-01

    The essential electrical systems of reactor designs have developed progressively with an increased focus on the use of redundant, segregated and independent safety system equipment 'trains'. In this arrangement, essential safety functions associated with safe shutdown and cooling of the reactor are replicated on near identical electrical systems with each of the trains of safety system equipment supported by a fully rated standby generator. Development in designs has seen the number of trains increased to enable maintenance to be undertaken with reactors at power, improving the economics of the units whilst maintaining nuclear safety. This paper provides a background to common cause failure and provides examples where supporting guidance and international experience is available. It also highlights the regulatory guidance available to UK licensees. Recent examples of common cause failures on plant in the UK are presented together with an issue identified during the recent Generic Design Assessment review of new reactor designs within the UK. It was identified that one design was claiming a very low probability of failure associated with the loss of a single break and no-break voltage level, orders of magnitude below the target figure within ONR's Safety Assessment Principles. On closer scrutiny it was established that a significant safety function provided from identical low voltage switchboards would be lost in the event of a common cause failure affecting these boards. The paper will explain the action that has been taken by the requesting party to improve the resilience of the design and how this impacts on the ONR reliability targets for reactor designs within the UK. (authors)

  17. Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal Hyperplasia and Other Causes of Access Failure

    Science.gov (United States)

    Duque, Juan C.; Tabbara, Marwan; Martinez, Laisel; Cardona, Jose; Vazquez-Padron, Roberto I; Salman, Loay H

    2016-01-01

    Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients’ morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty (PTA) continues to be the gold standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a two-stage brachio-basilic AVF that was complicated by failure four months after creation. Angiogram showed multiple juxta-anastomotic and mid-fistula stenotic lesions. PTA was successful in assisting maturation and subsequently cannulating AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis as biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH, and highlights the need for more therapeutic options to reduce AVF failure rate. PMID:28084215

  18. Therapeutic Inhibition of miR-208a Improves Cardiac Function and Survival During Heart Failure

    Science.gov (United States)

    Montgomery, Rusty L.; Hullinger, Thomas G.; Semus, Hillary M.; Dickinson, Brent A.; Seto, Anita G.; Lynch, Joshua M.; Stack, Christianna; Latimer, Paul A.; Olson, Eric N.; van Rooij, Eva

    2012-01-01

    Background Diastolic dysfunction in response to hypertrophy is a major clinical syndrome with few therapeutic options. MicroRNAs act as negative regulators of gene expression by inhibiting translation or promoting degradation of target mRNAs. Previously, we reported that genetic deletion of the cardiac-specific miR-208a prevents pathological cardiac remodeling and upregulation of Myh7 in response to pressure overload. Whether this miRNA might contribute to diastolic dysfunction or other forms of heart disease is currently unknown. Methods and Results Here, we show that systemic delivery of an antisense oligonucleotide induces potent and sustained silencing of miR-208a in the heart. Therapeutic inhibition of miR-208a by subcutaneous delivery of antimiR-208a during hypertension-induced heart failure in Dahl hypertensive rats dose-dependently prevents pathological myosin switching and cardiac remodeling while improving cardiac function, overall health, and survival. Transcriptional profiling indicates that antimiR-208a evokes prominent effects on cardiac gene expression; plasma analysis indicates significant changes in circulating levels of miRNAs on antimiR-208a treatment. Conclusions These studies indicate the potential of oligonucleotide-based therapies for modulating cardiac miRNAs and validate miR-208 as a potent therapeutic target for the modulation of cardiac function and remodeling during heart disease progression. PMID:21900086

  19. Phrenic paralysis during cardiac electronic device implantation: incidence, causes and clinical course.

    Science.gov (United States)

    López-Gil, María; Fontenla, Adolfo; Juliá, Justo; Parra, Juan José; Arribas, Fernando

    2016-10-01

    Phrenic paralysis is a known complication of central venous catheterization, but it is not listed as a complication related to cardiac implantable electronic device (CIED) implants. The aim of this study is to describe the incidence, causes, clinical picture, and management of phrenic paralysis occurring in this scenario. We retrospectively analysed data from our CIED implantation database and identified those patients who suffered phrenic paralysis during the implantation procedure. Four of 891 patients (subclavian puncture in 626) developed phrenic paralysis during pacemaker or defibrillator implant procedures. Severe respiratory failure needing ventilatory support occurred in two, being the phrenic paralysis transient in all of the cases. Transient phrenic paralysis may occur during CIED implantation probably related to the infiltration of local anaesthesia in the subclavian area. Mechanism, prevention, and management are discussed. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  20. Estimating changes in cardiac output using an implanted hemodynamic monitor in heart failure patients

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Ersgård, David

    2010-01-01

    OBJECTIVES: The aim of this study was to evaluate an algorithm that estimates changes in cardiac output (CO) from right ventricular (RV) pressure waveforms derived from an implantable hemodynamic monitor (IHM) in heart failure patients. DESIGN: Twelve heart failure patients (NYHA II-III, EF 32......%) with an implantable hemodynamic monitor (Chronicle) were included in this study. Changes in cardiac output were provoked by body position change at rest (left lateral supine, horizontal supine, sitting, and standing) and a steady state bicycle exercise at 20 watts. Estimated CO derived from the IHM (CO...... was -0.39 L/min (11%). Limits of agreement were +/-1.56 L/min and relative error was 21%. CONCLUSIONS: A simple algorithm based on RV pressure wave form characteristics derived from an IHM can be used to estimate changes in CO in heart failure patients. These findings encourage further research aiming...

  1. PACC information management code for common cause failures analysis

    International Nuclear Information System (INIS)

    Ortega Prieto, P.; Garcia Gay, J.; Mira McWilliams, J.

    1987-01-01

    The purpose of this paper is to present the PACC code, which, through an adequate data management, makes the task of computerized common-mode failure analysis easier. PACC processes and generates information in order to carry out the corresponding qualitative analysis, by means of the boolean technique of transformation of variables, and the quantitative analysis either using one of several parametric methods or a direct data-base. As far as the qualitative analysis is concerned, the code creates several functional forms for the transformation equations according to the user's choice. These equations are subsequently processed by boolean manipulation codes, such as SETS. The quantitative calculations of the code can be carried out in two different ways: either starting from a common cause data-base, or through parametric methods, such as the Binomial Failure Rate Method, the Basic Parameters Method or the Multiple Greek Letter Method, among others. (orig.)

  2. Detection of intra-cardiac thrombi and congestive heart failure in cats using computed tomographic angiography.

    Science.gov (United States)

    Vititoe, Kyle P; Fries, Ryan C; Joslyn, Stephen; Selmic, Laura E; Howes, Mark; Vitt, Jordan P; O'Brien, Robert T

    2018-04-16

    Arterial thromboembolism is a life-threatening condition in cats most commonly secondary to cardiac disease. Echocardiography is the reference standard to evaluate for presence of a thrombus. In humans, computed tomographic (CT) angiography is becoming widely used to detect left atrial thrombi precluding the use of sedation. The purpose of this prospective, controlled, methods comparison pilot study was threefold: (1) describe new CT angiography protocol used in awake cats with cardiac disease and congestive heart failure; (2) determine accuracy of continuous and dynamic acquisition CT angiography to identify and characterize cardiac thrombi from spontaneous echocardiographic contrast using transthoracic echocardiography as our reference standard; (3) identify known negative prognostic factors and comorbidities of the thorax that CT angiography may provide that complement or supersede echocardiographic examination. Fourteen cats with heart disease were recruited; 7 with thrombi and 7 with spontaneous echocardiographic contrast. Echocardiography and awake CT angiography were performed using a microdose of contrast. Six of 7 thrombi were identified on CT angiography as filling defects by at least one reviewer within the left auricle (n = 6) and right heart (n = 1). Highest sensitivity (71.4%) was in continuous phase and highest specificity (85.7%) was in dynamic studies with fair to moderate interobserver agreement (0.38 and 0.44). CT angiography identified prognostic cardiac information (left atrial enlargement, congestive heart failure, arterial thromboembolism) and comorbidities (suspected idiopathic pulmonary fibrosis, asthma). This study indicates CT angiography can readily identify cardiac thrombi, important prognostic information and comorbidities, and can be safely performed in cats with cardiac disease and congestive heart failure. © 2018 American College of Veterinary Radiology.

  3. Diseases causing acute renal failure in a tertiary care hospital

    International Nuclear Information System (INIS)

    Khan, G.; Hussain, K.; Rehman, A.

    2011-01-01

    Objective: This study was done to evaluate frequency of acute renal failure ( ARF ), its causes and out come of the patients. Study Design: Descriptive analytic study Place and Duration of Study: March to Dec 2007 at Combined Military Hospital Lahore. Patients and Methods: All patients, admitted in different wards of the hospital, who developed acute renal failure (doubling of serum creatinine measured on two occasions 12 hours apart), were included in this study. Results: A total of 39 patients were included in the study. Males were 19 (48.71%) and 20 (51.28%) were female. Mean age of patients was 40.2 years (SD=18.0). The major cause was acute Gastroenteritis seen in 23 (58.97%) cases. Others developed ARF due to, Abruptio Placentae 5 (12.82%), Postoperative 5 (12.82%), Eclampsia 3 (7.69%) and Drug induced 3 (7.69%) . Oliguric phase developed in 28 (71.79%) patients and lasted for 8.45 +- 4.16 days. Of these 17 (60.71%) patients had acute gastroenteritis. Conclusion: Gastroenteritis is the most common and important cause of ARF though gynaecological and surgical etiologies must be kept in mind. It is evident that the gynaecological and surgical patients need critical peri-partum and peri-operative monitoring to prevent development of ARF. Early institution of therapy will prevent subsequent morbidity associated with this disease. (author)

  4. Acute Unilateral Vestibular Failure Does Not Cause Spatial Hemineglect.

    Directory of Open Access Journals (Sweden)

    Julian Conrad

    Full Text Available Visuo-spatial neglect and vestibular disorders have common clinical findings and involve the same cortical areas. We questioned (1 whether visuo-spatial hemineglect is not only a disorder of spatial attention but may also reflect a disorder of higher cortical vestibular function and (2 whether a vestibular tone imbalance due to an acute peripheral dysfunction can also cause symptoms of neglect or extinction. Therefore, patients with an acute unilateral peripheral vestibular failure (VF were tested for symptoms of hemineglect.Twenty-eight patients with acute VF were assessed for signs of vestibular deficits and spatial neglect using clinical measures and various common standardized paper-pencil tests. Neglect severity was evaluated further with the Center of Cancellation method. Pathological neglect test scores were correlated with the degree of vestibular dysfunction determined by the subjective visual vertical and caloric testing.Three patients showed isolated pathological scores in one or the other neglect test, either ipsilesionally or contralesionally to the VF. None of the patients fulfilled the diagnostic criteria of spatial hemineglect or extinction.A vestibular tone imbalance due to unilateral failure of the vestibular endorgan does not cause spatial hemineglect, but evidence indicates it causes mild attentional deficits in both visual hemifields.

  5. Failure cause analysis and improvement for magnetic component cabinet

    International Nuclear Information System (INIS)

    Ge Bing

    1999-01-01

    The magnetic component cabinet is an important thermal control device fitted on the nuclear power. Because it used a self-saturation amplifier as a primary component, the magnetic component cabinet has some boundness. For increasing the operation safety on the nuclear power, the author describes a new scheme. In order that the magnetic component cabinet can be replaced, the new type component cabinet is developed. Integrate circuit will replace the magnetic components of every function parts. The author has analyzed overall failure cause for magnetic component cabinet and adopted some measures

  6. Cardiac myofibrillar contractile properties during the progression from hypertension to decompensated heart failure.

    Science.gov (United States)

    Hanft, Laurin M; Emter, Craig A; McDonald, Kerry S

    2017-07-01

    Heart failure arises, in part, from a constellation of changes in cardiac myocytes including remodeling, energetics, Ca 2+ handling, and myofibrillar function. However, little is known about the changes in myofibrillar contractile properties during the progression from hypertension to decompensated heart failure. The aim of the present study was to provide a comprehensive assessment of myofibrillar functional properties from health to heart disease. A rodent model of uncontrolled hypertension was used to test the hypothesis that myocytes in compensated hearts exhibit increased force, higher rates of force development, faster loaded shortening, and greater power output; however, with progression to overt heart failure, we predicted marked depression in these contractile properties. We assessed contractile properties in skinned cardiac myocyte preparations from left ventricles of Wistar-Kyoto control rats and spontaneous hypertensive heart failure (SHHF) rats at ~3, ~12, and >20 mo of age to evaluate the time course of myofilament properties associated with normal aging processes compared with myofilaments from rats with a predisposition to heart failure. In control rats, the myofilament contractile properties were virtually unchanged throughout the aging process. Conversely, in SHHF rats, the rate of force development, loaded shortening velocity, and power all increased at ~12 mo and then significantly fell at the >20-mo time point, which coincided with a decrease in left ventricular fractional shortening. Furthermore, these changes occurred independent of changes in β-myosin heavy chain but were associated with depressed phosphorylation of myofibrillar proteins, and the fall in loaded shortening and peak power output corresponded with the onset of clinical signs of heart failure. NEW & NOTEWORTHY This novel study systematically examined the power-generating capacity of cardiac myofilaments during the progression from hypertension to heart disease. Previously

  7. Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure.

    Science.gov (United States)

    Salah, Khibar; Kok, Wouter E; Eurlings, Luc W; Bettencourt, Paulo; Pimenta, Joana M; Metra, Marco; Verdiani, Valerio; Tijssen, Jan G; Pinto, Yigal M

    2015-10-01

    The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF). Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters. This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge. A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables. When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure

    DEFF Research Database (Denmark)

    St John Sutton, Martin; Ghio, Stefano; Plappert, Ted

    2009-01-01

    BACKGROUND: Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left...... ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. METHODS AND RESULTS: Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration > or =120 ms, LV end-diastolic dimension > or =55 mm, and LV ejection...... reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure. CONCLUSIONS: CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year...

  9. Cardiac arrest following ventilator fire: A rare cause

    Directory of Open Access Journals (Sweden)

    K Nazeer Ahmed

    2012-01-01

    Full Text Available Operating room fires are rare events, but when occur they result in serious and sometimes fatal consequences. Anaesthesia ventilator fire leading to cardiac arrest is a rare incident and has not been reported. We report a near catastrophic ventilator fire leading to cardiac arrest in a patient undergoing subtotal thyroidectomy. In the present case sparks due to friction or electrical short circuit within the ventilator might have acted as source of ignition leading to fire and explosion in the oxygen rich environment. The patient was successfully resuscitated and revived with uneventful recovery and no adverse sequelae. The cardiac arrest was possibly due to severe hypoxia resulting from inhalation of smoke containing high concentrations of carbon monoxide and other noxious gases.

  10. Upgrade of Common Cause Failure Modelling of NPP Krsko PSA

    International Nuclear Information System (INIS)

    Vukovic, I.; Mikulicic, V.; Vrbanic, I.

    2006-01-01

    Over the last thirty years the probabilistic safety assessments (PSA) have been increasingly applied in technical engineering practice. Various failure modes of system of concern are mathematically and explicitly modelled by means of fault tree structure. Statistical independence of basic events from which the fault tree is built is not acceptable for an event category referred to as common cause failures (CCF). Based on overview of current international status of modelling of common cause failures in PSA several steps were made related to primary technical basis for methodology and data used for CCF model upgrade project in NPP Krsko (NEK) PSA. As a primary technical basis for methodological aspects of CCF modelling in Krsko PSA the following documents were considered: NUREG/CR-5485, NUREG/CR-4780, and Westinghouse Owners Group documents (WOG) WCAP-15674 and WCAP-15167. Use of these documents is supported by the most relevant guidelines and standards in the field, such as ASME PRA Standard and NRC Regulatory Guide 1.200. WCAP documents are in compliance with NUREG/CR-5485 and NUREG/CR-4780. Additionally, they provide WOG perspective on CCF modelling, which is important to consider since NEK follows WOG practice in resolving many generic and regulatory issues. It is, therefore, desirable that NEK CCF methodology and modelling is in general accordance with recommended WOG approaches. As a primary basis for CCF data needed to estimate CCF model parameters and their uncertainty, the main used documents were: NUREG/CR-5497, NUREG/CR-6268, WCAP-15167, and WCAP-16187. Use of NUREG/CR-5497 and NUREG/CR-6268 as a source of data for CCF parameter estimating is supported by the most relevant industry and regulatory PSA guides and standards currently existing in the field, including WOG. However, the WCAP document WCAP-16187 has provided a basis for CCF parameter values specific to Westinghouse PWR plants. Many of events from NRC / INEEL database were re-classified in WCAP

  11. Pathogenesis of apical periodontitis and the causes of endodontic failures.

    Science.gov (United States)

    Nair, P N R

    2004-11-01

    Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.

  12. Riboflavin alleviates cardiac failure in Type I diabetic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Xue Zhao

    2011-09-01

    Full Text Available Heart failure (HF is a common and serious comorbidity of diabetes. Oxidative stress has been associated with the pathogenesis of chronic diabetic complications including cardiomyopathy. The ability of antioxidants to inhibit injury has raised the possibility of new therapeutic treatment for diabetic heart diseases. Riboflavin constitutes an essential nutrient for humans and animals and it is an important food additive. Riboflavin, a precursor of flavin mononucleotide (FMN and flavin adenine dinucleotide (FAD, enhances the oxidative folding and subsequent secretion of proteins. The objective of this study was to investigate the cardioprotective effect of riboflavin in diabetic rats. Diabetes was induced in 30 rats by a single injection of streptozotocin (STZ (70 mg /kg. Riboflavin (20 mg/kg was orally administered to animals immediately after induction of diabetes and was continued for eight weeks. Rats were examined for diabetic cardiomyopathy by left ventricular (LV remadynamic function. Myocardial oxidative stress was assessed by measuring the activity of superoxide dismutase (SOD, the level of malondialdehyde (MDA as well as heme oxygenase-1 (HO-1 protein level. Myocardial connective tissue growth factor (CTGF level was measured by Western blot in all rats at the end of the study. In the untreated diabetic rats, left ventricular systolic pressure (LVSP rate of pressure rose (+dp/dt, and rate of pressure decay (−dp/dt were depressed while left ventricular enddiastolic pressure (LVEDP was increased, which indicated the reduced left ventricular contractility and slowing of left ventricular relaxation. The level of SOD decreased, CTGF and HO-1 protein expression and MDA content rose. Riboflavin treatment significantly improved left ventricular systolic and diastolic function in diabetic rats, there were persistent increases in significant activation of SOD and the level of HO-1 protein, and a decrease in the level of CTGF. These results suggest

  13. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald

    2013-01-01

    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

  14. Pericardial effusion with cardiac tamponade caused by a central ...

    African Journals Online (AJOL)

    With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible ...

  15. SERCA2 Haploinsufficiency in a Mouse Model of Darier Disease Causes a Selective Predisposition to Heart Failure

    Directory of Open Access Journals (Sweden)

    Vikram Prasad

    2015-01-01

    Full Text Available Null mutations in one copy of ATP2A2, the gene encoding sarco/endoplasmic reticulum Ca2+-ATPase isoform 2 (SERCA2, cause Darier disease in humans, a skin condition involving keratinocytes. Cardiac function appears to be unimpaired in Darier disease patients, with no evidence that SERCA2 haploinsufficiency itself causes heart disease. However, SERCA2 deficiency is widely considered a contributing factor in heart failure. We therefore analyzed Atp2a2 heterozygous mice to determine whether SERCA2 haploinsufficiency can exacerbate specific heart disease conditions. Despite reduced SERCA2a levels in heart, Atp2a2 heterozygous mice resembled humans in exhibiting normal cardiac physiology. When subjected to hypothyroidism or crossed with a transgenic model of reduced myofibrillar Ca2+-sensitivity, SERCA2 deficiency caused no enhancement of the disease state. However, when combined with a transgenic model of increased myofibrillar Ca2+-sensitivity, SERCA2 haploinsufficiency caused rapid onset of hypertrophy, decompensation, and death. These effects were associated with reduced expression of the antiapoptotic Hax1, increased levels of the proapoptotic genes Chop and Casp12, and evidence of perturbations in energy metabolism. These data reveal myofibrillar Ca2+-sensitivity to be an important determinant of the cardiac effects of SERCA2 haploinsufficiency and raise the possibility that Darier disease patients are more susceptible to heart failure under certain conditions.

  16. Clinical research on correlation between BNP and left cardiac function in patients with heart failure

    International Nuclear Information System (INIS)

    Yin Xin; Xu Dandan; Wu Chunxu

    2005-01-01

    To investigate the correlation between brain natriuretic peptide (BNP) and the cardiac function in patients with heart failure(HF), the plasma level of BNP was determined by IRMA and the left cardiac function parameters were measured on echocardiogram in patients with different grade of HF. The results showed that the plasma level of BNP elevated with the worsening of heart failure (NYHA classification). The plasma levels of BNP were negatively correlated with left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVDd). The plasma level of BNP increases significantly along with the severity of HF classified by NYHA, and might be a biochemical parameter for evaluating the left ventricular function. (authors)

  17. Hereditary Hemorrhagic Telangiectasia Presenting as High Output Cardiac Failure during Pregnancy

    Directory of Open Access Journals (Sweden)

    Tareq Goussous

    2009-01-01

    Full Text Available High-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia (HHT. Here we report a 43-year-old woman who presented at 29 weeks gestation of her second pregnancy with complications of right-sided heart failure and preterm labor. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous malformations through non-invasive imaging. Subsequently, a family history of vascular malformations and epistaxis was elucidated and a diagnosis of HHT was made. This case is presented, along with a review of the literature and discussion of hepatic involvement in HHT with particular focus on the pregnant patient.

  18. Usefulness of cardiac 123I-MIBG imaging for the evaluation of diastolic heart failure

    International Nuclear Information System (INIS)

    Tanaka, Haruki; Kozai, Toshiyuki; Urabe, Yoshitoshi

    2007-01-01

    Significance of 123 I-MIBG (metaiodobenzylguanidine) scintigraphy in diagnosis of cardiac sympathetic nerve function is not yet elucidated in chronic heart failure derived from left ventricular diastolic defect despite its established importance in evaluation of severity and prognosis of chronic systolic heart failure. This study was performed to elucidate the usefulness of the imaging for chronic diastolic heart failure. Comparison was made of 47 hospitalized patients with chronic diastolic heart failure (D-group; left ejection fraction, 50% or more), 45 with chronic systolic failure (S-group; the fraction 123 I-MIBG with 2-detector gamma camera (Toshiba E.CAM), of which images were analyzed by Toshiba GMS-7000. Cardiac sympathetic nerve function in D-group was found stimulated to be impaired, in a similar extent to that in S-group; severity in NYHA classification was significantly correlated with late H/M ratio and WR; WR in cases with atrial fibrillation complication showed a significant correlation with plasma BNP level; and 123 I-MIBG scintigraphic evaluation of the nerve function in D-group was concluded to be useful for severity assessment. (T.I.)

  19. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  20. Raised cardiac enzymes in sepsis with renal failure: An encompassing umbrella or a masquerader?

    Directory of Open Access Journals (Sweden)

    Dilip Gude

    2014-01-01

    Full Text Available Elevation of cardiac enzymes and troponins particularly in settings of sepsis and renal failure may cloud the diagnostic picture of acute coronary syndrome in many cases. Interpretation of such elevated enzymes thus warrants caution. It necessitates adequate awareness amongst clinicians, of conditions with such elevation in the absence of myocardial ischemia/infarction as well as those that harbinger false positives. We discuss one such case that posed a diagnostic dilemma and review the pertinent literature.

  1. Renal function in patients with hypertension associated congestive cardiac failure seen in a tertiary hospital.

    Science.gov (United States)

    Osuji, C U; Nwaneli, C U; Onwubere, B J; Onwubuya, E I; Ahaneku, G I

    2012-01-01

    Background. Chronic kidney disease is frequently seen in patients with congestive cardiac failure and is an independent risk factor for morbidity and mortality. The aim of this study was to determine the prevalence of chronic kidney disease in patients with hypertension associated congestive cardiac failure. Method. One hundred and fifty patients with hypertension associated congestive cardiac failure were recruited consecutively from the medical outpatient department and the medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi over a one year period, January to December 2010. Patients' biodata and medical history were obtained, detailed physical examination done and each patient had a chest X-ray, 12 lead ECG, urinalysis, serum urea and creatinine assay done. Ethical clearance was obtained from the Ethical Review Board of our institution and data analysed using SPSS-version 16. Results. There were 86 males and 64 females with mean age 62.7 ± 12.5 years. The mean blood pressures were systolic 152.8 ± 28.5 mmHg and diastolic 94.3 ± 18 mmHg. 84.7% had blood pressure ≥140/90 mmHg on presentation. The mean GFR was 70.1 ± 31.3 mls/min. 76% of subjects had GFR <90 mls/min and no statistical significant difference between males and females, P = 0.344. The mean serum urea was 7.2 ± 51 mmol/L while the mean serum creatinine was 194 ± 416.2 mmol/L. Conclusions. This study has demonstrated that majority of patients presenting with hypertension associated congestive cardiac failure have some degree of chronic kidney disease.

  2. Oxidized CaMKII causes cardiac sinus node dysfunction in mice

    Science.gov (United States)

    Swaminathan, Paari Dominic; Purohit, Anil; Soni, Siddarth; Voigt, Niels; Singh, Madhu V.; Glukhov, Alexey V.; Gao, Zhan; He, B. Julie; Luczak, Elizabeth D.; Joiner, Mei-ling A.; Kutschke, William; Yang, Jinying; Donahue, J. Kevin; Weiss, Robert M.; Grumbach, Isabella M.; Ogawa, Masahiro; Chen, Peng-Sheng; Efimov, Igor; Dobrev, Dobromir; Mohler, Peter J.; Hund, Thomas J.; Anderson, Mark E.

    2011-01-01

    Sinus node dysfunction (SND) is a major public health problem that is associated with sudden cardiac death and requires surgical implantation of artificial pacemakers. However, little is known about the molecular and cellular mechanisms that cause SND. Most SND occurs in the setting of heart failure and hypertension, conditions that are marked by elevated circulating angiotensin II (Ang II) and increased oxidant stress. Here, we show that oxidized calmodulin kinase II (ox-CaMKII) is a biomarker for SND in patients and dogs and a disease determinant in mice. In wild-type mice, Ang II infusion caused sinoatrial nodal (SAN) cell oxidation by activating NADPH oxidase, leading to increased ox-CaMKII, SAN cell apoptosis, and SND. p47–/– mice lacking functional NADPH oxidase and mice with myocardial or SAN-targeted CaMKII inhibition were highly resistant to SAN apoptosis and SND, suggesting that ox-CaMKII–triggered SAN cell death contributed to SND. We developed a computational model of the sinoatrial node that showed that a loss of SAN cells below a critical threshold caused SND by preventing normal impulse formation and propagation. These data provide novel molecular and mechanistic information to understand SND and suggest that targeted CaMKII inhibition may be useful for preventing SND in high-risk patients. PMID:21785215

  3. Prevention of liver cancer cachexia-induced cardiac wasting and heart failure

    Science.gov (United States)

    Springer, Jochen; Tschirner, Anika; Haghikia, Arash; von Haehling, Stephan; Lal, Hind; Grzesiak, Aleksandra; Kaschina, Elena; Palus, Sandra; Pötsch, Mareike; von Websky, Karoline; Hocher, Berthold; Latouche, Celine; Jaisser, Frederic; Morawietz, Lars; Coats, Andrew J.S.; Beadle, John; Argiles, Josep M.; Thum, Thomas; Földes, Gabor; Doehner, Wolfram; Hilfiker-Kleiner, Denise; Force, Thomas; Anker, Stefan D.

    2014-01-01

    Aims Symptoms of cancer cachexia (CC) include fatigue, shortness of breath, and impaired exercise capacity, which are also hallmark symptoms of heart failure (HF). Herein, we evaluate the effects of drugs commonly used to treat HF (bisoprolol, imidapril, spironolactone) on development of cardiac wasting, HF, and death in the rat hepatoma CC model (AH-130). Methods and results Tumour-bearing rats showed a progressive loss of body weight and left-ventricular (LV) mass that was associated with a progressive deterioration in cardiac function. Strikingly, bisoprolol and spironolactone significantly reduced wasting of LV mass, attenuated cardiac dysfunction, and improved survival. In contrast, imidapril had no beneficial effect. Several key anabolic and catabolic pathways were dysregulated in the cachectic hearts and, in addition, we found enhanced fibrosis that was corrected by treatment with spironolactone. Finally, we found cardiac wasting and fibrotic remodelling in patients who died as a result of CC. In living cancer patients, with and without cachexia, serum levels of brain natriuretic peptide and aldosterone were elevated. Conclusion Systemic effects of tumours lead not only to CC but also to cardiac wasting, associated with LV-dysfunction, fibrotic remodelling, and increased mortality. These adverse effects of the tumour on the heart and on survival can be mitigated by treatment with either the β-blocker bisoprolol or the aldosterone antagonist spironolactone. We suggest that clinical trials employing these agents be considered to attempt to limit this devastating complication of cancer. PMID:23990596

  4. Genetic Dissection of Cardiac Remodeling in an Isoproterenol-Induced Heart Failure Mouse Model.

    Directory of Open Access Journals (Sweden)

    Jessica Jen-Chu Wang

    2016-07-01

    Full Text Available We aimed to understand the genetic control of cardiac remodeling using an isoproterenol-induced heart failure model in mice, which allowed control of confounding factors in an experimental setting. We characterized the changes in cardiac structure and function in response to chronic isoproterenol infusion using echocardiography in a panel of 104 inbred mouse strains. We showed that cardiac structure and function, whether under normal or stress conditions, has a strong genetic component, with heritability estimates of left ventricular mass between 61% and 81%. Association analyses of cardiac remodeling traits, corrected for population structure, body size and heart rate, revealed 17 genome-wide significant loci, including several loci containing previously implicated genes. Cardiac tissue gene expression profiling, expression quantitative trait loci, expression-phenotype correlation, and coding sequence variation analyses were performed to prioritize candidate genes and to generate hypotheses for downstream mechanistic studies. Using this approach, we have validated a novel gene, Myh14, as a negative regulator of ISO-induced left ventricular mass hypertrophy in an in vivo mouse model and demonstrated the up-regulation of immediate early gene Myc, fetal gene Nppb, and fibrosis gene Lgals3 in ISO-treated Myh14 deficient hearts compared to controls.

  5. A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma

    Directory of Open Access Journals (Sweden)

    Elvan Caglar Citak

    Full Text Available Abstract Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

  6. Does overprotection cause cardiac invalidism after acute myocardial infarction?

    Science.gov (United States)

    Riegel, B J; Dracup, K A

    1992-01-01

    To determine if overprotection on the part of the patient's family and friends contributes to the development of cardiac invalidism after acute myocardial infarction. Longitudinal survey. Nine hospitals in the southwestern United States. One hundred eleven patients who had experienced a first acute myocardial infarction. Subjects were predominantly male, older-aged, married, caucasian, and in functional class I. Eighty-one patients characterized themselves as being overprotected (i.e., receiving more social support from family and friends than desired), and 28 reported receiving inadequate support. Only two patients reported receiving as much support as they desired. Self-esteem, emotional distress, health perceptions, interpersonal dependency, return to work. Overprotected patients experienced less anxiety, depression, anger, confusion, more vigor, and higher self-esteem than inadequately supported patients 1 month after myocardial infarction (p Overprotection on the part of family and friends may facilitate psychosocial adjustment in the early months after an acute myocardial infarction rather than lead to cardiac invalidism.

  7. Diversity Strategies to Mitigate Postulated Common Cause Failure Vulnerabilities

    International Nuclear Information System (INIS)

    Wood, Richard Thomas

    2010-01-01

    This paper describes an approach to establish effective mitigating strategies that can resolve potential common-cause failure (CCF) vulnerabilities in instrumentation and control (I and C) systems at nuclear power plants. A particular objective in the development of these strategies, which consist of combinations of diversity attributes and their associated criteria, is to address the unique characteristics of digital technology that can contribute to CCF concerns. The research approach employed to establish diversity strategies involves investigation of available documentation on diversity usage and experience from nuclear power and non-nuclear industries, capture of expert knowledge and lessons learned, determination of common practices, and assessment of the nature of CCFs and compensating diversity attributes. The resulting diversity strategies address considerations such as the effect of technology choices, the nature of CCF vulnerabilities, and the prospective impact of each diversity type. In particular, the impact of each attribute and criterion on the purpose, process, product, and performance aspects of diverse systems are considered.

  8. Common cause failure and systems interactions issues - an overview

    International Nuclear Information System (INIS)

    Worledge, D.H.; Chu, B.B.; Conradi, L.L.; Smith, A.M.

    1985-01-01

    Common cause failures (CCFs) and systems interactions (SIs) are two concerns which have received significant attention over the years. Although many large and varied efforts have been directed toward these concerns, their resolution is less than satisfactory. Problems continue to exist, both in terms of understanding the basic issues represented by these concerns, and the perceived need for protection against their potentially harmful effects. This paper presents the results of recent EPRI work to provide a basis of understanding of these issues. Based on that improved understanding, a more appropriate way of defining and approaching the underlying technical questions is suggested. The current means of addressing the CCF and SI concerns are discussed and areas of additional activity needed to allow a more effective resolution are identified

  9. Hyperthyroidism causes cardiac dysfunction by mitochondrial impairment and energy depletion.

    Science.gov (United States)

    Maity, Sangeeta; Kar, Dipak; De, Kakali; Chander, Vivek; Bandyopadhyay, Arun

    2013-05-01

    This study elucidates the role of metabolic remodeling in cardiac dysfunction induced by hyperthyroidism. Cardiac hypertrophy, structural remodeling, and expression of the genes associated with fatty acid metabolism were examined in rats treated with triiodothyronine (T3) alone (8 μg/100 g body weight (BW), i.p.) for 15 days or along with a peroxisome proliferator-activated receptor alpha agonist bezafibrate (Bzf; 30 μg/100 g BW, oral) and were found to improve in the Bzf co-treated condition. Ultrastructure of mitochondria was damaged in T3-treated rat heart, which was prevented by Bzf co-administration. Hyperthyroidism-induced oxidative stress, reduction in cytochrome c oxidase activity, and myocardial ATP concentration were also significantly checked by Bzf. Heart function studied at different time points during the course of T3 treatment shows an initial improvement and then a gradual but progressive decline with time, which is prevented by Bzf co-treatment. In summary, the results demonstrate that hyperthyroidism inflicts structural and functional damage to mitochondria, leading to energy depletion and cardiac dysfunction.

  10. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

    NARCIS (Netherlands)

    Tomini, F.; van Asselt, A. D.

    OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

  11. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

    NARCIS (Netherlands)

    Tomini, F.; van Asselt, A. D.

    2012-01-01

    OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

  12. State-of-the-art implantable cardiac assist device therapy for heart failure: bridge to transplant and destination therapy.

    Science.gov (United States)

    Park, S J; Kushwaha, S S; McGregor, C G A

    2012-01-01

    Congestive heart failure is associated with poor quality of life (QoL) and low survival rates. The development of state-of-the-art cardiac devices holds promise for improved therapy in patients with heart failure. The field of implantable cardiac assist devices is changing rapidly with the emergence of continuous-flow pumps (CFPs). The important developments in this field, including pertinent clinical trials, registry reports, innovative research, and potential future directions are discussed in this paper.

  13. Effects of cardiac energy efficiency in diastolic heart failure. Assessment with positron emission tomography with 11C-acetate

    International Nuclear Information System (INIS)

    Hasegawa, Shinji; Yamamoto, Kazuhiro; Sakata, Yasushi; Takeda, Yasuharu; Kajimoto, Katsufumi; Kanai, Yasukazu; Hori, Masatsugu; Hatazawa, Jun

    2008-01-01

    Diastolic heart failure (DHF) has become a high social burden, and its major underlying cardiovascular disease is hypertensive heart disease. However, the pathogenesis of DHF remains to be clarified. This study aimed to assess the effects of cardiac energy efficiency in DHF patients. 11 C-Acetate positron emission tomography and echocardiography were conducted in 11 DHF Japanese patients and 10 normal volunteers. The myocardial clearance rate of radiolabeled 11 C-acetate was measured to calculate the work metabolic index (WMI), an index of cardiac efficiency. The ratio of peak mitral E wave velocity to peak early diastolic septal myocardial velocity (E/e') was calculated to assess left ventricular (LV) filling pressure. The LV mass index was greater and the mean age was higher in the DHF patients than in the normal volunteers. There was no difference in WMI between the two groups. However, WMI varied widely among the DHF patients and was inversely correlated with E/e' (r=-0.699, p=0.017). In contrast, there was no correlation in the normal volunteers. In conclusion, the inefficiency of energy utilization is not a primary cause of diastolic dysfunction or DHF, and cardiac efficiency may not affect diastolic function in normal hearts. However, the energy-wasting state may induce the elevation of LV filling pressure in DHF patients, which was considered to principally result from the progressive diastolic dysfunction. (author)

  14. Computer Simulation Lends New Insights Into Cyanide-Caused Cardiac Toxicity

    Science.gov (United States)

    2004-12-01

    current, ICl,sw is needed to terminate VF. There are several drugs that block ICl,sw. 5. DISCUSSION Exposure to CN has immediate consequences ...the search on the requirements on the means of pharmacological intervention to counter the effect of cyanide-caused cardiac toxicity . Of special...COMPUTER SIMULATION LENDS NEW INSIGHTS INTO CYANIDE-CAUSED CARDIAC TOXICITY C.K. Zoltani* U.S. Army Research Laboratory Computational and

  15. CSB-PGBD3 Mutations Cause Premature Ovarian Failure.

    Directory of Open Access Journals (Sweden)

    Yingying Qin

    2015-07-01

    Full Text Available Premature ovarian failure (POF is a rare, heterogeneous disorder characterized by cessation of menstruation occurring before the age of 40 years. Genetic etiology is responsible for perhaps 25% of cases, but most cases are sporadic and unexplained. In this study, through whole exome sequencing in a non-consanguineous family having four affected members with POF and Sanger sequencing in 432 sporadic cases, we identified three novel mutations in the fusion gene CSB-PGBD3. Subsequently functional studies suggest that mutated CSB-PGBD3 fusion protein was impaired in response to DNA damage, as indicated by delayed or absent recruitment to damaged sites. Our data provide the first evidence that mutations in the CSB-PGBD3 fusion protein can cause human disease, even in the presence of functional CSB, thus potentially explaining conservation of the fusion protein for 43 My since marmoset. The localization of the CSB-PGBD3 fusion protein to UVA-induced nuclear DNA repair foci further suggests that the CSB-PGBD3 fusion protein, like many other proteins that can cause POF, modulates or participates in DNA repair.

  16. Causes and consequences of nonpersistence with heart failure medication.

    LENUS (Irish Health Repository)

    Mockler, Mary

    2012-02-01

    Persistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons\\/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29%) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50% of occurrences, whereas medication was discontinued for an adverse reaction in 30% and for a justified medical reason in 15% of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95% confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95% confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95% confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization.

  17. Techniques for Identification of Left Ventricular Asynchrony for Cardiac Resynchronization Therapy in Heart Failure

    Directory of Open Access Journals (Sweden)

    Peter Schuster

    2005-07-01

    Full Text Available The most recent treatment option of medically refractory heart failure includes cardiac resynchronization therapy (CRT by biventricular pacing in selected patients in NYHA functional class III or IV heart failure. The widely used marker to indicate left ventricular (LV asynchrony has been the surface ECG, but seems not to be a sufficient marker of the mechanical events within the LV and prediction of clinical response. This review presents an overview of techniques for identification of left ventricular intra- and interventricular asynchrony. Both manuscripts for electrical and mechanical asynchrony are reviewed, partly predicting response to CRT. In summary there is still no gold standard for assessment of LV asynchrony for CRT, but both traditional and new echocardiographic methods have shown asynchronous LV contraction in heart failure patients, and resynchronized LV contraction during CRT and should be implemented as additional methods for selecting patients to CRT.

  18. An Odontoid Fracture Causing Apnea, Cardiac Instability, and Quadriplegia

    Directory of Open Access Journals (Sweden)

    Christian A. Bowers

    2012-01-01

    Full Text Available Odontoid fractures are typically associated with low rates of acute neurologic deficit and morbidity/mortality in nonelderly patients. In the patient in this case, traumatic injury triggered by a syncopal event led to a combined C1-C2 fracture and a fatal spinal cord injury with apnea, quadriplegia, and cardiovascular instability. We briefly review the anatomical basis for the pathophysiology of cardiac dysfunction following high-cervical spine injury and present an example of a worst-case scenario.

  19. Evaluation of long-term prognosis in patients with heart failure. Is cardiac imaging with iodine-123 metaiodobenzylguanidine useful?

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi

    1998-01-01

    The effect of cardiac sympathetic activity on long-term prognosis in patients with heart failure was evaluated by cardiac imaging with 123 I-MIBG in 46 patients admitted for the first episode of heart failure. Cardiac imaging was performed with 123 I-MIBG and 201 Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (percentage uptake). The cardiac uptake ratio of 123 I-MIBG (percentage uptake of 123 I-MIBG divided by percentage uptake of 201 Tl) and percentage washout of 123 I-MIBG from the heart over 3 hours were calculated as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of heart failure requiring readmission. Scintigraphic parameters, clinical parameters, left ventricular function obtained by echocardiography and neurohumoral parameters were compared between the event group and event-free group. During the follow-up period, cardiac events developed in 14 patients (30%). Univariate analysis showed uptake ratio and washout rate of 123 I-MIBG, percentage uptake of 201 Tl, New York Heart Association class at discharge, fractional shortening of the left ventricle, serum norepinephrine and atrial natriuretic peptide levels differed significantly between the two groups. Cox proportional-hazard analysis showed that the uptake ratio was an independent predictor of cardiac events. When a cut-off point in the uptake ratio equal to or less than 0.50 and age equal to or more than 65 years old were included in the Cox proportional-hazard analysis instead of actual numbers, relative risks of cardiac events by each index were 31.2 and 4.2, respectively. These data suggest that cardiac uptake of 123 I-MIBG is a strong and independent predictor of long-term prognosis in patients with heart failure. (K.H.)

  20. Evaluation of long-term prognosis in patients with heart failure. Is cardiac imaging with iodine-123 metaiodobenzylguanidine useful?

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    1998-06-01

    The effect of cardiac sympathetic activity on long-term prognosis in patients with heart failure was evaluated by cardiac imaging with {sup 123}I-MIBG in 46 patients admitted for the first episode of heart failure. Cardiac imaging was performed with {sup 123}I-MIBG and {sup 201}Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (percentage uptake). The cardiac uptake ratio of {sup 123}I-MIBG (percentage uptake of {sup 123}I-MIBG divided by percentage uptake of {sup 201}Tl) and percentage washout of {sup 123}I-MIBG from the heart over 3 hours were calculated as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of heart failure requiring readmission. Scintigraphic parameters, clinical parameters, left ventricular function obtained by echocardiography and neurohumoral parameters were compared between the event group and event-free group. During the follow-up period, cardiac events developed in 14 patients (30%). Univariate analysis showed uptake ratio and washout rate of {sup 123}I-MIBG, percentage uptake of {sup 201}Tl, New York Heart Association class at discharge, fractional shortening of the left ventricle, serum norepinephrine and atrial natriuretic peptide levels differed significantly between the two groups. Cox proportional-hazard analysis showed that the uptake ratio was an independent predictor of cardiac events. When a cut-off point in the uptake ratio equal to or less than 0.50 and age equal to or more than 65 years old were included in the Cox proportional-hazard analysis instead of actual numbers, relative risks of cardiac events by each index were 31.2 and 4.2, respectively. These data suggest that cardiac uptake of {sup 123}I-MIBG is a strong and independent predictor of long-term prognosis in patients with heart failure. (K.H.)

  1. American Heart Association's Life's Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function.

    Science.gov (United States)

    Folsom, Aaron R; Shah, Amil M; Lutsey, Pamela L; Roetker, Nicholas S; Alonso, Alvaro; Avery, Christy L; Miedema, Michael D; Konety, Suma; Chang, Patricia P; Solomon, Scott D

    2015-09-01

    Many people may underappreciate the role of lifestyle in avoiding heart failure. We estimated whether greater adherence in middle age to American Heart Association's Life's Simple 7 guidelines—on smoking, body mass, physical activity, diet, cholesterol, blood pressure, and glucose—is associated with lower lifetime risk of heart failure and greater preservation of cardiac structure and function in old age. We studied the population-based Atherosclerosis Risk in Communities Study cohort of 13,462 adults ages 45-64 years in 1987-1989. From the 1987-1989 risk factor measurements, we created a Life's Simple 7 score (range 0-14, giving 2 points for ideal, 1 point for intermediate, and 0 points for poor components). We identified 2218 incident heart failure events using surveillance of hospital discharge and death codes through 2011. In addition, in 4855 participants free of clinical cardiovascular disease in 2011-2013, we performed echocardiography from which we quantified left ventricular hypertrophy and diastolic dysfunction. One in four participants (25.5%) developed heart failure through age 85 years. Yet, this lifetime heart failure risk was 14.4% for those with a middle-age Life's Simple 7 score of 10-14 (optimal), 26.8% for a score of 5-9 (average), and 48.6% for a score of 0-4 (inadequate). Among those with no clinical cardiovascular event, the prevalence of left ventricular hypertrophy in late life was approximately 40% as common, and diastolic dysfunction was approximately 60% as common, among those with an optimal middle-age Life's Simple 7 score, compared with an inadequate score. Greater achievement of American Heart Association's Life's Simple 7 in middle age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Decreased adrenoceptor stimulation in heart failure rats reduces NGF expression by cardiac parasympathetic neurons.

    Science.gov (United States)

    Hasan, Wohaib; Smith, Peter G

    2014-04-01

    Postganglionic cardiac parasympathetic and sympathetic nerves are physically proximate in atrial cardiac tissue allowing reciprocal inhibition of neurotransmitter release, depending on demands from central cardiovascular centers or reflex pathways. Parasympathetic cardiac ganglion (CG) neurons synthesize and release the sympathetic neurotrophin nerve growth factor (NGF), which may serve to maintain these close connections. In this study we investigated whether NGF synthesis by CG neurons is altered in heart failure, and whether norepinephrine from sympathetic neurons promotes NGF synthesis. NGF and proNGF immunoreactivity in CG neurons in heart failure rats following chronic coronary artery ligation was investigated. NGF immunoreactivity was decreased significantly in heart failure rats compared to sham-operated animals, whereas proNGF expression was unchanged. Changes in neurochemistry of CG neurons included attenuated expression of the cholinergic marker vesicular acetylcholine transporter, and increased expression of the neuropeptide vasoactive intestinal polypeptide. To further investigate norepinephrine's role in promoting NGF synthesis, we cultured CG neurons treated with adrenergic receptor (AR) agonists. An 82% increase in NGF mRNA levels was detected after 1h of isoproterenol (β-AR agonist) treatment, which increased an additional 22% at 24h. Antagonist treatment blocked isoproterenol-induced increases in NGF transcripts. In contrast, the α-AR agonist phenylephrine did not alter NGF mRNA expression. These results are consistent with β-AR mediated maintenance of NGF synthesis in CG neurons. In heart failure, a decrease in NGF synthesis by CG neurons may potentially contribute to reduced connections with adjacent sympathetic nerves. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. What caused the failures of the solenoid valve screws

    International Nuclear Information System (INIS)

    Vassallo, T.P.; Mumford, J.R.; Hossain, F.

    2001-01-01

    At Seabrook Station on May 5,1998 following a lengthy purge of the pressurizer steam space through Containment isolation sample valve 1-RC-FV-2830, the UL status light associated with this solenoid valve did not come on when the valve was closed from the plant's main control board. The UL status light is used to confirm valve closure position to satisfy the plant's Technical Specification requirements. The incorrect valve position indication on the main control board was initially believed to have resulted from excessive heat from a failed voltage control module that did not reduce the voltage to the valve's solenoid coil. This conclusion was based on a similar event that occurred in November of 1996. Follow-up in-plant testing of the valve determined that the voltage control module had not failed and was functioning satisfactorily. Subsequent investigations determined the root cause of the event to be excessive heat-up of the valve caused by high process fluid temperature and an excessively long purge of the pressurizer. The excessive heat-up of the valve from the high temperature process fluid weakened the magnetic field strength of the valve stem magnet to the extent that the UL status light reed switch would not actuate when the valve was closed. Since the voltage control module was tested and found to be functioning properly it was not replaced. Only the UL status light reed switch was replaced with a more sensitive reed that would respond better to a reduced magnetic field strength that results from a hot magnet. During reed switch replacement, three terminal block screws in the valve housing were found fractured and three other terminal block screws fractured during determination of the electrical conductors. This paper describes the initial plant event and ensuing laboratory tests and examinations that were performed to determine the root cause of the failure of the terminal block screws from the Containment isolation sample solenoid valve. (author)

  4. Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Medeiros Barros

    2014-01-01

    Full Text Available Objective: To compare two analytical techniques used in the determination of plasma digoxin (LC-MS/MS and immunoassay and to verify which one better answer the need of the clinical monitoring routine of patients with cardiac heart failure. Method: The clinical findings in 15 cardiac heart failure (CHF outpatients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital were investigated. Blood samples of the patients were collected and analysed by Immunoassay and by Liquid Chromatography coupled to Mass Spectrometry (LC-MS/MS. Results: The results of the statistic test (Student p = 0,05 showed a significant difference between the analytical methods: immunoassay concentrations were higher than the concentrations determined by LCMS/ MS. The explanation may be because immunoassay method measures digoxin plus other metabolites and endogenous substances, while the LC-MS/MS method measures only the digoxin molecule. None of the patients, showed relevant clinical data suggestive of digitalis intoxication, even several drugs with potential interaction were associated with treatment. Conclusion: It was concluded, therefore, that LC-MS/MS me thod is safer, more selective and specific than immunoassay, being an option for therapeutic drug monitoring of digoxin, since the reference values would be obtain for digoxinemia by LC-MS/MS.

  5. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  6. Common cause failure: enhancing defenses against root cause and coupling factor

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Poorva; Kim, Sok Chul [KINS, Daejeon (Korea, Republic of)

    2016-10-15

    A Common Cause Failure(CCF) event refers to a specific class of dependent events that result from co-existence of two main factors: Susceptibility of components to fail or become unavailable due to particular root cause of failure, and coupling factor coupling mechanism) that creates the condition for multiple components getting affected. PSA (Probabilistic Safety Assessment) operating experience of Nuclear Power Plants have demonstrated that dependent events such as CCF events are major contributor to risk during operation. From cost-benefit consideration, putting significant design modifications in place to prevent CCF would not be desirable in terms of risk management regulatory effectiveness and efficiency. The aim of this study was to propose feasible defenses against CCF from cost benefit consideration to enhance the safety. This study provides the CDM and CFDM of EDG. Defenses employed against cause and coupling factor can be easily employed in operation and maintenance programme of NPP and are not an additional cost burden. Such enhancement of defense against the CCF can give a modest improvement in CDF. This approach is specifically helpful in plants that are already under operation and significant modifications are not economically feasible.

  7. [Reliability of nursing outcomes classification label "Knowledge: cardiac disease management (1830)" in outpatients with heart failure].

    Science.gov (United States)

    Cañón-Montañez, Wilson; Oróstegui-Arenas, Myriam

    2015-01-01

    To determine the reliability (internal consistency, inter-rater reproducibility and level of agreement) of nursing outcome: "Knowledge: cardiac disease management (1830)" of the version published in Spanish, in outpatients with heart failure. A reliability study was conducted on 116 outpatients with heart failure. Six indicators of nursing outcome were operationalized. All participants were assessed simultaneously by two evaluators. Three evaluation periods were defined: initial (at baseline), final (a month later), and follow-up (two months later). Internal consistency by Cronbach alpha coefficient, inter-rater reproducibility with intraclass correlation coefficient of reproducibility or agreement and level agreement using the 95% limits of Bland and Altman. Cronbach's alpha was 0.83 (95% CI: 0.77 - 0.89) in the final evaluation, and follow-up values of 0.85 (95% CI: 0.82-0.89) and 0.83 (95% CI: 0.78 - 0.88) were found for the first and second evaluator, respectively. The intraclass correlation coefficient showed values greater 0.9 in the three evaluation periods in both the random and mixed model. The Bland-Altman 95% limits of agreement were close to zero in the three evaluations performed. The questionnaire operationalized to assess the nursing outcome: "Knowledge: cardiac disease management (1830)" in its Spanish version, is a reliable method to measure skills and knowledge in outpatients with heart failure in the Colombian context. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Personal and social factors regarding medical non-compliance in cardiac failure patients

    International Nuclear Information System (INIS)

    Mujtaba, S.F.; Masood, T.; Khalid, D.

    2011-01-01

    Objective: To determine the frequency and association of various personal and social factors with medical non-compliance in cardiac failure patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: National Institute of Cardiovascular Diseases (NICVD), Karachi from January to August 2010. Methodology: Patients admitted in the medical wards of NICVD, who were being treated for cardiac failure, were included. Information regarding basic demographics, education level, self engagement in therapy and status of compliance was obtained by questionnaire. Statistical analysis was carried out by using Fisher's exact test and chi-square. Level of significance was < 0.05. Data was analyzed using SPSS V-15. Out of 267 patients, 73 (27.3%) were compliant while 194 (72.7%) were non-compliant. Educated, self caring patient, and those who knew names of their medications were more compliant than the rest. Conclusion: Medical non-compliance is very common in heart failure patients. Illiteracy and no self engagement in therapy are associated with non-compliance. (author)

  9. Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more.

    Science.gov (United States)

    Duncker, D; Veltmann, C

    2018-05-09

    In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.

  10. CCF-RBE common cause failure reliability benchmark exercise

    International Nuclear Information System (INIS)

    Poucet, A.; Amendola, A.; Cacciabue, P.C.

    1987-01-01

    This report summarizes results, obtained by the participants in the Reliability Benchmark Exercise on Common Cause Failures (CCF-RBE). The reference power plant of the CCF-RBE was the NPP at Grohnde (KWG): it is a 1300 MW PWR plant of KWU design and operated by the utility Preussen Elektra. The systems studied were the Start-up and Shut-down system (RR/RL) and the Emergency Feedwater System (RS) both systems that can feed water into the steam generators in the emergency power mode. The CCF-RBE was organized in two phases: 1. The first phase: during which all participants have performed an analysis on the complete system as defined by the assumed boundaries, i.e. the Start-up and Shut-down system (RR/RL) and the Emergency Feedwater System (RS). 2. The second phase: in which the scope was limited to the RS system. This limitation in scope was agreed upon in the discussion on the results of the first phase, which showed that, within the boundaries of the exercise, RR/RL and RS systems could be considered independent of each other. This report gives an overview of the works carried out, the results obtained and the conclusions and lessons that could be drawn from the CCF-RBE

  11. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  12. [The Relationship Between Quality of Life and Psychological and Behavioral Factors in Patients With Heart Failure Following Cardiac Resynchronization Therapy].

    Science.gov (United States)

    Huang, Jing; Fang, Jin-Bo; Zhao, Yi-Heng

    2018-06-01

    While cardiac resynchronization therapy improves the quality of life of patients with heart failure, some psychological and behavioral factors still affect the quality of life of these patients. However, information on the factors that affect the quality of life of these patients is limited. To describe the quality of life and investigate the relationship between quality of life and behavioral and psychological factors such as depression, smoking, drinking, water and sodium restrictions, exercise, and adherence in patients with chronic heart failure following cardiac resynchronization therapy. This cross-sectional study was conducted using the Morisky Medication Adherence Scale, Minnesota Living With Heart Failure Questionnaire, and Cardiac Depression Scale. A convenience sample of 141 patients with heart failure following cardiac resynchronization therapy were recruited from a tertiary academic hospital in Chengdu. The mean overall score of the Minnesota Living With Heart Failure Questionnaire was 30.89 (out of a total possible score of 105). Water restrictions, sodium restrictions, depression, and exercise were all shown to significantly predict quality of life among the participants. This paper describes the quality of life and defines the behavioral factors that affect the quality of life of patients with heart failure following cardiac resynchronization therapy. The findings suggest that nurses should manage and conduct health education for patients in order to improve their quality of life.

  13. Ongoing myocardial damage relates to cardiac sympathetic nervous disintegrity in patients with heart failure

    International Nuclear Information System (INIS)

    Arimoto, Takanori; Takeishi, Yasuchika; Niizeki, Takeshi

    2005-01-01

    Iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) has been used to assess the integrity and function of the cardiac sympathetic nervous system in patients with heart failure. Heart-type fatty acid binding protein (H-FABP) is released into the circulation when the myocardium is injured, and H-FABP has been recently used as a novel marker for the diagnosis of ongoing myocardial damage. The aim of the present study was to compare cardiac sympathetic nervous activity assessed by 123 I-MIBG imaging with serum levels of H-FABP in patients with heart failure. Fifty patients with chronic heart failure were studied. 123 I-MIBG imaging was carried out at 30 min (early) and 240 min (delayed) after the tracer injection. We measured serum levels of H-FABP using a sandwich enzyme linked immunosorbent assay. Heart to mediastinum (H/M) ratios of 123 I-MIBG decreased and washout rate increased with higher New York Heart Association (NYHA) functional class. H-FABP, norepinephrine and brain natriuretic peptide (BNP) levels increased as the severity of NYHA class advanced. Delayed H/M ratio was significantly correlated with H-FABP (r=-0.296, p=0.029) and BNP (r=-0.335, p=0.0213). Myocardial washout rate of 123 I-MIBG was also correlated with H-FABP (r=0.469, p 123 I-MIBG imaging is an appropriate approach to evaluate non-invasively not only cardiac sympathetic nervous activity, but also latent ongoing myocardial damage in the failing heart. (author)

  14. [11C]-Acetoacetate PET imaging: a potential early marker for cardiac heart failure

    International Nuclear Information System (INIS)

    Croteau, Etienne; Tremblay, Sébastien; Gascon, Suzanne; Dumulon-Perreault, Véronique; Labbé, Sébastien M.; Rousseau, Jacques A.; Cunnane, Stephen C.; Carpentier, André C.; Bénard, François; Lecomte, Roger

    2014-01-01

    The ketone body acetoacetate could be used as an alternate nutrient for the heart, and it also has the potential to improve cardiac function in an ischemic–reperfusion model or reduce the mitochondrial production of oxidative stress involved in cardiotoxicity. In this study, [ 11 C]-acetoacetate was investigated as an early marker of intracellular damage in heart failure. Methods: A rat cardiotoxicity heart failure model was induced by doxorubicin, Dox(+). [ 14 C]-Acetoacetate, a non-positron (β −) emitting radiotracer, was used to characterize the arterial blood input function and myocardial mitochondrial uptake. Afterward, [ 11 C]-acetoacetate (β +) myocardial PET images were obtained for kinetic analysis and heart function assessment in control Dox(−) (n = 15) and treated Dox(+) (n = 6) rats. The uptake rate (K 1 ) and myocardial clearance rate (k 2 or k mono ) were extracted. Results: [ 14 C]-Acetoacetate in the blood was increased in Dox(+), from 2 min post-injection until the last withdrawal point when the heart was harvested, as well as the uptake in the heart and myocardial mitochondria (unpaired t-test, p < 0.05). PET kinetic analysis of [ 11 C]-acetoacetate showed that rate constants K 1 , k 2 and k mono were decreased in Dox(+) (p < 0.05) combined with a reduction of 24% of the left ventricular ejection fraction (p < 0.001). Conclusion: Radioactive acetoacetate ex vivo analysis [ 14 C], and in vivo kinetic [ 11 C] studies provided evidence that [ 11 C]-acetoacetate can assess heart failure Dox(+). Contrary to myocardial flow reserve (rest–stress protocol), [ 11 C]-acetoacetate can be used to assess reduced kinetic rate constants without requirement of hyperemic stress response. The proposed [ 11 C]-acetoacetate cardiac radiotracer in the investigation of heart disease is novel and paves the way to a potential role for [ 11 C]-acetoacetate in cardiac pathophysiology

  15. MicroRNAs in Heart Failure, Cardiac Transplantation, and Myocardial Recovery: Biomarkers with Therapeutic Potential.

    Science.gov (United States)

    Shah, Palak; Bristow, Michael R; Port, J David

    2017-12-01

    Heart failure is increasing in prevalence with a lack of recently developed therapies that produce major beneficial effects on its associated mortality. MicroRNAs are small non-coding RNA molecules that regulate gene expression, are differentially regulated in heart failure, and are found in the circulation serving as a biomarker of heart failure. Data suggests that microRNAs may be used to detect allograft rejection in cardiac transplantation and may predict the degree of myocardial recovery in patients with a left ventricular assist device or treated with beta-blocker therapy. Given their role in regulating cellular function, microRNAs are an intriguing target for oligonucleotide therapeutics, designed to mimic or antagonize (antagomir) their biological effects. We review the current state of microRNAs as biomarkers of heart failure and associated conditions, the mechanisms by which microRNAs control cellular function, and how specific microRNAs may be targeted with novel therapeutics designed to treat heart failure.

  16. Taxonomy for Common-Cause Failure Vulnerability and Mitigation

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Richard Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Korsah, Kofi [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Mullens, James Allen [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Pullum, Laura L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-01

    Applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The potential for CCF vulnerability inhibits I&C modernization, thereby challenging the long-term sustainability of existing plants. For new plants and advanced reactor concepts, concern about CCF vulnerability in highly integrated digital I&C systems imposes a design burden that results in higher costs and increased complexity. The regulatory uncertainty in determining which mitigation strategies will be acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. To address the conditions that constrain the transition to digital I&C technology by the US nuclear industry, crosscutting research is needed to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for nuclear power plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is investigating mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive basis to qualify digital technology for nuclear power applications. This report documents the development of a CCF taxonomy. The basis for the CCF taxonomy was generated by determining consistent terminology and establishing a classification approach. The terminology is based on definitions from standards, guides, and relevant nuclear power industry technical reports. The classification approach is derived from identified classification schemes focused on I&C systems and key characteristics, including failure modes. The CCF taxonomy provides the basis for a systematic organization of key systems aspects relevant to analyzing the potential for

  17. Loss of Akap1 Exacerbates Pressure Overload-Induced Cardiac Hypertrophy and Heart Failure

    Directory of Open Access Journals (Sweden)

    Gabriele G. Schiattarella

    2018-05-01

    Full Text Available Left ventricular hypertrophy (LVH is a major contributor to the development of heart failure (HF. Alterations in cyclic adenosine monophosphate (cAMP-dependent signaling pathways participate in cardiomyocyte hypertrophy and mitochondrial dysfunction occurring in LVH and HF. cAMP signals are received and integrated by a family of cAMP-dependent protein kinase A (PKA anchor proteins (AKAPs, tethering PKA to discrete cellular locations. AKAPs encoded by the Akap1 gene (mitoAKAPs promote PKA mitochondrial targeting, regulating mitochondrial structure and function, reactive oxygen species production, and cell survival. To determine the role of mitoAKAPs in LVH development, in the present investigation, mice with global genetic deletion of Akap1 (Akap1-/-, Akap1 heterozygous (Akap1+/-, and their wild-type (wt littermates underwent transverse aortic constriction (TAC or SHAM procedure for 1 week. In wt mice, pressure overload induced the downregulation of AKAP121, the major cardiac mitoAKAP. Compared to wt, Akap1-/- mice did not display basal alterations in cardiac structure or function and cardiomyocyte size or fibrosis. However, loss of Akap1 exacerbated LVH and cardiomyocyte hypertrophy induced by pressure overload and accelerated the progression toward HF in TAC mice, and these changes were not observed upon prevention of AKAP121 degradation in seven in absentia homolog 2 (Siah2 knockout mice (Siah2-/-. Loss of Akap1 was also associated to a significant increase in cardiac apoptosis as well as lack of activation of Akt signaling after pressure overload. Taken together, these results demonstrate that in vivo genetic deletion of Akap1 enhances LVH development and accelerates pressure overload-induced cardiac dysfunction, pointing at Akap1 as a novel repressor of pathological LVH. These results confirm and extend the important role of mitoAKAPs in cardiac response to stress.

  18. Caffeoylxanthiazonoside exerts cardioprotective effects during chronic heart failure via inhibition of inflammatory responses in cardiac cells.

    Science.gov (United States)

    Yang, Bin; Wang, Fei; Cao, Huili; Liu, Guifang; Zhang, Yuean; Yan, Ping; Li, Bao

    2017-11-01

    Caffeoylxanthiazonoside (CYT) is an active constituent isolated from the fruit of the Xanthium strumarium L plant. The aim of the present study was to investigate the cardioprotective effects of oral administration of CYT on chronic heart failure (CHF) and its underlying mechanisms. A rat model of CHF was first established, and cardiac function indices, including the heart/body weight index, left heart/body weight index, fractional shortening (FS), ejection fraction (EF), cardiac output (CO) and heart rate (HR), were subsequently determined by cardiac ultrasound. Serum levels of lactate dehydrogenase (LDH) and creatine kinase (CK), and the levels of pro-inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-1β in heart tissues and cardiac microvascular endothelial cells (CMECs) were determined using ELISA. In addition, the protein expression levels of nuclear factor-κB (NF-κB) signaling pathway members were determined by western blotting in CMECs. The results demonstrated that oral administration of 10, 20, 40 mg/kg CYT significantly reduced cardiac hypertrophy and reversed FS, EF, CO and HR when compared with CHF model rats. In addition, CYT administration significantly decreased the levels of TNF-α, IL-6 and IL-1β in heart tissues, as well as serum LDH and CK levels. Furthermore, exposure of CMECs to 20, 40 and 80 µg/ml CYT significantly decreased the production of TNF-α, IL-1β and IL-6. The protein expression levels of cytoplasmic NF-κB p65 and IκB were upregulated, while nuclear NF-κB p65 was downregulated following treatment of CMECs with 20, 40 and 80 µg/ml CYT when compared with untreated CHF model controls. In conclusion, the results of the current study suggest that CYT demonstrates cardioprotective effects in CHF model rats by suppressing the expression of pro-inflammatory cytokines and the NF-κB signaling pathway.

  19. Loss of Akap1 Exacerbates Pressure Overload-Induced Cardiac Hypertrophy and Heart Failure.

    Science.gov (United States)

    Schiattarella, Gabriele G; Boccella, Nicola; Paolillo, Roberta; Cattaneo, Fabio; Trimarco, Valentina; Franzone, Anna; D'Apice, Stefania; Giugliano, Giuseppe; Rinaldi, Laura; Borzacchiello, Domenica; Gentile, Alessandra; Lombardi, Assunta; Feliciello, Antonio; Esposito, Giovanni; Perrino, Cinzia

    2018-01-01

    Left ventricular hypertrophy (LVH) is a major contributor to the development of heart failure (HF). Alterations in cyclic adenosine monophosphate (cAMP)-dependent signaling pathways participate in cardiomyocyte hypertrophy and mitochondrial dysfunction occurring in LVH and HF. cAMP signals are received and integrated by a family of cAMP-dependent protein kinase A (PKA) anchor proteins (AKAPs), tethering PKA to discrete cellular locations. AKAPs encoded by the Akap1 gene (mitoAKAPs) promote PKA mitochondrial targeting, regulating mitochondrial structure and function, reactive oxygen species production, and cell survival. To determine the role of mitoAKAPs in LVH development, in the present investigation, mice with global genetic deletion of Akap1 ( Akap1 -/- ), Akap1 heterozygous ( Akap1 +/- ), and their wild-type ( wt ) littermates underwent transverse aortic constriction (TAC) or SHAM procedure for 1 week. In wt mice, pressure overload induced the downregulation of AKAP121, the major cardiac mitoAKAP. Compared to wt, Akap1 -/- mice did not display basal alterations in cardiac structure or function and cardiomyocyte size or fibrosis. However, loss of Akap1 exacerbated LVH and cardiomyocyte hypertrophy induced by pressure overload and accelerated the progression toward HF in TAC mice, and these changes were not observed upon prevention of AKAP121 degradation in seven in absentia homolog 2 ( Siah2 ) knockout mice ( Siah2 -/- ). Loss of Akap1 was also associated to a significant increase in cardiac apoptosis as well as lack of activation of Akt signaling after pressure overload. Taken together, these results demonstrate that in vivo genetic deletion of Akap1 enhances LVH development and accelerates pressure overload-induced cardiac dysfunction, pointing at Akap1 as a novel repressor of pathological LVH. These results confirm and extend the important role of mitoAKAPs in cardiac response to stress.

  20. Renal and cardiac function during alpha1-beta-blockade in congestive heart failure

    DEFF Research Database (Denmark)

    Heitmann, M; Davidsen, U; Stokholm, K H

    2002-01-01

    The kidney and the neurohormonal systems are essential in the pathogenesis of congestive heart failure (CHF) and the physiologic response. Routine treatment of moderate to severe CHF consists of diuretics, angiotensin-converting enzyme (ACE) inhibition and beta-blockade. The need for control...... of renal function during initiation of ACE-inhibition in patients with CHF is well known. The aim of this study was to investigate whether supplementation by a combined alpha1-beta-blockade to diuretics and ACE-inhibition might improve cardiac function without reducing renal function....

  1. Regenerative therapy and tissue engineering for the treatment of end-stage cardiac failure

    Science.gov (United States)

    Finosh, G.T.; Jayabalan, Muthu

    2012-01-01

    Regeneration of myocardium through regenerative therapy and tissue engineering is appearing as a prospective treatment modality for patients with end-stage heart failure. Focusing on this area, this review highlights the new developments and challenges in the regeneration of myocardial tissue. The role of various cell sources, calcium ion and cytokine on the functional performance of regenerative therapy is discussed. The evolution of tissue engineering and the role of tissue matrix/scaffold, cell adhesion and vascularisation on tissue engineering of cardiac tissue implant are also discussed. PMID:23507781

  2. How does pressure overload cause cardiac hypertrophy and dysfunction? High-ouabain affinity cardiac Na+ pumps are crucial.

    Science.gov (United States)

    Blaustein, Mordecai P

    2017-11-01

    Left ventricular hypertrophy is frequently observed in hypertensive patients and is believed to be due to the pressure overload and cardiomyocyte stretch. Three recent reports on mice with genetically engineered Na + pumps, however, have demonstrated that cardiac ouabain-sensitive α 2 -Na + pumps play a key role in the pathogenesis of transaortic constriction-induced hypertrophy. Hypertrophy was delayed/attenuated in mice with mutant, ouabain-resistant α 2 -Na + pumps and in mice with cardiac-selective knockout or transgenic overexpression of α 2 -Na + pumps. The latter, seemingly paradoxical, findings can be explained by comparing the numbers of available (ouabain-free) high-affinity (α 2 ) ouabain-binding sites in wild-type, knockout, and transgenic hearts. Conversely, hypertrophy was accelerated in α 2 -ouabain-resistant (R) mice in which the normally ouabain-resistant α 1 -Na + pumps were mutated to an ouabain-sensitive (S) form (α 1 S/S α 2 R/R or "SWAP" vs. wild-type or α 1 R/R α 2 S/S mice). Furthermore, transaortic constriction-induced hypertrophy in SWAP mice was prevented/reversed by immunoneutralizing circulating endogenous ouabain (EO). These findings show that EO and its receptor, ouabain-sensitive α 2 , are critical factors in pressure overload-induced cardiac hypertrophy. This complements reports linking elevated plasma EO to hypertension, cardiac hypertrophy, and failure in humans and elucidates the underappreciated role of the EO-Na + pump pathway in cardiovascular disease. Copyright © 2017 the American Physiological Society.

  3. Fuel element failures caused by iodine stress corrosion

    International Nuclear Information System (INIS)

    Videm, K.; Lunde, L.

    1976-01-01

    Sections of unirradiated cladding tubes were plugged in both ends by mechanical seals and internally pressurized with argon containing iodine. The time to failure and the strain at failure as a function of stress was determined for tubing with different heat treatments. Fully annealed tubes suffer cracking at the lowest stress but exhibit the largest strains at failure. Elementary iodine is not necessary for stress corrosion: small amounts of iodides of zirconium, iron and aluminium can also give cracking. Moisture, however, was found to act as an inhibitor. A deformation threshold exists below which stress corrosion failure does not occur regardless of the exposure time. This deformation limit is lower the harder the tube. The deformation at failure is dependent on the deformation rate and has a minimum at 0.1%/hr. At higher deformation rates the failure deformation increases, but only slightly for hard tubes. Fuel was over-power tested at ramp rates varying between 0.26 to 30 W/cm min. For one series of fuel pins the failure deformations of 0.8% at high ramp rates were in good agreement with predictions based on stress corrosion experiments. For another series of experiments the failure deformation was surprisingly low, about 0.2%. (author)

  4. Concise Review: Pluripotent Stem Cell-Derived Cardiac Cells, A Promising Cell Source for Therapy of Heart Failure: Where Do We Stand?

    Science.gov (United States)

    Gouadon, Elodie; Moore-Morris, Thomas; Smit, Nicoline W; Chatenoud, Lucienne; Coronel, Ruben; Harding, Sian E; Jourdon, Philippe; Lambert, Virginie; Rucker-Martin, Catherine; Pucéat, Michel

    2016-01-01

    Heart failure is still a major cause of hospitalization and mortality in developed countries. Many clinical trials have tested the use of multipotent stem cells as a cardiac regenerative medicine. The benefit for the patients of this therapeutic intervention has remained limited. Herein, we review the pluripotent stem cells as a cell source for cardiac regeneration. We more specifically address the various challenges of this cell therapy approach. We question the cell delivery systems, the immune tolerance of allogenic cells, the potential proarrhythmic effects, various drug mediated interventions to facilitate cell grafting and, finally, we describe the pathological conditions that may benefit from such an innovative approach. As members of a transatlantic consortium of excellence of basic science researchers and clinicians, we propose some guidelines to be applied to cell types and modes of delivery in order to translate pluripotent stem cell cardiac derivatives into safe and effective clinical trials. © 2015 AlphaMed Press.

  5. Hypertrophy of Neurons Within Cardiac Ganglia in Human, Canine, and Rat Heart Failure: The Potential Role of Nerve Growth Factor

    OpenAIRE

    Singh, Sanjay; Sayers, Scott; Walter, James S.; Thomas, Donald; Dieter, Robert S.; Nee, Lisa M.; Wurster, Robert D.

    2013-01-01

    Background Autonomic imbalances including parasympathetic withdrawal and sympathetic overactivity are cardinal features of heart failure regardless of etiology; however, mechanisms underlying these imbalances remain unknown. Animal model studies of heart and visceral organ hypertrophy predict that nerve growth factor levels should be elevated in heart failure; whether this is so in human heart failure, though, remains unclear. We tested the hypotheses that neurons in cardiac ganglia are hyper...

  6. Team-Based Care for Managing Cardiac Comorbidities in Heart Failure.

    Science.gov (United States)

    Bellam, Naveen; Kelkar, Anita A; Whellan, David J

    2015-07-01

    The need for HF management is predicted to increase as the HF population ages. Balancing HF and the multiple cardiac comorbidities remains difficult for any single provider, but becomes Fig. 6. Five-year rates of death or urgent heart transplantation by deciles of total cholesterol in heart failure. (From Horwich TB, Fonarow GC, Hamilton MA, et al. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail 2002;8(4):222; with permission.) easier with the involvement of a team. Collaboration between physicians, nurses, nurse practitioners, physician assistants, pharmacists, and other health care workers reduces the burden of care coordination and simultaneously improves delivery of care. Team-based approaches increase cost-effectiveness, reduce hospitalization rates, and equally important, give patients more resources and support, which research shows may ultimately improve compliance and outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Angiotensin-converting enzyme inhibition improves cardiac fatty acid metabolism in patients with congestive heart failure.

    Science.gov (United States)

    Yamauchi, S; Takeishi, Y; Minamihaba, O; Arimoto, T; Hirono, O; Takahashi, H; Miyamoto, T; Nitobe, J; Nozaki, N; Tachibana, H; Watanabe, T; Fukui, A; Kubota, I

    2003-08-01

    This study aimed to examine whether angiotensin-converting enzyme (ACE) inhibition improved cardiac fatty acid metabolism in patients with congestive heart failure (CHF). Myocardial 123I-beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP) imaging was performed in 25 patients with CHF and in 10 control subjects. Myocardial 123I-BMIPP images were obtained 30 min and 4 h after tracer injection. The heart-to-mediastinum (H/M) ratio of 123I-BMIPP uptake and the washout rate of 123I-BMIPP from the myocardium were calculated. Patients were given enalapril for 6 months, and 123I-BMIPP imaging was repeated. H/M ratios on early and delayed images were lower in CHF patients than in normal controls (Pacid metabolism by ACE inhibition may represent a new mechanism for the beneficial effect of this therapy in heart failure.

  8. Update on Common-Cause Failure Experience and Mitigation Practices

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Richard Thomas [ORNL; Muhlheim, Michael David [ORNL; Pullum, Laura L [ORNL; Smith, Cyrus M [ORNL; Holcomb, David Eugene [ORNL; Korsah, Kofi [ORNL

    2014-04-01

    Experience in other industries has shown that digital technology can provide substantial benefits in terms of performance and reliability. However, the U.S. nuclear power industry has been slow to adopt the technology extensively in its instrumentation and control (I&C) applications because of inhibiting factors such as regulatory uncertainty, insufficient technological experience base, implementation complexity, limited availability of nuclear-qualified products and vendors, and inadequate definition of modernization cost recapture. Although there have been examples of digital technology usage in the nuclear power industry, challenges to the qualification of digital technology for high-integrity nuclear power plant (NPP) applications have severely constrained more widespread progress in achieving the benefits that are possible through the transition to digital. The U.S. Department of Energy (DOE) Office of Nuclear Energy (NE) established the Advanced Sensors and Instrumentation (ASI) technology area under the Nuclear Energy Enabling Technologies (NEET) Program to coordinate the instrumentation and controls (I&C) research across DOE NE and to identify and lead efforts to address common needs. As part of the NEET ASI research program, the Digital Technology Qualification project was established. Under this project, the Oak Ridge National Laboratory (ORNL) is leading the investigation into mitigation of digital common-cause failure (CCF) vulnerabilities for nuclear-qualified applications. This technical report documents updated and expanded findings from research activities by ORNL. Specifically, the report describes CCF experience in the nuclear and nonnuclear industries, identifies the state of the practice for CCF mitigation through key examples, and presents conclusions from the determination of knowledge gaps.

  9. Middle aortic syndrome as a cause of heart failure in children and its management.

    OpenAIRE

    Gupta, S; Goswami, B; Ghosh, D C; Sen Gupta, A N

    1981-01-01

    Two cases of middle aortic syndrome in children are described along with two other cases reported earlier. In childhood, this disease may present as incipient or overt cardiac failure. Surgical treatment should be undertaken based on an objective assessment of the severity of the stricture and after taking into account the future growth of the child.

  10. A cause-defense approach to the understanding and analysis of common cause failures

    International Nuclear Information System (INIS)

    Paula, Henrique M.; Campbell, David J.; Parry, Gareth W.; Mitchell, Donald B.; Rasmuson, Dale M.

    1990-03-01

    For improved reliability and safety, nuclear power plants are designed with redundant safety systems, many of which also have redundant trains of equipment within the system. However, the very high reliability theoretically achievable through the use of redundancy is often compromised by single events that can individually render redundant components unavailable (common cause failure [CCF] events). As evidenced by the results of probabilistic risk assessments (PRAs) and by historical experience with nuclear power plant operations, CCF events are usually major contributors to the risk posed by nuclear power plant operation. Thus, it is important that PRAs recognize the potential for CCF events and realistically account for CCF contributions to system unavailability and plant risk. Much progress has been made over the years in the area of CCF analysis, including the development of both qualitative and quantitative analysis methods. Until now, however, CCF methodologies have not explicitly and systematically accounted for the impact of plant-specific defenses, such as design features and operational and maintenance policies, in place to reduce the likelihood of failure occurrences at nuclear power plants. Recognizing the importance of this issue, the NRC has funded a research effort that has focused on developing the cause-defense methodology for CCF analysis and prevention. This report presents the results of this research. Specifically, this report discusses the development of (1) procedures for identifying the potential for CCF events at individual nuclear power plants and (2) cause-defense matrices for analysis of CCF events. Also, new concepts and more precise definitions are introduced to enhance CCF terminology and interpretation of historical event data. (author)

  11. [Developmental radicular groove as a cause of endodontic failure].

    Science.gov (United States)

    Fabra Campos, H; Millet Part, J

    1989-01-01

    A clinical case of apical injury on an upper lateral incisor with endodontical and surgical failures in its treatment is presented. Extraction of the incisor and its study at the stereoscopic microscope showed the existence of a developmental groove running from the cingulum to the end of the root, establishing a communication between the crevice and the apical part of the tooth. Bacterial infection through the groove could provide an explanation for treatment failure.

  12. Rooting out causes in failure analysis; Risk analysis

    Energy Technology Data Exchange (ETDEWEB)

    Keith, Graeme

    2010-07-01

    The Deepwater Horizon disaster was a terrible reminder of the consequences of equipment failure on facilities operating in challenging environments. Thankfully catastrophes on the scale of the Deepwater Horizon are rare, but equipment failure is a daily occurrence on installations around the globe. The consequences range from short unexpected downtime, to a total stop on production. from a brief burst of flaring to lasting environmental damage and from the momentary discomfiture of a worker to incapability or death. (Author)

  13. Extracorporeal membrane oxygenation in near-drowning patients with cardiac or pulmonary failure.

    Science.gov (United States)

    Kim, Kun Il; Lee, Won Yong; Kim, Hyoung Soo; Jeong, Jae Han; Ko, Ho Hyun

    2014-12-12

    The aim of this study was to determine the early outcomes of using extracorporeal membrane oxygenation (ECMO) in near-drowning patients with cardiac or pulmonary failure. This study was based on data from 9 patients including 2 children (mean age 33; 8 males, 1 female) who received ECMO after near-drowning between 2008 and 2013. Veno-arterial or veno-arteriovenous ECMO was used in 2 patients with sustained cardiac arrest and veno-venous ECMO was used in 7 patients with severe acute respiratory distress syndrome (ARDS). The means of the partial arterial oxygen pressure (PaO2), Murray score, sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS-II) prior to ECMO were 59.7 ± 9.9 mmHg on 100% oxygen, 3.5 ± 0.6, 11.4 ± 1.9, and 73.0 ± 9.2, respectively. The PaO2 mean improved to 182 ± 152 mmHg within 2 h post-ECMO. The mean of SOFA score and SAPS-II decreased significantly to 8.6 ± 3.2 (p = 0.013) and 46.4 ± 5.1 (p = 0.008), respectively, at 24 h post-ECMO with mean flow rate of 3.9 ± 0.8 l/min. ECMO was weaned at a mean duration of 188 (range, 43-672) h in all patients. Seven patients were discharged home without neurological sequelae, while 2 patients who had hypoxic brain damage died after further referral. The overall survival with favourable neurological outcomes at 3 months was 77.8%. There were no complications related to ECMO. ECMO was safe and effective for patients with ongoing cardiac arrest or ARDS after a near-drowning incident and can be used as a resuscitative strategy in near-drowning patients with cardiac or pulmonary failure resistant to conventional ventilator therapy.

  14. [Sodium hydrosulfide improves cardiac functions and structures in rats with chronic heart failure].

    Science.gov (United States)

    Li, Xiao-hui; Zhang, Chao-ying; Zhang, Ting

    2011-11-22

    To explore the effects of sodium hydrosulfide (NaHS), a hydrogen sulphide (H(2)S) donor, on cardiac functions and structures in rats with chronic heart failure induced by volume overload and examine its influence on cardiac remodelling. A total of 47 SD rats (120 - 140 g) were randomly divided into 5 groups:shunt group (n = 11), sham group (n = 8), shunt + NaHS group (n = 10), sham + NaHS group (n = 8) and shunt + phentolamine group (n = 10). The rat model of chronic heart failure was induced by abdominal aorta-inferior vena cava puncture. At Week 8 post-operation, hemodynamic parameters, microstructures and ultrastructures of myocardial tissues were analyzed. Extracellular collagen content in myocardial tissues was analyzed after Sirius red staining. Right ventricular hydroxyproline concentration was determined and compared. At Week 8 post-operation, compared with the sham operation and shunt + NaHS groups, the shunt group showed significantly increased right ventricular systolic pressure (RVSP) and right ventricular end diastolic pressure (RVEDP) (mm Hg: 35.2 ± 3.9 vs 21.4 ± 3.7 and 28.1 ± 2.7, 32 ± 5 vs 21 ± 4 and 26 ± 4, all P vs 2336 ± 185 and 1835 ± 132, 1331 ± 107 vs 2213 ± 212 and 1768 ± 116, all P non-uniformly in the shunt group, some fiber mitochondria were highly swollen and contained vacuoles. And sarcoplasmic reticulum appeared slightly dilated. Polarized microscopy indicated that, collagen content (particularly type-I collagen) increased in the shunt group compared with the sham operation group. Additionally, compared with the shunt group, the shunt and NaHS treatment groups showed an amelioration of myocardial damage, an alleviation of myocardial fiber changes and a decrease in myocardial collagen content (particularly type-I collagen). Compared with the sham operation and shunt + NaHS groups, the shunt group displayed increased right ventricular hydroxyproline (mg×g(-1)·pro: 1.32 ± 0.25 vs 0.89 ± 0.18 and 0.83 ± 0.19, all P < 0

  15. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study.

    Science.gov (United States)

    Häggström, J; Boswood, A; O'Grady, M; Jöns, O; Smith, S; Swift, S; Borgarelli, M; Gavaghan, B; Kresken, J-G; Patteson, M; Ablad, B; Bussadori, C M; Glaus, T; Kovacević, A; Rapp, M; Santilli, R A; Tidholm, A; Eriksson, A; Belanger, M C; Deinert, M; Little, C J L; Kvart, C; French, A; Rønn-Landbo, M; Wess, G; Eggertsdottir, A V; O'Sullivan, M L; Schneider, M; Lombard, C W; Dukes-McEwan, J; Willis, R; Louvet, A; DiFruscia, R

    2008-01-01

    Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. A prospective single-blinded study with dogs randomized to PO receive pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy.

  16. Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

    International Nuclear Information System (INIS)

    Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke

    2000-01-01

    Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5±6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33±0.22 in chronic heart failure class I, 2.50±0.34 in class II, 1.95±0.61 in class III, and 1.39±0.29 in class IV (p<0.05). %WR was 24.8±12.8% in chronic heart failure class I, 23.3±10.2% in class II, 49.2±24.5% in class III, and 66.3±26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

  17. Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke [Nihon Univ., Tokyo (Japan). School of Medicine

    2000-12-01

    Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5{+-}6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33{+-}0.22 in chronic heart failure class I, 2.50{+-}0.34 in class II, 1.95{+-}0.61 in class III, and 1.39{+-}0.29 in class IV (p<0.05). %WR was 24.8{+-}12.8% in chronic heart failure class I, 23.3{+-}10.2% in class II, 49.2{+-}24.5% in class III, and 66.3{+-}26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

  18. Extracellular high-mobility group box 1 mediates pressure overload-induced cardiac hypertrophy and heart failure.

    Science.gov (United States)

    Zhang, Lei; Liu, Ming; Jiang, Hong; Yu, Ying; Yu, Peng; Tong, Rui; Wu, Jian; Zhang, Shuning; Yao, Kang; Zou, Yunzeng; Ge, Junbo

    2016-03-01

    Inflammation plays a key role in pressure overload-induced cardiac hypertrophy and heart failure, but the mechanisms have not been fully elucidated. High-mobility group box 1 (HMGB1), which is increased in myocardium under pressure overload, may be involved in pressure overload-induced cardiac injury. The objectives of this study are to determine the role of HMGB1 in cardiac hypertrophy and cardiac dysfunction under pressure overload. Pressure overload was imposed on the heart of male wild-type mice by transverse aortic constriction (TAC), while recombinant HMGB1, HMGB1 box A (a competitive antagonist of HMGB1) or PBS was injected into the LV wall. Moreover, cardiac myocytes were cultured and given sustained mechanical stress. Transthoracic echocardiography was performed after the operation and sections for histological analyses were generated from paraffin-embedded hearts. Relevant proteins and genes were detected. Cardiac HMGB1 expression was increased after TAC, which was accompanied by its translocation from nucleus to both cytoplasm and intercellular space. Exogenous HMGB1 aggravated TAC-induced cardiac hypertrophy and cardiac dysfunction, as demonstrated by echocardiographic analyses, histological analyses and foetal cardiac genes detection. Nevertheless, the aforementioned pathological change induced by TAC could partially be reversed by HMGB1 inhibition. Consistent with the in vivo observations, mechanical stress evoked the release and synthesis of HMGB1 in cultured cardiac myocytes. This study indicates that the activated and up-regulated HMGB1 in myocardium, which might partially be derived from cardiac myocytes under pressure overload, may be of crucial importance in pressure overload-induced cardiac hypertrophy and cardiac dysfunction. © 2015 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  19. Pill Properties that Cause Dysphagia and Treatment Failure

    Science.gov (United States)

    Fields, Jeremy; Go, Jorge T.; Schulze, Konrad S.

    2015-01-01

    Background Pills (tablets and capsules) are widely used to administer prescription drugs or to take supplements such as vitamins. Unfortunately, little is known about how much effort it takes Americans to swallow these various pills. More specifically, it is not known to what extent hard-to-swallow pills might affect treatment outcomes (eg, interfering with adherence to prescribed medications or causing clinical complications). It is also unclear which properties (eg, size, shape, or surface texture) Americans prefer or reject for their pills. To learn more about these issues, we interviewed a small group of individuals. Methods We invited individuals in waiting rooms of our tertiary health care center to participate in structured interviews about their pill-taking habits and any problems they have swallowing pills. We inquired which pill properties they believed caused swallowing problems. Participants scored capsules and pills of representative size, shape, and texture for swallowing effort and reported their personal preferences. Results Of 100 successive individuals, 99 participants completed the interview (65% women, mean age = 41 years, range = 23-77 years). Eighty-three percent took pills daily (mean 4 pills/d; 56% of those pills were prescribed by providers). Fifty-four percent of participants replied yes to the question, "Did you ever have to swallow a solid medication that was too difficult?" Four percent recounted serious complications: 1% pill esophagitis, 1% pill impaction, and 2% stopped treatments (antibiotic and prenatal supplement) because they could not swallow the prescribed pills. Half of all participants routinely resorted to special techniques (eg, plenty of liquids or repeated or forceful swallows). Sixty-one percent of those having difficulties cited specific pill properties: 27% blamed size (20% of problems were caused by pills that were too large whereas 7% complained about pills that were too small to sense); 12% faulted rough surface

  20. C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.

    Science.gov (United States)

    Hernandez, Caleb; Shuler, Klaus; Hannan, Hashibul; Sonyika, Chionesu; Likourezos, Antonios; Marshall, John

    2008-02-01

    Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At present there is the need for a means of differentiating between various causes of cardiac arrest, which are not a direct result of a primary ventricular arrhythmia. Identifying the cause of pulseless electrical activity or asystole is important as the underlying cause is what guides management in such cases. This approach, incorporating ultrasound to manage cardiac arrest aids in the diagnosis of the most common and easily reversible causes of cardiac arrest not caused by primary ventricular arrhythmia, namely; severe hypovolemia, tension pneumothorax, cardiac tamponade, and massive pulmonary embolus. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions. We include several clinical images demonstrating examples of cardiac tamponade, massive pulmonary embolus, and severe hypovolemia secondary to abdominal aortic aneurysm. In conclusion, this protocol has the potential to reduce the time required to determine the etiology of a cardiac arrest and thus decrease the time between arrest and appropriate therapy.

  1. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P heart failure, this simple...

  2. Cardiac I123-MIBG Correlates Better than Ejection Fraction with Symptoms Severity in Systolic Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, Sandra M.; Moscavitch, Samuel D.; Carestiato, Larissa R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Felix, Renata M. [Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Rodrigues, Ronaldo C.; Messias, Leandro R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader C. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Nóbrega, Antonio Cláudio L.; Mesquita, Evandro Tinoco [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco, E-mail: ctinocom@cardiol.br [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2013-07-15

    The association of autonomic activation, left ventricular ejection fraction (LVEF) and heart failure functional class is poorly understood. Our aim was to correlate symptom severity with cardiac sympathetic activity, through iodine-123-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy and with LVEF in systolic heart failure (HF) patients without previous beta-blocker treatment. Thirty-one patients with systolic HF, class I to IV of the New York Heart Association (NYHA), without previous beta-blocker treatment, were enrolled and submitted to {sup 123}I-MIBG scintigraphy and to radionuclide ventriculography for LVEF determination. The early and delayed heart/mediastinum (H/M) ratio and the washout rate (WR) were performed. According with symptom severity, patients were divided into group A, 13 patients in NYHA class I/II, and group B, 18 patients in NYHA class III/IV. Compared with group B patients, group A had a significantly higher LVEF (25% ± 12% in group B vs. 32% ± 7% in group A, p = 0.04). Group B early and delayed H/M ratios were lower than group A ratios (early H/M 1.49 ± 0.15 vs. 1.64 ± 0.14, p = 0.02; delayed H/M 1.39 ± 0.13 vs. 1.58 ± 0.16, p = 0.001, respectively). WR was significantly higher in group B (36% ± 17% vs. 30% ± 12%, p= 0.04). The variable that showed the best correlation with NYHA class was the delayed H/M ratio (r= -0.585; p=0.001), adjusted for age and sex. This study showed that cardiac {sup 123}I-MIBG correlates better than ejection fraction with symptom severity in systolic heart failure patients without previous beta-blocker treatment.

  3. Acute renal failure caused by Klebsiella pneumoniae pyelonephritis

    NARCIS (Netherlands)

    Creyghton, W. M.; Lobatto, S.; Weening, J. J.

    2001-01-01

    We report a 34-year-old male patient without prior medical history who presented with acute renal failure due to acute bacterial pyelonephritis. Both blood and urine cultures grew Klebsiella pneumoniae. Although a kidney biopsy revealed extensive necrosis and no viable glomeruli, renal function

  4. A Markov Model for Commen-Cause Failures

    DEFF Research Database (Denmark)

    Platz, Ole

    1984-01-01

    A continuous time four-state Markov chain is shown to cover several of the models that have been used for describing dependencies between failures of components in redundant systems. Among these are the models derived by Marshall and Olkin and by Freund and models for one-out-of-three and two...

  5. Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.

    Science.gov (United States)

    Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian

    2009-01-01

    Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

  6. Emerging role of liver X receptors in cardiac pathophysiology and heart failure.

    Science.gov (United States)

    Cannon, Megan V; van Gilst, Wiek H; de Boer, Rudolf A

    2016-01-01

    Liver X receptors (LXRs) are master regulators of metabolism and have been studied for their pharmacological potential in vascular and metabolic disease. Besides their established role in metabolic homeostasis and disease, there is mounting evidence to suggest that LXRs may exert direct beneficial effects in the heart. Here, we aim to provide a conceptual framework to explain the broad mode of action of LXRs and how LXR signaling may be an important local and systemic target for the treatment of heart failure. We discuss the potential role of LXRs in systemic conditions associated with heart failure, such as hypertension, diabetes, and renal and vascular disease. Further, we expound on recent data that implicate a direct role for LXR activation in the heart, for its impact on cardiomyocyte damage and loss due to ischemia, and effects on cardiac hypertrophy, fibrosis, and myocardial metabolism. Taken together, the accumulating evidence supports the notion that LXRs may represent a novel therapeutic target for the treatment of heart failure.

  7. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  8. Correlation between endogenous polyamines in human cardiac tissues and clinical parameters in patients with heart failure.

    Science.gov (United States)

    Meana, Clara; Rubín, José Manuel; Bordallo, Carmen; Suárez, Lorena; Bordallo, Javier; Sánchez, Manuel

    2016-02-01

    Polyamines contribute to several physiological and pathological processes, including cardiac hypertrophy in experimental animals. This involves an increase in ornithine decarboxylase (ODC) activity and intracellular polyamines associated with cyclic adenosine monophosphate (cAMP) increases. The aim of the study was to establish the role of these in the human heart in living patients. For this, polyamines (by high performance liquid chromatography) and the activity of ODC and N(1)-acetylpolyamine oxidases (APAO) were determined in the right atrial appendage of 17 patients undergoing extracorporeal circulation to correlate with clinical parameters. There existed enzymatic activity associated with the homeostasis of polyamines. Left atria size was positively associated with ODC (r = 0.661, P = 0.027) and negatively with APAO-N(1) -acetylspermine (r = -0.769, P = 0.026), suggesting that increased levels of polyamines are associated with left atrial hemodynamic overload. Left ventricular ejection fraction (LVEF) and heart rate were positively associated with spermidine (r = 0.690, P = 0.003; r = 0.590, P = 0.021) and negatively with N(1)-acetylspermidine (r = -0.554, P = 0.032; r = -0.644, P = 0.018). LVEF was negatively correlated with cAMP levels (r = -0.835, P = 0.001) and with cAMP/ODC (r = -0.794, P = 0.011), cAMP/spermidine (r = -0.813, P = 0.001) and cAMP/spermine (r = -0.747, P = 0.003) ratios. Abnormal LVEF patients showed decreased ODC activity and spermidine, and increased N(1) -acetylspermidine, and cAMP. Spermine decreased in congestive heart failure patients. The trace amine isoamylamine negatively correlated with septal wall thickness (r = -0.634, P = 0.008) and was increased in cardiac heart failure. The results indicated that modifications in polyamine homeostasis might be associated with cardiac function and remodelling. Increased cAMP might have a deleterious effect on function. Further studies should confirm these findings and the involvement of

  9. Exploitation of a component event data bank for common cause failure analysis

    International Nuclear Information System (INIS)

    Games, A.M.; Amendola, A.; Martin, P.

    1985-01-01

    Investigations into using the European Reliability Data System Component Event Data Bank for common cause failure analysis have been carried out. Starting from early exercises where data were analyzed without computer aid, different types of linked multiple failures have been identified. A classification system is proposed based on this experience. It defines a multiple failure event space wherein each category defines causal, modal, temporal and structural links between failures. It is shown that a search algorithm which incorporates the specific interrogative procedures of the data bank can be developed in conjunction with this classification system. It is concluded that the classification scheme and the search algorithm are useful organizational tools in the field of common cause failures studies. However, it is also suggested that the use of the term common cause failure should be avoided since it embodies to many different types of linked multiple failures

  10. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure.

    Science.gov (United States)

    Schmid, Jean-Paul; Noveanu, Markus; Morger, Cyrill; Gaillet, Raymond; Capoferri, Mauro; Anderegg, Matthias; Saner, Hugo

    2007-06-01

    Whole-body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (Vo(2)) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak Vo(2) 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak Vo(2) 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32 degrees C) water immersion and exercise was measured using a non-invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). Vo(2) during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak Vo(2) of at least 15 ml/kg/min during a symptom-limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and Vo(2) are lower than in patients with CAD with preserved left ventricular function and controls

  11. A single exposure to photochemical smog causes airway irritation and cardiac dysrhythmia in mice

    Science.gov (United States)

    The data presented here shows that a single exposure to photochemical smog causes airway irritation and cardiac dysrhythmia in mice. Smog, which is a complex mixture of particulate matter and gaseous irritants (ozone, sulfur dioxide, reactive aldehydes), as well as components whi...

  12. Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors

    NARCIS (Netherlands)

    de Vreede-Swagemakers, J. J.; Gorgels, A. P.; Dubois-Arbouw, W. I.; Dalstra, J.; Daemen, M. J.; van Ree, J. W.; Stijns, R. E.; Wellens, H. J.

    1998-01-01

    To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate. During a five year period (1991-95)

  13. Adaptive servo ventilation improves Cheyne-Stokes respiration, cardiac function, and prognosis in chronic heart failure patients with cardiac resynchronization therapy.

    Science.gov (United States)

    Miyata, Makiko; Yoshihisa, Akiomi; Suzuki, Satoshi; Yamada, Shinya; Kamioka, Masashi; Kamiyama, Yoshiyuki; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2012-09-01

    Cheyne-Stokes respiration (CSR-CSA) is often observed in patients with chronic heart failure (CHF). Although cardiac resynchronization therapy (CRT) is effective for CHF patients with left ventricular dyssynchrony, it is still unclear whether adaptive servo ventilation (ASV) improves cardiac function and prognosis of CHF patients with CSR-CSA after CRT. Twenty two patients with CHF and CSR-CSA after CRT defibrillator (CRTD) implantation were enrolled in the present study and randomly assigned into two groups: 11 patients treated with ASV (ASV group) and 11 patients treated without ASV (non-ASV group). Measurement of plasma B-type natriuretic peptide (BNP) levels (before 3, and 6 months later) and echocardiography (before and 6 months) were performed in each group. Patients were followed up to register cardiac events (cardiac death and re-hospitalization) after discharge. In the ASV group, indices for apnea-hypopnea, central apnea, and oxyhemoglobin saturation were improved on ASV. BNP levels, cardiac systolic and diastolic function were improved with ASV treatment for 6 months. Importantly, the event-free rate was significantly higher in the ASV group than in the non-ASV group. ASV improves CSR-CSA, cardiac function, and prognosis in CHF patients with CRTD. Patients with CSR-CSA and post CRTD implantation would get benefits by treatment with ASV. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  14. Heart failure in pregnant women with cardiac disease: Data from the ROPAC

    NARCIS (Netherlands)

    T.P.E. Ruys (Titia); J.W. Roos-Hesselink (Jolien); R. Hall (Ruth); M.T. Subirana-Domèlnech (Maria); J. Grando-Ting (Jennifer); M. Estensen (Mette); R. Crepaz (Roberto); V. Fesslova (Vlasta); M. Gurvitz (Michelle); J. de Backer (Julie); M.R. Johnson (Mark); P.G. Pieper (Petronella)

    2014-01-01

    textabstractObjective Heart failure (HF) is one of the most important complications in pregnant women with heart disease, causing maternal and fetal mortality and morbidity. Methods This is an international observational registry of patients with structural heart disease during pregnancy. Sixty

  15. Heart failure in pregnant women with cardiac disease : data from the ROPAC

    NARCIS (Netherlands)

    Ruys, Titia P. E.; Roos-Hesselink, Jolien W.; Hall, Roger; Subirana-Domenech, Maria T.; Grando-Ting, Jennifer; Estensen, Mette; Crepaz, Roberto; Fesslova, Vlasta; Gurvitz, Michelle; De Backer, Julie; Johnson, Mark R.; Pieper, Petronella G.

    2014-01-01

    Objective Heart failure (HF) is one of the most important complications in pregnant women with heart disease, causing maternal and fetal mortality and morbidity. Methods This is an international observational registry of patients with structural heart disease during pregnancy. Sixty hospitals in 28

  16. Hemodynamic changes during weaning: can we assess and predict cardiac-related weaning failure by transthoracic echocardiography?

    Science.gov (United States)

    Voga, Gorazd

    2010-01-01

    Cardiac-related failure of weaning from mechanical ventilation is an important reason for prolonged mechanical ventilation, intensive care unit treatment, and increased morbidity and mortality. When transthoracic echocardiography (TTE) is routinely performed before a weaning trial, patients at high risk of cardiac-related failure can be detected by low left ventricular (LV) ejection fraction, diastolic dysfunction, and elevated LV filling pressure. During the weaning trial, a further increase of LV filling pressure and progression of diastolic failure can be observed by repeated TTE. Owing to certain limitations concerning patients and methodology, TTE cannot be employed in every patient and invasive hemodynamic monitoring is still mandatory in selected patients with repetitive weaning failure.

  17. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences.

    Science.gov (United States)

    Lorenzi-Filho, Geraldo; Genta, Pedro R; Figueiredo, Adelaide C; Inoue, Daniel

    2005-08-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

  18. Left atrial leiomyosarcoma as cause of heart failure

    International Nuclear Information System (INIS)

    Valdes Martin, Alexander

    2012-01-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

  19. Analysis for the cause of the condensate pump bearing failure

    International Nuclear Information System (INIS)

    Cheng Yiyan

    2012-01-01

    This paper discussed the influence of the foreign matters for the rolling bearing's service life, analyzed the reason, way and harm of soft foreign matters disabling the bearings. And some measures were brought forward to improve the maintenance quality, which could be used for reference to enhance the ability of estimating the failure of the motor's rolling bearings, and to improve the level of the maintenance work. (author)

  20. Exploration of flexible phenylpropylurea scaffold as novel cardiac myosin activators for the treatment of systolic heart failure.

    Science.gov (United States)

    Manickam, Manoj; Jalani, Hitesh B; Pillaiyar, Thanigaimalai; Sharma, Niti; Boggu, Pulla Reddy; Venkateswararao, Eeda; Lee, You-Jung; Jeon, Eun-Seok; Jung, Sang-Hun

    2017-07-07

    A series of flexible urea derivatives have been synthesized and demonstrated as selective cardiac myosin ATPase activator. Among them 1-phenethyl-3-(3-phenylpropyl)urea (1, cardiac myosin ATPase activation at 10 μM = 51.1%; FS = 18.90; EF = 12.15) and 1-benzyl-3-(3-phenylpropyl)urea (9, cardiac myosin ATPase activation = 53.3%; FS = 30.04; EF = 18.27) showed significant activity in vitro and in vivo. The change of phenyl ring with tetrahydropyran-4-yl moiety viz., 1-(3-phenylpropyl)-3-((tetrahydro-2H-pyran-4-yl)methyl)urea (14, cardiac myosin ATPase activation = 81.4%; FS = 20.50; EF = 13.10), and morpholine moiety viz., 1-(2-morpholinoethyl)-3-(3-phenylpropyl)urea (21, cardiac myosin ATPase activation = 44.0%; FS = 24.79; EF = 15.65), proved to be efficient to activate the cardiac myosin. The potent compounds 1, 9, 14 and 21 were found to be selective for cardiac myosin over skeletal and smooth myosins. Thus, these urea derivatives are potent scaffold to develop as a newer cardiac myosin activator for the treatment of systolic heart failure. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. 'NTA', a locally named unclear condition that causes failure to thrive ...

    African Journals Online (AJOL)

    'NTA', a locally named unclear condition that causes failure to thrive amongst under five children in southeastern Nigeria: An assessment of mothers' and caregivers' perception of its causes and management.

  2. Analysis Method of Common Cause Failure on Non-safety Digital Control System

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Goo; Oh, Eun Gse [KHNP, Daejeon (Korea, Republic of)

    2014-08-15

    The effects of common cause failure on safety digital instrumentation and control system had been considered in defense in depth analysis with safety analysis method. However, the effects of common cause failure on non-safety digital instrumentation and control system also should be evaluated. The common cause failure can be included in credible failure on the non-safety system. In the I and C architecture of nuclear power plant, many design feature has been applied for the functional integrity of control system. One of that is segmentation. Segmentation defenses the propagation of faults in the I and C architecture. Some of effects from common cause failure also can be limited by segmentation. Therefore, in this paper there are two type of failure mode, one is failures in one control group which is segmented, and the other is failures in multiple control group because that the segmentation cannot defense all effects from common cause failure. For each type, the worst failure scenario is needed to be determined, so the analysis method has been proposed in this paper. The evaluation can be qualitative when there is sufficient justification that the effects are bounded in previous safety analysis. When it is not bounded in previous safety analysis, additional analysis should be done with conservative assumptions method of previous safety analysis or best estimation method with realistic assumptions.

  3. Cardiac Failure as an Unusual Presentation in a Patient with History of Amyotrophic Lateral Sclerosis

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Namazi

    2014-01-01

    Full Text Available Amyotrophic lateral sclerosis (ALS is the most well-known form of motor neuron diseases in which both upper and lower motor neurons are involved in this disease. We presented an unusual case of ALS whom had presented with chief complaint of dyspnea. Cardiac failure was diagnosed at the final stage of the ALS disease. The pathogenetic mechanism leading to an elevated occurrence of cardiomyopathy in ALS is not comprehensible. Dilated cardiomyopathy has been explained in some previous studies. Based on the collected data, it was hypothesized that cardiomyopathy is underdiagnosed in the ALS population, probably because symptoms are masqueraded as a result of the patients’ disability. It was suggested that in all motor neuron diseases a serial cardiological evaluation should be executed, including annual echocardiography.

  4. Association of hypothyroidism with adverse events in patients with heart failure receiving cardiac resynchronization therapy.

    Science.gov (United States)

    Sharma, Ajay K; Vegh, Eszter; Orencole, Mary; Miller, Alexandra; Blendea, Dan; Moore, Stephanie; Lewis, Gregory D; Singh, Jagmeet P; Parks, Kimberly A; Heist, E Kevin

    2015-05-01

    Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in particular in patients with heart failure (HF). The aim of this study was to evaluate the impact of hypothyroidism on patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of level of control of hypothyroidism on risk of adverse events after CRT implantation was also evaluated. We included consecutive patients in whom a CRT device was implanted from April 2004 to April 2010 at our institution with sufficient follow-up data available for analysis; 511 patients were included (age 68.5±12.4 years, women 20.4%); 84 patients with a clinical history of hypothyroidism, on treatment with thyroid hormone repletion or serum thyroid-stimulating hormone level≥5.00 μU/ml, were included in the hypothyroid group. The patients were followed for up to 3 years after implant for a composite end point of hospitalization for HF, left ventricular assist device placement, or heart transplant and cardiac death; 215 composite end point events were noted in this period. In a multivariate model, hypothyroidism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.027 to 2.085, p=0.035), female gender (HR 0.64, 95% CI 0.428 to 0.963, p=0.032), and creatinine (HR 1.26, 95% CI 1.145 to 1.382, phypothyroidism at baseline developed the composite end point compared with 39.8% of those with euthyroidism (p=0.02). In conclusion, hypothyroidism is associated with a worse prognosis after CRT implantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Imaging cardiac activation sequence during ventricular tachycardia in a canine model of nonischemic heart failure.

    Science.gov (United States)

    Han, Chengzong; Pogwizd, Steven M; Yu, Long; Zhou, Zhaoye; Killingsworth, Cheryl R; He, Bin

    2015-01-15

    Noninvasive cardiac activation imaging of ventricular tachycardia (VT) is important in the clinical diagnosis and treatment of arrhythmias in heart failure (HF) patients. This study investigated the ability of the three-dimensional cardiac electrical imaging (3DCEI) technique for characterizing the activation patterns of spontaneously occurring and norepinephrine (NE)-induced VTs in a newly developed arrhythmogenic canine model of nonischemic HF. HF was induced by aortic insufficiency followed by aortic constriction in three canines. Up to 128 body-surface ECGs were measured simultaneously with bipolar recordings from up to 232 intramural sites in a closed-chest condition. Data analysis was performed on the spontaneously occurring VTs (n=4) and the NE-induced nonsustained VTs (n=8) in HF canines. Both spontaneously occurring and NE-induced nonsustained VTs initiated by a focal mechanism primarily from the subendocardium, but occasionally from the subepicardium of left ventricle. Most focal initiation sites were located at apex, right ventricular outflow tract, and left lateral wall. The NE-induced VTs were longer, more rapid, and had more focal sites than the spontaneously occurring VTs. Good correlation was obtained between imaged activation sequence and direct measurements (averaged correlation coefficient of ∼0.70 over 135 VT beats). The reconstructed initiation sites were ∼10 mm from measured initiation sites, suggesting good localization in such a large animal model with cardiac size similar to a human. Both spontaneously occurring and NE-induced nonsustained VTs had focal initiation in this canine model of nonischemic HF. 3DCEI is feasible to image the activation sequence and help define arrhythmia mechanism of nonischemic HF-associated VTs. Copyright © 2015 the American Physiological Society.

  6. [Cardiac resynchronization therapy for heart failure - from experimental pacing to evidence-based therapy].

    Science.gov (United States)

    Götze, S; Butter, C; Fleck, E

    2006-01-01

    Within the last decade, cardiac resynchronization therapy (CRT) has become an evidence-based cornerstone for a subset of patients with chronic heart failure. For those, who suffer from ischemic or non-ischemic cardiomyopathies at NYHA III or IV, have sinus rhythm, a left bundle branch block and a left ventricular ejection fraction below 35%, CRT has evolved as an important treatment option with promising results. Numerous studies have shown that in these patients pacemaker-mediated correction of intra- and interventicular conduction disturbances can improve not only clinical symptoms, exercise tolerance and the frequency of hospitalizations, but even more important the overall mortality. These clinical results are due to several functional aspects. In the failing heart characteristic intra- and interventricular alterations in electrical conduction result in mechanical asynchrony that leads to an abnormal contraction of the left ventricle with delayed activation of the lateral wall, a paradoxical septal movement, a reduced diastolic filling and a mitral regurgitation due to dyssynchrony of papillary muscle activation. It is conceivable that these functional changes have fatal consequences for the failing heart. AV-optimized left- or biventricular stimulation by modern pacemakers can correct the pathological dyssynchrony, thereby improving cardiac function and clinical outcome in these patients. Although tremendous progress in cardiac resynchronization therapy has been made during the last decade, a couple of questions still need to be resolved. Critical issues are the identification of patients, who will predictably benefit from CRT, the value of CRT-pacemakers versus CRT-ICDs, and the usefullness of CRT in patients with atrial fibrillation.

  7. Noninvasive pulse contour analysis for determination of cardiac output in patients with chronic heart failure.

    Science.gov (United States)

    Roth, Sebastian; Fox, Henrik; Fuchs, Uwe; Schulz, Uwe; Costard-Jäckle, Angelika; Gummert, Jan F; Horstkotte, Dieter; Oldenburg, Olaf; Bitter, Thomas

    2018-05-01

    Determination of cardiac output (CO) is essential in diagnosis and management of heart failure (HF). The gold standard to obtain CO is invasive assessment via thermodilution (TD). Noninvasive pulse contour analysis (NPCA) is supposed as a new method of CO determination. However, a validation of this method in HF is pending and performed in the present study. Patients with chronic-stable HF and reduced left ventricular ejection fraction (LVEF ≤ 45%; HF-REF) underwent right heart catheterization including TD. NPCA using the CNAP Monitor (V5.2.14, CNSystems Medizintechnik AG) was performed simultaneously. Three standardized TD measurements were compared with simultaneous auto-calibrated NPCA CO measurements. In total, 84 consecutive HF-REF patients were enrolled prospectively in this study. In 4 patients (5%), TD was not successful and for 22 patients (26%, 18 with left ventricular assist device), no NPCA signal could be obtained. For the remaining 58 patients, Bland-Altman analysis revealed a mean bias of + 1.92 L/min (limits of agreement ± 2.28 L/min, percentage error 47.4%) for CO. With decreasing cardiac index, as determined by the gold standard of TD, there was an increasing gap between CO values obtained by TD and NPCA (r = - 0.75, p TD-CI classified 52 (90%) patients to have a reduced CI (REF patients, auto-calibrated NPCA systematically overestimates CO with decrease in cardiac function. Therefore, to date, NPCA cannot be recommended in this cohort.

  8. Cardiac function improved by sarcoplasmic reticulum Ca2+-ATPase overexpression in a heart failure model induced by chronic myocardial ischemia

    Directory of Open Access Journals (Sweden)

    Wei XIN

    2011-04-01

    Full Text Available Objective Chronic myocardial ischemia(CMI has become an important cause of heart failure(HF.The aim of present study was to examine the effects of Sarco-endoplasmic reticulum calcium ATPase(SERCA2a gene transfer in HF model in large animal induced by CMI.Methods HF was reproduced in minipigs by ligating the initial segment of proximal left anterior descending(LAD coronary artery with an ameroid constrictor to produce progressive vessel occlusion and ischemia.After confirmation of myocardial perfusion defect and cardiac function impairment by SPECT and echocardiography in the model,animals were divided into 4 groups: HF group;HF+enhanced green fluorescent protein(EGFP group;HF+SERCA2a group;and sham operation group as control.rAAV1-EGFP and rAAV1-SERCA2a(1×1012 vg for each animal were directly and intramyocardially injected to the animals of HF+EGFP and HF+SERCA2a groups.Sixty days after the gene transfer,the expression of SERCA2a at the protein level was examined by Western blotting and immunohistochemistry,the changes in cardiac function were determined by echocardiographic and hemodynamic analysis,and the changes in serum inflammatory and neuro-hormonal factors(including BNP,TNF-a,IL-6,ET-1 and Ang II were determined by radioimmunoassay.Results Sixty days after gene transfer,LVEF,Ev/Av and ±dp/dtmax increased significantly(P < 0.05,along with an increase of SERCA2a protein expression in the ischemic myocardium(PP < 0.05,accompanied by a significant decrease of inflammatory and neural-hormonal factors(PP < 0.05 in HF+SERCA2a group as compared with HF/HF+EGFP group.Conclusions Overexpression of SERCA2a may significantly improve the cardiac function of the ischemic myocardium of HF model induced by CMI and reverse the activation of neural-hormonal factors,implying that it has a potential therapeutic significance in CMI related heart failure.

  9. Aerobic exercise training rescues cardiac protein quality control and blunts endoplasmic reticulum stress in heart failure rats.

    Science.gov (United States)

    Bozi, Luiz H M; Jannig, Paulo R; Rolim, Natale; Voltarelli, Vanessa A; Dourado, Paulo M M; Wisløff, Ulrik; Brum, Patricia C

    2016-11-01

    Cardiac endoplasmic reticulum (ER) stress through accumulation of misfolded proteins plays a pivotal role in cardiovascular diseases. In an attempt to reestablish ER homoeostasis, the unfolded protein response (UPR) is activated. However, if ER stress persists, sustained UPR activation leads to apoptosis. There is no available therapy for ER stress relief. Considering that aerobic exercise training (AET) attenuates oxidative stress, mitochondrial dysfunction and calcium imbalance, it may be a potential strategy to reestablish cardiac ER homoeostasis. We test the hypothesis that AET would attenuate impaired cardiac ER stress after myocardial infarction (MI). Wistar rats underwent to either MI or sham surgeries. Four weeks later, rats underwent to 8 weeks of moderate-intensity AET. Myocardial infarction rats displayed cardiac dysfunction and lung oedema, suggesting heart failure. Cardiac dysfunction in MI rats was paralleled by increased protein levels of UPR markers (GRP78, DERLIN-1 and CHOP), accumulation of misfolded and polyubiquitinated proteins, and reduced chymotrypsin-like proteasome activity. These results suggest an impaired cardiac protein quality control. Aerobic exercise training improved exercise capacity and cardiac function of MI animals. Interestingly, AET blunted MI-induced ER stress by reducing protein levels of UPR markers, and accumulation of both misfolded and polyubiquinated proteins, which was associated with restored proteasome activity. Taken together, our study provide evidence for AET attenuation of ER stress through the reestablishment of cardiac protein quality control, which contributes to better cardiac function in post-MI heart failure rats. These results reinforce the importance of AET as primary non-pharmacological therapy to cardiovascular disease. © 2016 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  10. Medical Image of the Week: Cardiac Magnetic Resonance Imaging Findings of Severe RV Failure

    Directory of Open Access Journals (Sweden)

    Wickstrom K

    2018-05-01

    Full Text Available No abstract available. Article truncated at 150 words. A 56-year-old man with history a of alcohol abuse presents with progressive shortness of breath on exertion, bilateral lower extremity swelling and 12-pound weight gain over two weeks. His transthoracic echocardiography (Figure 1 demonstrated severely increased global right ventricle (RV size, severely dilated right atrium (RA, severe pulmonary artery (PA dilation, moderate tricuspid regurgitation (TR and right ventricular systolic pressure (RVSP estimated at 85 + central venous pressure (CVP in the context of severely reduced RV systolic function. Right heart catheterization (RHC showed PA pressure (systolic/diastolic, mean of 94/28, 51 mmHg with a PA occlusion pressure of 12 mmHg. After extensive evaluation, our patient’s presentation of right heart failure seemed to be a manifestation of idiopathic pulmonary arterial hypertension. Our patient subsequently had cardiac MRI (cMRI with findings shown above (Figure 2. CMRI is a valuable, three-dimensional imaging modality that provides detailed morphology of the cardiac chambers along with accurate …

  11. Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure.

    Science.gov (United States)

    Otaki, Yoichiro; Watanabe, Tetsu; Takahashi, Hiroki; Funayama, Akira; Kinoshita, Daisuke; Yokoyama, Miyuki; Takahashi, Tetsuya; Nishiyama, Satoshi; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Kubota, Isao

    2016-02-01

    Renal tubular damage (RTD) and hypoalbuminemia are risks for poor prognosis in patients with chronic heart failure (CHF). Renal tubules play a pivotal role in amino acid and albumin reabsorption, which maintain serum albumin levels. The aims of the present study were to (1) examine the association of RTD with hypoalbuminemia, and (2) assess the prognostic importance of comorbid RTD and hypoalbuminemia in patients with CHF. We measured N-acetyl-β-D-glucosamidase (NAG) levels and the urinary β2-microglobulin to creatinine ratio (UBCR) in 456 patients with CHF. RTD was defined as UBCR ≥ 300 μg/g or NAG ≥ 14.2 U/g. There were moderate correlations between RTD markers and serum albumin (NAG, r = -0.428, P < 0.0001; UBCR, r = -0.399, P < 0.0001). Multivariate logistic analysis showed that RTD was significantly related to hypoalbuminemia in patients with CHF. There were 134 cardiac events during a median period of 808 days. The comorbidity of RTD and hypoalbuminemia was increased with advancing New York Heart Association functional class. Multivariate Cox proportional hazard regression analysis showed that the presence of RTD and hypoalbuminemia was associated with cardiac events. The net reclassification index was significantly improved by adding RTD and hypoalbuminemia to the basic risk factors. Comorbid RTD and hypoalbuminemia are frequently observed and increase the risk for extremely poor outcome in patients with CHF.

  12. Seismically induced common cause failures in PSA of nuclear power plants

    International Nuclear Information System (INIS)

    Ravindra, M.K.; Johnson, J.J.

    1991-01-01

    In this paper, a research project on the seismically induced common cause failures in nuclear power plants performed for Toshiba Corp. is described. The objective of this research was to develop the procedure for estimating the common cause failure probabilities of different nuclear power plant components using the combination of seismic experience data, the review of sources of dependency, sensitivity studies and engineering judgement. The research project consisted of three tasks: the investigation of damage instances in past earthquakes, the analysis of multiple failures and their root causes, and the development of the methodology for assessing seismically induced common cause failures. The details of these tasks are explained. In this paper, the works carried out in the third task are described. A methodology for treating common cause failures and the correlation between component failures is formulated; it highlights the modeling of event trees taking into account common cause failures and the development of fault trees considering the correlation between component failures. The overview of seismic PSA, the quantification methods for dependent failures and Latin Hypercube sampling method are described. (K.I.)

  13. Failure cause and failure rate evaluation on pumps of BWR plants in PSA. Hypothesis testing for typical or plant specific failure rate of pumps

    International Nuclear Information System (INIS)

    Sanada, Takahiro; Nakamura, Makoto

    2009-01-01

    In support of domestic nuclear industry effort to gather and analyze failure data of components concerning nuclear power plants, Nuclear Information Archives (NUCIA) are published for useful information to help PSA. This report focuses on NUCIA pertaining to pumps in domestic nuclear power plants, and provides the reliable estimation on failure rate of pumps resulting from failure cause analysis and hypothesis testing of classified and plant specific failure rate of pumps for improving quality in PSA. The classified and plant specific failure rate of pumps are estimated by analyzing individual domestic nuclear power plant's data of 26 Boiling Water Reactors (BWRs) concerning functionally structurally classified pump failures reported from beginning of commercial operation to March 31, 2007. (author)

  14. Study on the relationship between plasma BNP levels and left cardiac function in patients with heart failure

    International Nuclear Information System (INIS)

    Yin Xin; Xu Dandan; Wu Chunxu

    2005-01-01

    Objective: To investigate the relationship between plasma brain natriuretic peptide (BNP) levels and cardiac function in patients with heart failure. Methods: Plasma levels of BNP (with IRMA) and left cardiac function parameters (examined with echocardiogram) were obtained in 80 patients with heart failure at admission and repeatedly examined in 43 of them later after 2w treatment a swell as in 30 controls. Results: The plasma BNP levels increased along with the deterioration of cardiac function, with significant differences among the patients with different cardiac function grades (P<0.01). After 2w treatment, the plasma BNP levels were significantly lower than those before (P<0.01). The plasma levels of BNP were negatively correlated with left ventricular ejection fraction (LVEF) and left ventricle fraction shortening, but positively correlated with left ventricular end-systolic diameter (LVSd) and left ventricular end-diastolic diameter (LVDd). Conclusion: Plasma levels of BNP were closely related to the severity of heart failure and could serve as a biochemical marker for assessing the left cardiac function. (authors)

  15. Impact of exercise rehabilitation on cardiac neuronal function in heart failure. An iodine-123 metaiodobenzylguanidine scintigraphy study

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, D.; Bouvard, G. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France); Lecluse, E.; Grollier, G.; Potier, J.C. [Service de Cardiologie, CHU Cote de Nacre, Caen (France); Belin, A. [Service de Readaptation Cardiaque, CHU Cote de Nacre, Caen (France); Babatasi, G. [Service de Chirurgie Cardio-Thoracique, CHU Cote de Nacre, Caen (France); Amar, M.H. [Centre Francois Baclesse, Caen (France). Service de Recherche Clinique

    1998-03-01

    Exercise training can induce important haemodynamic and metabolic adaptations in patients with chronic heart failure due to severe left ventricular dysfunction. This study examined the impact of exercise rehabilitation on cardiac neuronal function using iodine-123 metaiobodenzylguanidine (MIBG) scintigraphy. Fourteen patients (11 men, 3 women; mean age 48 years; range: 36-66 years) with stable chronic heart failure of NYHA class II-III and an initial resting radionuclide left ventricular ejection fraction (LVEF) <50% were enrolled in the study. Patients underwent progressive, supervised endurance training (treadmill test, Bruce protocol) during a 6-month period (60 sessions, 3 sessions per week) at a cardiac rehabilitation referral centre in order to measure exercise parameters. Planar {sup 123}I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (heart-mediastinum ratio activity, 4 h after intravenous injection of 185 MBq of MIBG). Radionuclide LVEF was also assessed at the outset and after 6 months of exercise training. Workload (801{+-}428 vs 1229{+-}245 kpm.min{sup -1}, P=0.001), exercise duration (504{+-}190 vs 649{+-}125 s, P=0.02), and myocardial MIBG uptake (135%{+-}19% vs 156%{+-}25%, P=0.02) increased significantly after rehabilitation. However, LVEF did not change significantly (23%{+-}9% vs 21%{+-}10%, p=NS). It is concluded that exercise rehabilitation induces improvement of cardiac neuronal function without having negative effects on cardiac contractility in patients with stable chronic heart failure. (orig.)

  16. [Pseudohypoaldosteronisme type I: a rare cause of failure to thrive].

    Science.gov (United States)

    Derache, A-F; Rousseau, S; Holder-Espinasse, M; Bouquillon, S; Bresson, S; Ythier, H; Ganga-Zandzou, P-S

    2012-05-01

    We report on a boy, born on term, presenting with a weight loss and a persistent failure to thrive after 10 days despite a normal behavior under bottle-feeding. The clinical examination was normal and biological assessment revealed hyponatremia with hyponatriuria, normal kaliemia and elevated aldosterone values, leading to type I pseudohypoaldosteronism diagnosis. Treatment with salt supplementation allowed growth improvement. The diagnosis was confirmed by the identification of a mutation in the mineralocorticoid receptor. This change was also found in several family members. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  17. Yogi Detox Tea: A Potential Cause of Acute Liver Failure.

    Science.gov (United States)

    Kesavarapu, Keerthana; Kang, Mitchell; Shin, Jaewook James; Rothstein, Kenneth

    2017-01-01

    We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

  18. Yogi Detox Tea: A Potential Cause of Acute Liver Failure

    Directory of Open Access Journals (Sweden)

    Keerthana Kesavarapu

    2017-01-01

    Full Text Available We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

  19. Recurrent infective endocarditis causing heart valve failure: A case report

    Directory of Open Access Journals (Sweden)

    Victoria McIntyre, BASc Chemical Engineering (2018 candidate

    2017-11-01

    Full Text Available Infective endocarditis (IE is an infection that does not usually respond rapidly to treatment, often because its early symptoms are non-specific. The diseased valves (native or bioprosthetic may be calcified and the thrombotic vegetations on them typically friable and embolize easily. Left untreated IE leads to damage to the infected valve and to congestive heart failure (CHF. Its treatment usually requires heart valve replacement. Our 69-year-old patient had IE, and underwent aortic valve replacement (AVR with a bioprosthesis. This case stresses the complications of IE and its tendency to recur in patients with bioprosthetic heart valves (BHV who previously had IE.

  20. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Esther Ern-Hwei Chan

    2016-01-01

    Full Text Available Hydrothorax secondary to a pancreaticopleural fistula (PPF is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up.

  1. Root Causes of Component Failures Program: Methods and applications

    International Nuclear Information System (INIS)

    Satterwhite, D.G.; Cadwallader, L.C.; Vesely, W.E.; Meale, B.M.

    1986-12-01

    This report contains information pertaining to definitions, methodologies, and applications of root cause analysis. Of specific interest, and highlighted throughout the discussion, are applications pertaining to current and future Nuclear Regulatory Commission (NRC) light water reactor safety programs. These applications are discussed in view of addressing specific program issues under NRC consideration and reflect current root cause analysis capabilities

  2. Red Cell Distribution Width and Serum BNP Level Correlation in Diabetic Patients with Cardiac Failure: A Cross - Sectional Study.

    Science.gov (United States)

    A R, Subhashree

    2014-06-01

    Red cell distribution width (RDW) is a red cell measurement given by fully automated hematology analyzers. It is a measure of heterogeneity in the size of circulating erythrocytes. Studies have shown that it is a prognostic marker in non - anemic diabetic patients with symptomatic cardiovascular disease but its correlation with cardiac failure in diabetics has not been studied so far. Moreover, studies have also shown that a higher RDW may reflect an underlying inflammatory state. Since Diabetes is a pro inflammatory state there is a possibility that it might have an influence on the RDW values even when there is no cardiac failure, but research data on this aspect is lacking. B-type natriuretic peptide (BNP) is a proven marker for cardiac failure whose values are comparable with echo cardio graphic findings in assessing the left ventricular dysfunction. This study aimed to find out the correlation between RDW% and serum BNP levels in Diabetics with heart failure (cases) when compared to those without failure (controls). Further, we compared the RDW % values of the cases with controls. Settings and Design : The study was approved by institutional ethical and research committee. A cross-sectional study was conducted with patients attending the Diabetes clinic of a tertiary care hospital in Chennai, India, during the period of October to December 2013. Hundred known cases of type II Diabetes mellitus attending Diabetes centre of the Hospital, with clinical and Echo cardio graphic features of cardiac failure were included as cases. Hundred age and gender matched diabetics with negative history of cardiovascular disease and with normal Echo cardio graphic features were included as controls. Informed consent was obtained from all the cases and controls. Demographic data and clinical history were gathered from all the cases and controls by using a standardized self - administered questionnaire. Biochemical and hematological parameters which included Fasting and

  3. Infection and microleakage the caused of endodontic failure

    Directory of Open Access Journals (Sweden)

    Kurniasri Amas Achiar

    2008-03-01

    Full Text Available The success of endodontic treatment depends on the quality of endodontic treatment and the final restoration. The mean reason for endodontic treatment failure is usually microleakage. That is why it becomes one of the priorities for dental research to prevent microleakage. Infection during the root canal treatment can be prevented. First, by employing strict aseptic clinical techniques follows by cleaning all bacteria and preoperative necrotic pulp-tissue remnants from the root canal. Irrigants are essential in this phase. The shaping of the canal is also an important prerequisite for endodontic success. Removal of the smear layer can enhance seal ability. Second, obturation of the root canal should leave the tooth in the most biological inert condition possible, and it must prevent reinfection as well as the growth of any microorganisms remaining in the canal. The application of an antibacterial dressing between appointments is absolutely necessary or the root canal has to be obturated at the first appointment in order to deprive the microorganisms of nutrients and space to multiply. The temporary filling must be at least 3.5 mm thick. Failure occurs because of missed canals, iatrogenic events and radicular fractures have to be avoided. At the end, clinicians have to confirm that the root canal is cleaned and hermetically obturated because hermetic root canal filling will prevent the leakage of an irritant to the apical area.

  4. [Acetaminophen (paracetamol) causing renal failure: report on 3 pediatric cases].

    Science.gov (United States)

    Le Vaillant, J; Pellerin, L; Brouard, J; Eckart, P

    2013-06-01

    Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Cardiac Stress and Inflammatory Markers as Predictors of Heart Failure in Patients With Type 2 Diabetes : The ADVANCE Trial

    NARCIS (Netherlands)

    Ohkuma, Toshiaki; Jun, Min; Woodward, Mark; Zoungas, Sophia; Cooper, Mark E; Grobbee, Diederick E; Hamet, Pavel; Mancia, Giuseppe; Williams, Bryan; Welsh, Paul; Sattar, Naveed; Shaw, Jonathan E.; Rahimi, Kazem; Chalmers, John

    OBJECTIVE: This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes.

  6. Kinin B1 receptor blockade and ACE inhibition attenuate cardiac postinfarction remodeling and heart failure in rats

    International Nuclear Information System (INIS)

    Lin, Xinchun; Bernloehr, Christian; Hildebrandt, Tobias; Stadler, Florian J.; Doods, Henri; Wu, Dongmei

    2016-01-01

    Introduction: The aim of the present study was to evaluate the effects of the novel kinin B1 receptor antagonist BI113823 on postinfarction cardiac remodeling and heart failure, and to determine whether B1 receptor blockade alters the cardiovascular effects of an angiotensin 1 converting enzyme (ACE) inhibitor in rats. Methods and results: Sprague Dawley rats were subjected to permanent occlusion of the left coronary artery. Cardiovascular function was determined at 6 weeks postinfarction. Treatment with either B1 receptor antagonist (BI113823) or an ACE inhibitor (lisinopril) alone or in combination significantly reduced the heart weight-to-body weight and lung weight-to-body weight ratios, and improved postinfarction cardiac function as evidenced by greater cardiac output, the maximum rate of left ventricular pressure rise (± dP/dtmax), left ventricle ejection fraction, fractional shorting, better wall motion, and attenuation of elevated left ventricular end diastolic pressure (LVEDP). Furthermore, all three treatment groups exhibited significant reduction in cardiac interstitial fibrosis, collagen deposition, CD68 positive macrophages, neutrophils, and proinflammatory cytokine production (TNF-α and IL-1β), compared to vehicle controls. Conclusion: The present study shows that treatment with the novel kinin B1 receptor antagonist, BI113823, reduces postinfarction cardiac remodeling and heart failure, and does not influence the cardiovascular effects of the ACE inhibitor. - Highlights: • We examined the role of kinin B1 receptors in the development of heart failure. • Kinin B1 receptor blockade attenuates post-infarction cardiac remodeling. • Kinin B1 receptor blockade improves dysfunction, and prevented heart failure. • B1 receptor blockade does not affect the cardio-protection of an ACE inhibitor.

  7. Kinin B1 receptor blockade and ACE inhibition attenuate cardiac postinfarction remodeling and heart failure in rats

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Xinchun [Department of Research, Mount Sinai Medical Center, Miami Beach, FL 33140 (United States); Bernloehr, Christian; Hildebrandt, Tobias [Boehringer Ingelheim Pharma GmbH & Co.KG, Biberach (Germany); Stadler, Florian J., E-mail: fjstadler@szu.edu.cn [Shenzhen Engineering Laboratory for Advanced Technology of Ceramics, Shenzhen 518060 (China); Doods, Henri [Boehringer Ingelheim Pharma GmbH & Co.KG, Biberach (Germany); Wu, Dongmei, E-mail: dongmeiwu@bellsouth.net [Department of Research, Mount Sinai Medical Center, Miami Beach, FL 33140 (United States); Department of BIN Convergence Technology, Chonbuk National University (Korea, Republic of)

    2016-08-15

    Introduction: The aim of the present study was to evaluate the effects of the novel kinin B1 receptor antagonist BI113823 on postinfarction cardiac remodeling and heart failure, and to determine whether B1 receptor blockade alters the cardiovascular effects of an angiotensin 1 converting enzyme (ACE) inhibitor in rats. Methods and results: Sprague Dawley rats were subjected to permanent occlusion of the left coronary artery. Cardiovascular function was determined at 6 weeks postinfarction. Treatment with either B1 receptor antagonist (BI113823) or an ACE inhibitor (lisinopril) alone or in combination significantly reduced the heart weight-to-body weight and lung weight-to-body weight ratios, and improved postinfarction cardiac function as evidenced by greater cardiac output, the maximum rate of left ventricular pressure rise (± dP/dtmax), left ventricle ejection fraction, fractional shorting, better wall motion, and attenuation of elevated left ventricular end diastolic pressure (LVEDP). Furthermore, all three treatment groups exhibited significant reduction in cardiac interstitial fibrosis, collagen deposition, CD68 positive macrophages, neutrophils, and proinflammatory cytokine production (TNF-α and IL-1β), compared to vehicle controls. Conclusion: The present study shows that treatment with the novel kinin B1 receptor antagonist, BI113823, reduces postinfarction cardiac remodeling and heart failure, and does not influence the cardiovascular effects of the ACE inhibitor. - Highlights: • We examined the role of kinin B1 receptors in the development of heart failure. • Kinin B1 receptor blockade attenuates post-infarction cardiac remodeling. • Kinin B1 receptor blockade improves dysfunction, and prevented heart failure. • B1 receptor blockade does not affect the cardio-protection of an ACE inhibitor.

  8. Imaging of non-cardiac, non-traumatic causes of acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

    2012-12-15

    Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

  9. Myopic loss aversion: Potential causes of replication failures

    Directory of Open Access Journals (Sweden)

    Alexander Klos

    2013-09-01

    Full Text Available This paper presents two studies on narrow bracketing and myopic loss aversion. The first study shows that the tendency to segregate multiple gambles is eliminated if subjects face a certainty equivalent or a probability equivalent task instead of a binary choice. The second study argues that the behavioral differences previously attributed entirely to myopic loss aversion are partly because long-term return properties are simply easier to grasp if the return information is already provided in the form of long-term returns rather than one-year returns. Both results may be related to recent failures to replicate myopic loss aversion. When the choice situation is structured in such a way that it draws respondents' attention to the final outcome distribution and/or if severe misestimations of long-term returns based on short-term return information are unlikely, behavioral differences consistent with myopic loss aversion are less likely to be observed.

  10. Accessory papillary muscles and papillary muscle hypertrophy are associated with sudden cardiac arrest of unknown cause.

    Science.gov (United States)

    Uhm, Jae-Sun; Youn, Jong-Chan; Lee, Hye-Jeong; Park, Junbeom; Park, Jin-Kyu; Shim, Chi Young; Hong, Geu-Ru; Joung, Boyoung; Pak, Hui-Nam; Lee, Moon-Hyoung

    2015-10-15

    The present study was performed for elucidating the associations between the morphology of the papillary muscles (PMs) and sudden cardiac arrest (SCA). We retrospectively reviewed history, laboratory data, electrocardiography, echocardiography, coronary angiography, and cardiac CT/MRI for 190 patients with SCA. The prevalence of accessory PMs and PM hypertrophy in patients with SCA of unknown cause was compared with that in patients with SCA of known causes and 98 age- and sex-matched patients without SCA. An accessory PM was defined as a PM with origins separated from the anterolateral and posteromedial PMs, or a PM that branched into two or three bellies at the base of the anterolateral or posteromedial PM. PM hypertrophy was defined as at least one of the two PMs having a diameter of ≥1.1cm. In 49 patients (age 49.9±15.9years; 38 men) the cause of SCA was unknown, whereas 141 (age 54.2±16.6years; 121 men) had a known cause. The prevalence of accessory PMs was significantly higher in the unknown-cause group than in the known-cause group (24.5% and 7.8%, respectively; p=0.002) or the no-SCA group (7.1%, p=0.003). The same was true for PM hypertrophy (unknown-cause 12.2%, known-cause 2.1%, p=0.010; no SCA group 1.0%, p=0.006). By logistic regression, accessory PM and PM hypertrophy were independently associated with sudden cardiac arrest of unknown cause. An accessory PM and PM hypertrophy are associated with SCA of unknown cause. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. A hybrid of fuzzy FMEA-AHP to determine factors affecting alternator failure causes

    Directory of Open Access Journals (Sweden)

    Reza Kiani Aslani

    2014-09-01

    Full Text Available This paper presents a method to determine factors influencing alternator failure causes. Failure Mode and Effects Analysis (FMEA is one of the first systematic techniques for failure analysis based on three factors including Probability (P, Severity (S and Detection (D. Traditional FMEA method considers equal weights for all three factors, however, in read-world cases; one may wish to consider various weights. The proposed study develops a mathematical model to determine optimal weights based on analytical hierarchy process technique. The implementation of the proposed study has been demonstrated for a read-world case study of alternator failure causes.

  12. Apocynin improving cardiac remodeling in chronic renal failure disease is associated with up-regulation of epoxyeicosatrienoic acids.

    Science.gov (United States)

    Zhang, Kun; Liu, Yu; Liu, Xiaoqiang; Chen, Jie; Cai, Qingqing; Wang, Jingfeng; Huang, Hui

    2015-09-22

    Cardiac remodeling is one of the most common cardiac abnormalities and associated with a high mortality in chronic renal failure (CRF) patients. Apocynin, a nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase inhibitor, has been showed cardio-protective effects. However, whether apocynin can improve cardiac remodeling in CRF and what is the underlying mechanism are unclear. In the present study, we enrolled 94 participants. In addition, we used 5/6 nephrectomized rats to mimic cardiac remodeling in CRF. Serum levels of epoxyeicosatrienoic acids (EETs) and its mainly metabolic enzyme-soluble epoxide hydrolase (sEH) were measured. The results showed that the serum levels of EETs were significantly decreased in renocardiac syndrome participants (P < 0.05). In 5/6 nephrectomized CRF model, the ratio of left ventricular weight / body weight, left ventricular posterior wall thickness, and cardiac interstitial fibrosis were significantly increased while ejection fraction significantly decreased (P < 0.05). All these effects could partly be reversed by apocynin. Meanwhile, we found during the process of cardiac remodeling in CRF, apocynin significantly increased the reduced serum levels of EETs and decreased the mRNA and protein expressions of sEH in the heart (P < 0.05). Our findings indicated that the protective effect of apocynin on cardiac remodeling in CRF was associated with the up-regulation of EETs. EETs may be a new mediator for the injury of kidney-heart interactions.

  13. Apocynin improving cardiac remodeling in chronic renal failure disease is associated with up-regulation of epoxyeicosatrienoic acids

    Science.gov (United States)

    Chen, Jie; Cai, Qingqing; Wang, Jingfeng; Huang, Hui

    2015-01-01

    Cardiac remodeling is one of the most common cardiac abnormalities and associated with a high mortality in chronic renal failure (CRF) patients. Apocynin, a nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase inhibitor, has been showed cardio-protective effects. However, whether apocynin can improve cardiac remodeling in CRF and what is the underlying mechanism are unclear. In the present study, we enrolled 94 participants. In addition, we used 5/6 nephrectomized rats to mimic cardiac remodeling in CRF. Serum levels of epoxyeicosatrienoic acids (EETs) and its mainly metabolic enzyme-soluble epoxide hydrolase (sEH) were measured. The results showed that the serum levels of EETs were significantly decreased in renocardiac syndrome participants (P < 0.05). In 5/6 nephrectomized CRF model, the ratio of left ventricular weight /body weight, left ventricular posterior wall thickness, and cardiac interstitial fibrosis were significantly increased while ejection fraction significantly decreased (P < 0.05). All these effects could partly be reversed by apocynin. Meanwhile, we found during the process of cardiac remodeling in CRF, apocynin significantly increased the reduced serum levels of EETs and decreased the mRNA and protein expressions of sEH in the heart (P < 0.05). Our findings indicated that the protective effect of apocynin on cardiac remodeling in CRF was associated with the up-regulation of EETs. EETs may be a new mediator for the injury of kidney-heart interactions. PMID:26322503

  14. A multiple shock model for common cause failures using discrete Markov chain

    International Nuclear Information System (INIS)

    Chung, Dae Wook; Kang, Chang Soon

    1992-01-01

    The most widely used models in common cause analysis are (single) shock models such as the BFR, and the MFR. But, single shock model can not treat the individual common cause separately and has some irrational assumptions. Multiple shock model for common cause failures is developed using Markov chain theory. This model treats each common cause shock as separately and sequently occuring event to implicate the change in failure probability distribution due to each common cause shock. The final failure probability distribution is evaluated and compared with that from the BFR model. The results show that multiple shock model which minimizes the assumptions in the BFR model is more realistic and conservative than the BFR model. The further work for application is the estimations of parameters such as common cause shock rate and component failure probability given a shock,p, through the data analysis

  15. Emergency room thoracotomy for acute traumatic cardiac tamponade caused by a blunt cardiac injury: A case report

    Directory of Open Access Journals (Sweden)

    Kenichiro Ishida

    2017-01-01

    Conclusion: A prompt diagnosis using FAST and treatment can be lifesaving in traumatic acute cardiac tamponade. A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space.

  16. Image-guided left ventricular lead placement in cardiac resynchronization therapy for patients with heart failure: a meta-analysis.

    Science.gov (United States)

    Jin, Yan; Zhang, Qi; Mao, Jia-Liang; He, Ben

    2015-05-10

    Heart failure (HF) is a debilitating condition that affects millions of people worldwide. One means of treating HF is cardiac resynchronization therapy (CRT). Recently, several studies have examined the use of echocardiography (ECHO) in the optimization of left ventricular (LV) lead placement to increase the response to CRT. The objective of this study was to synthesize the available data on the comparative efficacy of image-guided and standard CRT. We searched the PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014 with the following combinations of search terms: left ventricular lead placement, cardiac resynchronization therapy, image-guided, and echocardiography-guided. Studies meeting all of the inclusion criteria and none of the exclusion criteria were eligible for inclusion. The primary outcome measures were CRT response rate, change in LV ejection fraction (LVEF), and change in LV end systolic volume (LVESV). Secondary outcomes included the rates of all-cause mortality and HF-related hospitalization. Our search identified 103 articles, 3 of which were included in the analysis. In total, 270 patients were randomized to the image-guided CRT and 241, to the standard CRT. The pooled estimates showed a significant benefit for image-guided CRT (CRT response: OR, 2.098, 95 % CI, 1.432-3.072; LVEF: difference in means, 3.457, 95 % CI, 1.910-5.005; LVESV: difference in means, -20.36, 95 % CI, -27.819 - -12.902). Image-guided CRT produced significantly better clinical outcomes than the standard CRT. Additional trials are warranted to validate the use of imaging in the prospective optimization of CRT.

  17. Diencephalic syndrome: a rare cause of failure to thrive.

    Science.gov (United States)

    Tosur, Mustafa; Tomsa, Anca; Paul, David L

    2017-07-06

    Timely diagnosis of diencephalic syndrome is not often the case for patients presenting with failure to thrive (FTT) because of its rarity and lack of specific symptoms. Herein, we report two cases of diencephalic syndrome (2-year-old girl and 10-month-old boy) presenting with severe emaciation. Both patients had histories of poor weight gain for months despite having good appetites prior to diagnosis. Initial work-up did not reveal the diagnosis. Horizontal nystagmus was noted in both patients: by a neurologist in the first patient and by a family member in the second patient. MRI of the brain showed large suprasellar mass and pilocytic astrocytoma was confirmed by pathology in each case. The patients were started on appropriate chemotherapy with interval improvements in weight gain. These cases illustrate the importance of cranial imaging and consideration of diencephalic syndrome for children presenting with FTT despite normal or increased caloric intake. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Estimation of common cause failure parameters with periodic tests

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Anne [Institut Charles Delaunay - Universite de technologie de Troyes - FRE CNRS 2848, 12, rue Marie Curie - BP 2060 -10010 Troyes cedex (France)], E-mail: anne.barros@utt.fr; Grall, Antoine [Institut Charles Delaunay - Universite de technologie de Troyes - FRE CNRS 2848, 12, rue Marie Curie - BP 2060 -10010 Troyes cedex (France); Vasseur, Dominique [Electricite de France, EDF R and D - Industrial Risk Management Department 1, av. du General de Gaulle- 92141 Clamart (France)

    2009-04-15

    In the specific case of safety systems, CCF parameters estimators for standby components depend on the periodic test schemes. Classically, the testing schemes are either staggered (alternation of tests on redundant components) or non-staggered (all components are tested at the same time). In reality, periodic tests schemes performed on safety components are more complex and combine staggered tests, when the plant is in operation, to non-staggered tests during maintenance and refueling outage periods of the installation. Moreover, the CCF parameters estimators described in the US literature are derived in a consistent way with US Technical Specifications constraints that do not apply on the French Nuclear Power Plants for staggered tests on standby components. Given these issues, the evaluation of CCF parameters from the operating feedback data available within EDF implies the development of methodologies that integrate the testing schemes specificities. This paper aims to formally propose a solution for the estimation of CCF parameters given two distinct difficulties respectively related to a mixed testing scheme and to the consistency with EDF's specific practices inducing systematic non-simultaneity of the observed failures in a staggered testing scheme.

  19. Fuel failure in water reactors: Causes and mitigation. Proceedings of a technical meeting

    International Nuclear Information System (INIS)

    2003-03-01

    The objective of this technical meeting (TM) was to review the present knowledge of the causes and mechanisms of fuel failure in water reactors during normal operational conditions. Emphasis has been given to analysis of failure causes and their mitigation by means of design as well as plant and core operation including strategies for operation with failed fuel. Some information on detection techniques (on-line monitoring and diagnostics, flux tilting, sipping techniques, etc) has also been presented. This TM presented also the progress on the above-mentioned subjects since the last meeting held in 1992 (Dimitrovgrad, Russian Federation). The topics covered in the papers were as follows: Experience feedback on fuel reliability (8 papers); Strategies to avoid or mitigate fuel failures (4 papers); Experimental studies on fuel failures and degradation mechanisms (4 papers); Modelling of fuel failure mechanisms (3 papers); Detection and monitoring during operation or outage (4 papers); Modelling and assessment of fuel failures (3 papers)

  20. Procedures for treating common cause failures in safety and reliability studies: Procedural framework and examples

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1988-01-01

    This report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that cutset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework comprises four major stages: (1) System Logic Model Development; (2) Identification of Common Cause Component Groups; (3) Common Cause Modeling and Data Analysis; and (4) System Quantification and Interpretation of Results. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. 22 figs., 34 tabs

  1. Symptoms and causes : gender effects and institutional failures.

    OpenAIRE

    Hashimzade, N.; Vershinina, N.

    2017-01-01

    The existence and causes of gender gaps in pay and in occupational choice have been increasingly at the centre of research in economics, sociology, psychology, managerial science, and other fields. The research findings across countries and over time generally suggest that gaps exist and are significant, indicating that gender inequality remains persistent in many areas, even in the developed Western democracies. Forcefully closing the gaps directly, however, may not be sufficient in the long...

  2. (m, M) Machining system with two unreliable servers, mixed spares and common-cause failure

    OpenAIRE

    Jain, Madhu; Mittal, Ragini; Kumari, Rekha

    2015-01-01

    This paper deals with multi-component machine repair model having provision of warm standby units and repair facility consisting of two heterogeneous servers (primary and secondary) to provide repair to the failed units. The failure of operating and standby units may occur individually or due to some common cause. The primary server may fail partially following full failure whereas secondary server faces complete failure only. The life times of servers and operating/standby units and their re...

  3. Impact of exercise rehabilitation on cardiac neuronal function in heart failure. An iodine-123 metaiodobenzylguanidine scintigraphy study

    International Nuclear Information System (INIS)

    Agostini, D.; Bouvard, G.; Lecluse, E.; Grollier, G.; Potier, J.C.; Belin, A.; Babatasi, G.; Amar, M.H.

    1998-01-01

    Exercise training can induce important haemodynamic and metabolic adaptations in patients with chronic heart failure due to severe left ventricular dysfunction. This study examined the impact of exercise rehabilitation on cardiac neuronal function using iodine-123 metaiobodenzylguanidine (MIBG) scintigraphy. Fourteen patients (11 men, 3 women; mean age 48 years; range: 36-66 years) with stable chronic heart failure of NYHA class II-III and an initial resting radionuclide left ventricular ejection fraction (LVEF) 123 I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (heart-mediastinum ratio activity, 4 h after intravenous injection of 185 MBq of MIBG). Radionuclide LVEF was also assessed at the outset and after 6 months of exercise training. Workload (801±428 vs 1229±245 kpm.min -1 , P=0.001), exercise duration (504±190 vs 649±125 s, P=0.02), and myocardial MIBG uptake (135%±19% vs 156%±25%, P=0.02) increased significantly after rehabilitation. However, LVEF did not change significantly (23%±9% vs 21%±10%, p=NS). It is concluded that exercise rehabilitation induces improvement of cardiac neuronal function without having negative effects on cardiac contractility in patients with stable chronic heart failure. (orig.)

  4. Nutritional leucine supplementation attenuates cardiac failure in tumour-bearing cachectic animals.

    Science.gov (United States)

    Toneto, Aline Tatiane; Ferreira Ramos, Luiz Alberto; Salomão, Emilianne Miguel; Tomasin, Rebeka; Aereas, Miguel Arcanjo; Gomes-Marcondes, Maria Cristina Cintra

    2016-12-01

    The condition known as cachexia presents in most patients with malignant tumours, leading to a poor quality of life and premature death. Although the cancer-cachexia state primarily affects skeletal muscle, possible damage in the cardiac muscle remains to be better characterized and elucidated. Leucine, which is a branched chain amino acid, is very useful for preserving lean body mass. Thus, this amino acid has been studied as a coadjuvant therapy in cachectic cancer patients, but whether this treatment attenuates the effects of cachexia and improves cardiac function remains poorly understood. Therefore, using an experimental cancer-cachexia model, we evaluated whether leucine supplementation ameliorates cachexia in the heart. Male Wistar rats were fed either a leucine-rich or a normoprotein diet and implanted or not with subcutaneous Walker-256 carcinoma. During the cachectic stage (approximately 21 days after tumour implantation), when the tumour mass was greater than 10% of body weight, the rats were subjected to an electrocardiogram analysis to evaluate the heart rate, QT-c, and T wave amplitude. The myocardial tissues were assayed for proteolytic enzymes (chymotrypsin, alkaline phosphatase, cathepsin, and calpain), cardiomyopathy biomarkers (myeloperoxidase, tissue inhibitor of metalloproteinases, and total plasminogen activator inhibitor 1), and caspase-8, -9, -3, and -7 activity. Both groups of tumour-bearing rats, especially the untreated group, had electrocardiography alterations that were suggestive of ischemia, dilated cardiomyopathy, and sudden death risk. Additionally, the rats in the untreated tumour-bearing group but not their leucine-supplemented littermates exhibited remarkable increases in chymotrypsin activity and all three heart failure biomarkers analysed, including an increase in caspase-3 and -7 activity. Our data suggest that a leucine-rich diet could modulate heart damage, cardiomyocyte proteolysis, and apoptosis driven by cancer

  5. Cardiac Organ Damage and Arterial Stiffness in Autonomic Failure: Comparison With Essential Hypertension.

    Science.gov (United States)

    Milazzo, Valeria; Maule, Simona; Di Stefano, Cristina; Tosello, Francesco; Totaro, Silvia; Veglio, Franco; Milan, Alberto

    2015-12-01

    Autonomic failure (AF) is characterized by orthostatic hypotension, supine hypertension, and increased blood pressure (BP) variability. AF patients develop cardiac organ damage, similarly to essential hypertension (EH), and have higher arterial stiffness than healthy controls. Determinants of cardiovascular organ damage in AF are not well known: both BP variability and mean BP values may be involved. The aim of the study was to evaluate cardiac organ damage, arterial stiffness, and central hemodynamics in AF, compared with EH subjects with similar 24-hour BP and a group of healthy controls, and to evaluate determinants of target organ damage in patients with AF. Twenty-seven patients with primary AF were studied (mean age, 65.7±11.2 years) using transthoracic echocardiography, carotid-femoral pulse wave velocity, central hemodynamics, and 24-hour ambulatory BP monitoring. They were compared with 27 EH subjects matched for age, sex, and 24-hour mean BP and with 27 healthy controls. AF and EH had similar left ventricular mass (101.6±33.3 versus 97.7±28.1 g/m(2), P=0.59) and carotid-femoral pulse wave velocity (9.3±1.8 versus 9.2±3.0 m/s, P=0.93); both parameters were significantly lower in healthy controls (Phypertensive heart disease and increased arterial stiffness, similar to EH with comparable mean BP values. Twenty-four-hour and nighttime systolic BP were determinants of cardiovascular damage, independent of BP variability. © 2015 American Heart Association, Inc.

  6. Congenital and hereditary causes of sudden cardiac death in young adults: diagnosis, differential diagnosis, and risk stratification.

    Science.gov (United States)

    Stojanovska, Jadranka; Garg, Anubhav; Patel, Smita; Melville, David M; Kazerooni, Ella A; Mueller, Gisela C

    2013-01-01

    Sudden cardiac death is defined as death from unexpected circulatory arrest-usually a result of cardiac arrhythmia-that occurs within 1 hour of the onset of symptoms. Proper and timely identification of individuals at risk for sudden cardiac death and the diagnosis of its predisposing conditions are vital. A careful history and physical examination, in addition to electrocardiography and cardiac imaging, are essential to identify conditions associated with sudden cardiac death. Among young adults (18-35 years), sudden cardiac death most commonly results from a previously undiagnosed congenital or hereditary condition, such as coronary artery anomalies and inherited cardiomyopathies (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy [ARVC], dilated cardiomyopathy, and noncompaction cardiomyopathy). Overall, the most common causes of sudden cardiac death in young adults are, in descending order of frequency, hypertrophic cardiomyopathy, coronary artery anomalies with an interarterial or intramural course, and ARVC. Often, sudden cardiac death is precipitated by ventricular tachycardia or fibrillation and may be prevented with an implantable cardioverter defibrillator (ICD). Risk stratification to determine the need for an ICD is challenging and involves imaging, particularly echocardiography and cardiac magnetic resonance (MR) imaging. Coronary artery anomalies, a diverse group of congenital disorders with a variable manifestation, may be depicted at coronary computed tomographic angiography or MR angiography. A thorough understanding of clinical risk stratification, imaging features, and complementary diagnostic tools for the evaluation of cardiac disorders that may lead to sudden cardiac death is essential to effectively use imaging to guide diagnosis and therapy.

  7. Star fruit (Averrhoa carambola) intoxication: an important cause of consciousness disturbance in patients with renal failure.

    Science.gov (United States)

    Chang, Chin-Tung; Chen, Yung-Chang; Fang, Ji-Tseng; Huang, Chiu-Ching

    2002-05-01

    Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. Most cases in the literature are uremic patients on maintenance dialysis. We present a patient with chronic renal failure, who was not on dialysis program yet, suffered from star fruit intoxication with presentation of consciousness disturbance and successfully managed by a session of hemodialysis.

  8. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon

    Directory of Open Access Journals (Sweden)

    Tantchou Tchoumi Jacques Cabral

    2011-02-01

    Full Text Available INTRODUCTION: The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. METHODS: Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. RESULTS: The results showed that the occurrence of congestive heart failure in our centre was 5,7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5, plus or minus 18 years old. Post rheumatic valvulopathies (14.6% and congenital heart diseases (1.9% were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8,3% in elderly followed by hypertensive cardiomyopathy (4.4%. Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6% and Cor pulmonale (8% were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days, the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. CONCLUSION: Our data show a high incidence of congestive heart failure mainly due to post

  9. Identifying potential functional impact of mutations and polymorphisms: Linking heart failure, increased risk of arrhythmias and sudden cardiac death.

    Directory of Open Access Journals (Sweden)

    BENOIT eJAGU

    2013-09-01

    Full Text Available Researchers and clinicians have discovered several important concepts regarding the mechanisms responsible for increased risk of arrhythmias, heart failure and sudden cardiac death. One major step in defining the molecular basis of normal and abnormal cardiac electrical behaviour has been the identification of single mutations that greatly increase the risk for arrhythmias and sudden cardiac death by changing channel-gating characteristics. Indeed, mutations in several genes encoding ion channels, such as SCN5A, which encodes the major cardiac Na+ channel, have emerged as the basis for a variety of inherited cardiac arrhythmias such as long QT syndrome, Brugada syndrome, progressive cardiac conduction disorder, sinus node dysfunction or sudden infant death syndrome. In addition, genes encoding ion channel accessory proteins, like anchoring or chaperone proteins, which modify the expression, the regulation of endocytosis and the degradation of ion channel α-subunits have also been reported as susceptibility genes for arrhythmic syndromes. The regulation of ion channel protein expression also depends on a fine-tuned balance among different other mechanisms, such as gene transcription, RNA processing, post-transcriptional control of gene expression by miRNA, protein synthesis, assembly and post-translational modification and trafficking.

  10. The Major Causes for the Failure of Knowledge Management

    International Nuclear Information System (INIS)

    Prusak, L.

    2016-01-01

    Full text: It is a well-known but disheartening fact that many knowledge management projects either fail outright or do not live up to the expected promises of working with knowledge. Some of the causes of these failed attempts are easy to understand: Macroeconomic changes that can constrain an organization’s new project funding; change of ownership or senior management with new ideas and disdain of older projects, and several other forces out of the control of KM managers. However in my experience there are other sources for these failed attempts that are not too difficult to avoid and can make a huge difference in the sustainability and value of knowledge and learning projects. This talk will focus on these—fully aware that there are other disarming factors at work. (author

  11. The China Patient-centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective heart failure study design.

    Science.gov (United States)

    Yu, Yuan; Zhang, Hongzhao; Li, Xi; Lu, Yuan; Masoudi, Frederick A; Krumholz, Harlan M; Li, Jing

    2018-05-10

    Heart failure (HF) is a leading cause of hospitalisation in China, which is experiencing a rapid increase in cardiovascular disease prevalence. Yet, little is known about current burden of disease, quality of care and treatment outcomes of HF in China. The objective of this paper is to describe the study methodology, data collection and abstraction, and progress to date of the China Patient-centered Evaluative Assessment of Cardiac Events 5 Retrospective Heart Failure Study (China PEACE 5r-HF). The China PEACE 5r-HF Study will examine a nationally representative sample of more than 10 000 patient records hospitalised for HF in 2015 in China. The study is a retrospective cohort study. Patients have been selected using a two-stage sampling design stratified by economic-geographical regions. We will collect patient characteristics, diagnostic testing, treatments and in-hospital outcomes, including death and complications, and charges of hospitalisation. Data quality will be monitored by a central coordinating centre and will address case ascertainment, data abstraction and data management. As of October 2017, we have sampled 15 538 medical records from 189 hospitals, and have received 15 057 (96.9%) of these for data collection, and completed data abstraction and quality control on 7971. The Central Ethics Committee at the Chinese National Center for Cardiovascular Diseases approved the study. All collaborating hospitals accepted central ethics committee approval with the exception of 15 hospitals, which obtained local approval by internal ethics committees. Findings will be disseminated in future peer-reviewed papers and will serve as a foundation for improving the care for HF in China. NCT02877914. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. DRESS syndrome secondary to ibuprofen as a cause of hyperacute liver failure

    Directory of Open Access Journals (Sweden)

    Valentín Roales-Gómez

    2014-08-01

    Full Text Available Acute liver failure has a high mortality and its most frequent cause in Spain is viral infection. In this article, we present a case of fulminant liver failure. The failure is secondary to an idiosyncratic reaction to ibuprofen, an entity included in the DRESS syndrome. This syndrome plays a key role in the differential diagnosis of acute liver failure, since its unfortunate course often requires liver transplantation as the only useful therapeutic weapon. This case illustrates the need for an efficient coordination between hospitals as a key factor for improving the prognosis.

  13. Failures in outdoor insulation caused by bird excrement

    Energy Technology Data Exchange (ETDEWEB)

    Montoya Tena, Gerardo; Hernandez C., Ramiro [Instituto de Investigaciones Electricas, Reforma 113, Col. Palmira, C.P. 62490 Cuernavaca, Mor. (Mexico); Montoya T., Jorge I. [Universidad Politecnica del Valle de Toluca, Toluca Edomex (Mexico)

    2010-06-15

    The bird excrement, combined with humidity, causes line outages in transmission lines. In order to standardize the criteria to solve the problem, a research project was developed in Mexico. The solutions found in worldwide review can be classified into four groups: elimination of birds, devices of dissuasion, physical barriers, and covering devices. The first group includes all bird elimination techniques. These alternatives are forbidden in Mexico, and in most of the countries. The second group has shown to be effective at the beginning of its application; however once the birds are habituated to the device, it loses its effectiveness. The efficiency of the third group, the use of physical barriers, is high, as demonstrated by more than a few review reports informing drastic reductions of flashovers on the transmission lines where they have been installed. The fourth group is conformed by components whose function is to protect or to cover the insulation. According to the experience in Mexico, covering devices have shown to be very effective. The contamination by bird excrement has not a unique solution. The most viable solution is a combination of alternatives. Even though, a solution adopted for a region may not be suitable for another region. Therefore, each case should be approached according to the particular conditions of the region. (author)

  14. [Sudden Cardiac Death of Young Persons: Risk Factors, Causes, Morphological Equivalents].

    Science.gov (United States)

    Shilova, M A; Mamedov, M N

    2015-01-01

    The article contains literature review on the problem of causes of sudden cardiac death (SCD) among young people as well as results of author's own retrospective study of deaths of persons before 39 years based on forensic autopsies performed during 10 year period. The study of structure and dynamics of causes of death, its risk factors and the role of connective tissue dysplasia in development of terminal symptomocomlexes allowed to establish that main mechanism of SCD in young people was arrhythmogenic developing as a response to provoking factors--physical effort, psychoemotional stress, consumption of light alcoholic beverages.

  15. Emergency cricothyrotomy for trismus caused by instantaneous rigor in cardiac arrest patients.

    Science.gov (United States)

    Lee, Jae Hee; Jung, Koo Young

    2012-07-01

    Instantaneous rigor as muscle stiffening occurring in the moment of death (or cardiac arrest) can be confused with rigor mortis. If trismus is caused by instantaneous rigor, orotracheal intubation is impossible and a surgical airway should be secured. Here, we report 2 patients who had emergency cricothyrotomy for trismus caused by instantaneous rigor. This case report aims to help physicians understand instantaneous rigor and to emphasize the importance of securing a surgical airway quickly on the occurrence of trismus. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Reliability-based failure cause assessment of collapsed bridge during construction

    International Nuclear Information System (INIS)

    Choi, Hyun-Ho; Lee, Sang-Yoon; Choi, Il-Yoon; Cho, Hyo-Nam; Mahadevan, Sankaran

    2006-01-01

    Until now, in many forensic reports, the failure cause assessments are usually carried out by a deterministic approach so far. However, it may be possible for the forensic investigation to lead to unreasonable results far from the real collapse scenario, because the deterministic approach does not systematically take into account any information on the uncertainties involved in the failures of structures. Reliability-based failure cause assessment (reliability-based forensic engineering) methodology is developed which can incorporate the uncertainties involved in structural failures and structures, and to apply them to the collapsed bridge in order to identify the most critical failure scenario and find the cause that triggered the bridge collapse. Moreover, to save the time and cost of evaluation, an algorithm of automated event tree analysis (ETA) is proposed and possible to automatically calculate the failure probabilities of the failure events and the occurrence probabilities of failure scenarios. Also, for reliability analysis, uncertainties are estimated more reasonably by using the Bayesian approach based on the experimental laboratory testing data in the forensic report. For the applicability, the proposed approach is applied to the Hang-ju Grand Bridge, which collapsed during construction, and compared with deterministic approach

  17. Revision of unicompartmental knee arthroplasty: implants used and causes of failure

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2014-04-01

    Full Text Available OBJECTIVE: to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO in the period between January 1990 and January 2013.METHODS: a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting.RESULTS: in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK.CONCLUSION: in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.

  18. 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

    International Nuclear Information System (INIS)

    Ishida, Yoshio; Shimozu, Junko; Yasumura, Yoshio; Nagatani, Kenzo; Miyatake, Kunio

    1998-01-01

    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 β-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.)

  19. 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)

    1998-02-01

    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.)

  20. Postnatal ablation of Foxm1 from cardiomyocytes causes late onset cardiac hypertrophy and fibrosis without exacerbating pressure overload-induced cardiac remodeling.

    Directory of Open Access Journals (Sweden)

    Craig Bolte

    Full Text Available Heart disease remains a leading cause of morbidity and mortality in the industrialized world. Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and the most common cause of sudden cardiac death. Foxm1 transcription factor (also known as HFH-11B, Trident, Win or MPP2 plays an important role in the pathogenesis of various cancers and is a critical mediator of post-injury repair in multiple organs. Foxm1 has been previously shown to be essential for heart development and proliferation of embryonic cardiomyocytes. However, the role of Foxm1 in postnatal heart development and in cardiac injury has not been evaluated. To delete Foxm1 in postnatal cardiomyocytes, αMHC-Cre/Foxm1(fl/fl mice were generated. Surprisingly, αMHC-Cre/Foxm1(fl/fl mice exhibited normal cardiomyocyte proliferation at postnatal day seven and had no defects in cardiac structure or function but developed cardiac hypertrophy and fibrosis late in life. The development of cardiomyocyte hypertrophy and cardiac fibrosis in aged Foxm1-deficient mice was associated with reduced expression of Hey2, an important regulator of cardiac homeostasis, and increased expression of genes critical for cardiac remodeling, including MMP9, αSMA, fibronectin and vimentin. We also found that following aortic constriction Foxm1 mRNA and protein were induced in cardiomyocytes. However, Foxm1 deletion did not exacerbate cardiac hypertrophy or fibrosis following chronic pressure overload. Our results demonstrate that Foxm1 regulates genes critical for age-induced cardiomyocyte hypertrophy and cardiac fibrosis.

  1. A cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report.

    Science.gov (United States)

    Rao, Dinesh; Sood, Divya; Pathak, P; Dongre, Sudhir D

    2014-01-01

    Incidence of sudden cardiac death (SCD) has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India. The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred. A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127), followed closely by the age group 60-69 (28.43%; n-58). Male to female ratio was around 10:1. The maximum number of deaths (n=78) was within few hours (6 hours) after the onset of signs and symptoms. In 24 (11.8%) cases major narrowing was noted in both the main coronaries, in 87 (42.6%) cases in the left anterior descending coronary artery (LAD), and in 18 (51.5%) cases in the right coronary artery (RCA). The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86%) and myocardial infarction (n-104; 50.9%). most of the SCDs occurred in the place of residence (n-80; 39.2%) followed closely by death in hospital (n-49; 24.01%). Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1.

  2. Spiral wave drift and complex-oscillatory spiral waves caused by heterogeneities in two-dimensional in vitro cardiac tissues

    International Nuclear Information System (INIS)

    Woo, Sung-Jae; Hong, Jin Hee; Kim, Tae Yun; Bae, Byung Wook; Lee, Kyoung J

    2008-01-01

    Understanding spiral reentry wave dynamics in cardiac systems is important since it underlies various cardiac arrhythmia including cardiac fibrillation. Primary cultures of dissociated cardiac cells have been a convenient and useful system for studying cardiac wave dynamics, since one can carry out systematic and quantitative studies with them under well-controlled environments. One key drawback of the dissociated cell culture is that, inevitably, some spatial inhomogeneities in terms of cell types and density, and/or the degree of gap junction connectivity, are introduced to the system during the preparation. These unintentional spatial inhomogeneities can cause some non-trivial wave dynamics, for example, the entrainment dynamics among different spiral waves and the generation of complex-oscillatory spiral waves. The aim of this paper is to quantify these general phenomena in an in vitro cardiac system and provide explanations for them with a simple physiological model having some realistic spatial inhomogeneities incorporated

  3. High intensity interval and endurance training have opposing effects on markers of heart failure and cardiac remodeling in hypertensive rats.

    Science.gov (United States)

    Holloway, Tanya M; Bloemberg, Darin; da Silva, Mayne L; Simpson, Jeremy A; Quadrilatero, Joe; Spriet, Lawrence L

    2015-01-01

    There has been re-emerging interest and significant work dedicated to investigating the metabolic effects of high intensity interval training (HIIT) in recent years. HIIT is considered to be a time efficient alternative to classic endurance training (ET) that elicits similar metabolic responses in skeletal muscle. However, there is a lack of information on the impact of HIIT on cardiac muscle in disease. Therefore, we determined the efficacy of ET and HIIT to alter cardiac muscle characteristics involved in the development of diastolic dysfunction, such as ventricular hypertrophy, fibrosis and angiogenesis, in a well-established rodent model of hypertension-induced heart failure before the development of overt heart failure. ET decreased left ventricle fibrosis by ~40% (P hypertension. However, HIIT promoted a pathological adaptation in the left ventricle in the presence of hypertension, highlighting the need for further research on the widespread effects of HIIT in the presence of disease.

  4. Procedures for treating common cause failures in safety and reliability studies: Analytical background and techniques

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1989-01-01

    Volume I of this report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that subset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. This document, Volume 2, contains a series of appendices that provide additional background and methodological detail on several important topics discussed in Volume I

  5. Patient-reported causes of heart failure in a large European sample

    DEFF Research Database (Denmark)

    Timmermans, Ivy; Denollet, Johan; Pedersen, Susanne S.

    2018-01-01

    ), psychosocial (35%, mainly (work-related) stress), and natural causes (32%, mainly heredity). There were socio-demographic, clinical and psychological group differences between the various categories, and large discrepancies between prevalence of physical risk factors according to medical records and patient...... distress (OR = 1.54, 95% CI = 0.94–2.51, p = 0.09), and behavioral causes and a less threatening view of heart failure (OR = 0.64, 95% CI = 0.40–1.01, p = 0.06). Conclusion: European patients most frequently reported comorbidities, smoking, stress, and heredity as heart failure causes, but their causal......Background: Patients diagnosed with chronic diseases develop perceptions about their disease and its causes, which may influence health behavior and emotional well-being. This is the first study to examine patient-reported causes and their correlates in patients with heart failure. Methods...

  6. Causes and effects of vital instrumentation and control power supply bus failures

    International Nuclear Information System (INIS)

    Muhlheim, M.D.; Murphy, G.A.

    1987-01-01

    This article presents the results of a study in which the objective was to evaluate nuclear power-plant operating experience to identify the causes and the effects of vital instrumentation and control (I and C) power supply bus failures. Vital I and C power is normally provided to essential instrumentation and controls through either vital d-c or a-c power supply systems. The vital d-c power supply system generally provides control power for starting the diesel generators, for operating electrical circuit breakers, and for controlling various logic circuits. The vital d-c power system also supplies vital a-c power through an inverter. The vital a-c power supply system generally feeds the reactor protection system channels, the engineered safety features actuation system channels, and critical instrumentation in the control room. The leading cause of vital bus failures is inverter failures; other causes are human errors, battery charger failures, and miscellaneous failures. The effects of these failures are that the margin of safety can be degraded by (1) denying key information to the operators, (2) inducing plant transients, (3) causing safety injection actuations, and (4) causing the loss of shutdown cooling flow

  7. A pragmatic approach to estimate alpha factors for common cause failure analysis

    International Nuclear Information System (INIS)

    Hassija, Varun; Senthil Kumar, C.; Velusamy, K.

    2014-01-01

    Highlights: • Estimation of coefficients in alpha factor model for common cause analysis. • A derivation of plant specific alpha factors is demonstrated. • We examine sensitivity of common cause contribution to total system failure. • We compare beta factor and alpha factor models for various redundant configurations. • The use of alpha factors is preferable, especially for large redundant systems. - Abstract: Most of the modern technological systems are deployed with high redundancy but still they fail mainly on account of common cause failures (CCF). Various models such as Beta Factor, Multiple Greek Letter, Binomial Failure Rate and Alpha Factor exists for estimation of risk from common cause failures. Amongst all, alpha factor model is considered most suitable for high redundant systems as it arrives at common cause failure probabilities from a set of ratios of failures and the total component failure probability Q T . In the present study, alpha factor model is applied for the assessment of CCF of safety systems deployed at two nuclear power plants. A method to overcome the difficulties in estimation of the coefficients viz., alpha factors in the model, importance of deriving plant specific alpha factors and sensitivity of common cause contribution to the total system failure probability with respect to hazard imposed by various CCF events is highlighted. An approach described in NUREG/CR-5500 is extended in this study to provide more explicit guidance for a statistical approach to derive plant specific coefficients for CCF analysis especially for high redundant systems. The procedure is expected to aid regulators for independent safety assessment

  8. α-Decomposition for estimating parameters in common cause failure modeling based on causal inference

    International Nuclear Information System (INIS)

    Zheng, Xiaoyu; Yamaguchi, Akira; Takata, Takashi

    2013-01-01

    The traditional α-factor model has focused on the occurrence frequencies of common cause failure (CCF) events. Global α-factors in the α-factor model are defined as fractions of failure probability for particular groups of components. However, there are unknown uncertainties in the CCF parameters estimation for the scarcity of available failure data. Joint distributions of CCF parameters are actually determined by a set of possible causes, which are characterized by CCF-triggering abilities and occurrence frequencies. In the present paper, the process of α-decomposition (Kelly-CCF method) is developed to learn about sources of uncertainty in CCF parameter estimation. Moreover, it aims to evaluate CCF risk significances of different causes, which are named as decomposed α-factors. Firstly, a Hybrid Bayesian Network is adopted to reveal the relationship between potential causes and failures. Secondly, because all potential causes have different occurrence frequencies and abilities to trigger dependent failures or independent failures, a regression model is provided and proved by conditional probability. Global α-factors are expressed by explanatory variables (causes’ occurrence frequencies) and parameters (decomposed α-factors). At last, an example is provided to illustrate the process of hierarchical Bayesian inference for the α-decomposition process. This study shows that the α-decomposition method can integrate failure information from cause, component and system level. It can parameterize the CCF risk significance of possible causes and can update probability distributions of global α-factors. Besides, it can provide a reliable way to evaluate uncertainty sources and reduce the uncertainty in probabilistic risk assessment. It is recommended to build databases including CCF parameters and corresponding causes’ occurrence frequency of each targeted system

  9. Empagliflozin Prevents Worsening of Cardiac Function in an Experimental Model of Pressure Overload-Induced Heart Failure

    Directory of Open Access Journals (Sweden)

    Nikole J. Byrne, BSc

    2017-08-01

    Full Text Available This study sought to determine whether the sodium/glucose cotransporter 2 (SGLT2 inhibitor empagliflozin improved heart failure (HF outcomes in nondiabetic mice. The EMPA-REG OUTCOME (Empagliflozin, Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients trial demonstrated that empagliflozin markedly prevented HF and cardiovascular death in subjects with diabetes. However, despite ongoing clinical trials in HF patients without type 2 diabetes, there are no objective and translational data to support an effect of SGLT2 inhibitors on cardiac structure and function, particularly in the absence of diabetes and in the setting of established HF. Male C57Bl/6 mice were subjected to either sham or transverse aortic constriction surgery to induce HF. Following surgery, mice that progressed to HF received either vehicle or empagliflozin for 2 weeks. Cardiac function was then assessed in vivo using echocardiography and ex vivo using isolated working hearts. Although vehicle-treated HF mice experienced a progressive worsening of cardiac function over the 2-week treatment period, this decline was blunted in empagliflozin-treated HF mice. Treatment allocation to empagliflozin resulted in an improvement in cardiac systolic function, with no significant changes in cardiac remodeling or diastolic dysfunction. Moreover, isolated hearts from HF mice treated with empagliflozin displayed significantly improved ex vivo cardiac function compared to those in vehicle-treated controls. Empagliflozin treatment of nondiabetic mice with established HF blunts the decline in cardiac function both in vivo and ex vivo, independent of diabetes. These data provide important basic and translational clues to support the evaluation of SGLT2 inhibitors as a treatment strategy in a broad range of patients with established HF.

  10. Collections and Analyses of Common Cause Failure Data for the Korea Standard and Westinghouse Type NPPs

    International Nuclear Information System (INIS)

    Kang, Dae Il; Han, S. H.

    2007-04-01

    The analyses of the CCF events for domestic NPPs were performed to establish the domestic database for the CCF events and to deliver supply them to the operation office of the international common cause failure data exchange (ICDE) project. We collected and analyzed the CCF events of emergency diesel generators, centrifugal pumps, motor-operated valves, check valves, circuit breakers for the Korean Standard Type nuclear power plants (NPPs), Yonggwang Units 3 and 4 and Ulchin Units 3 and 4, and the Westinghouse type NPPs, Kori Unit 3 and 4 and Yonggwang Units 1 and 2. First, the components to be collected and analyzed were classified into the common cause component groups (CCCGs) according to the ICDE coding guidelines. Next, the CCF events were identified based on reviews of the component database for the PSA and its related documents, and consultations with NPP staff. Fourteen CCF events were identified. The ratio of the number of CCF events to that of individual failure events was identified as approximately 10 percentages. However, an in depth review of the CCF events showed that most failure severities of them were identified as partial CCF events, which can be interpreted as some component failures within the CCCGs. Root causes of the CCF events were identified as 9 internal part failures, 2 human errors, 2 design deficiencies, 1 procedure inadequacy. It could be concluded that the major root causes of the CCF events were internal piece part failures

  11. Cardiomyopathies as a Cause of Sudden Cardiac Death (SCD in Egypt: Recognition and Preventive Strategies Needed

    Directory of Open Access Journals (Sweden)

    Nora Fnon

    2016-06-01

    Full Text Available This study aimed at evaluating the epidemiological characteristics and pathological features of different types of cardiomyopathies in Egypt, highlighting the role of the forensic pathologist in identifying cases of cardiomyopathies and initiating for their families a possible genetic study aiming at prevention of sudden death. All cases with sudden cardiac death (SCD due to cardiomyopathies during the period from the beginning of January 2010 until the end of December 2014 (5 years were included in this study. All hearts underwent detailed gross and histological examination. Circumstances of death, medical history, and post-mortem pathological findings were thoroughly  investigated. Out of 535 cases of sudden cardiac death, there were 22 cases (4.1% diagnosed as having cardiomyopathies; sudden death was their first presentation. Eighteen cases (81.8% were male, with the 4th decade (11 cases, 50% being the most affected age; severe physical activity and exertion were evident in death circumstances of 14 cases (63.6%; pathological evaluation revealed that hypertrophic cardiomyopathy was the most frequent type, being diagnosed in 10 cases (45%. Cardiomyopathies are an infrequent cause of sudden cardiac death. Most deaths are in children and adults, so cases are of high social impact that demands multidisciplinary research and resources. In all cases of SCD, forensic autopsy should be done. Forensic study is the key to identifying an affected family and the starting point regarding assessing them.

  12. Common cause failure rate estimates for diesel generators in nuclear power plants

    International Nuclear Information System (INIS)

    Steverson, J.A.; Atwood, C.L.

    1982-01-01

    Common cause fault rates for diesel generators in nuclear power plants are estimated, using Licensee Event Reports for the years 1976 through 1978. The binomial failure rate method, used for obtaining the estimates, is briefly explained. Issues discussed include correct classification of common cause events, grouping of the events into homogeneous data subsets, and dealing with plant-to-plant variation

  13. Decreased adrenoceptor stimulation in heart failure rats reduces NGF expression by cardiac parasympathetic neurons

    OpenAIRE

    Hasan, Wohaib; Smith, Peter G

    2013-01-01

    Postganglionic cardiac parasympathetic and sympathetic nerves are physically proximate in atrial cardiac tissue allowing reciprocal inhibition of neurotransmitter release, depending on demands from central cardiovascular centers or reflex pathways. Parasympathetic cardiac ganglion (CG) neurons synthesize and release the sympathetic neurotrophin nerve growth factor (NGF), which may serve to maintain these close connections. In this study we investigated whether NGF synthesis by CG neurons is a...

  14. Investigation into Cause of High Temperature Failure of Boiler Superheater Tube

    Science.gov (United States)

    Ghosh, D.; Ray, S.; Roy, H.; Shukla, A. K.

    2015-04-01

    The failure of the boiler tubes occur due to various reasons like creep, fatigue, corrosion and erosion. This paper highlights a case study of typical premature failure of a final superheater tube of 210 MW thermal power plant boiler. Visual examination, dimensional measurement, chemical analysis, oxide scale thickness measurement, microstructural examination are conducted as part of the investigations. Apart from these investigations, sulfur print, Energy Dispersive spectroscopy (EDS) and X ray diffraction analysis (XRD) are also conducted to ascertain the probable cause of failure of final super heater tube. Finally it has been concluded that the premature failure of the super heater tube can be attributed to the combination of localized high tube metal temperature and loss of metal from the outer surface due to high temperature corrosion. The corrective actions have also been suggested to avoid this type of failure in near future.

  15. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.......To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF....

  16. Intravenous Milrinone Infusion Improves Congestive Heart Failure Caused by Diastolic Dysfunction

    Science.gov (United States)

    Albrecht, Carlos A.; Giesler, Gregory M.; Kar, Biswajit; Hariharan, Ramesh; Delgado, Reynolds M.

    2005-01-01

    Although there have been significant advances in the medical treatment of heart failure patients with impaired systolic function, very little is known about the diagnosis and treatment of diastolic dysfunction. We report the cases of 3 patients in New York Heart Association functional class IV who had echocardiographically documented diastolic dysfunction as the main cause of heart failure. All 3 patients received medical therapy with long-term milrinone infusion. PMID:16107121

  17. Reduced capacity of cardiac efferent sympathetic neurons to release noradrenaline and modify cardiac function in tachycardia-induced canine heart failure.

    Science.gov (United States)

    Cardinal, R; Nadeau, R; Laurent, C; Boudreau, G; Armour, J A

    1996-09-01

    To investigate the capacity of efferent sympathetic neurons to modulate the failing heart, stellate ganglion stimulation was performed in dogs with biventricular heart failure induced by rapid ventricular pacing (240 beats/min) for 4-6 weeks. Less noradrenaline was released from cardiac myoneural junctions into coronary sinus blood in response to left stellate ganglion stimulation in anesthetized failing heart preparations (582 pg/mL, lower and upper 95% confidence intervals of 288 and 1174 pg/mL, n = 19) compared with healthy heart preparations (6391 pg/mL, 95% confidence intervals of 4180 and 9770 pg/mL, n = 14; p < 0.001). There was substantial adrenaline extraction by failing hearts (49 +/- 6%), although it was slightly lower than in healthy heart preparations (65 +/- 9%, p = 0.055). In contrast with healthy heart preparations, no net release of adrenaline occurred during stellate ganglion stimulation in any of the failing heart preparations, and ventricular tissue levels of adrenaline fell below the sensitivity limit of the HPLC technique. In failing heart preparations, maximal electrical stimulation of right or left stellate ganglia resulted in minimal augmentation of left ventricular intramyocardial (17%) and chamber (12%) systolic pressures. These indices were augmented by 145 and 97%, respectively, following exogenous noradrenaline administration. Thus, the cardiac efferent sympathetic neurons' reduced capacity to release noradrenaline and modify cardiac function can contribute to reduction of sympathetic support to the failing heart.

  18. Anti-glomerular basement membrane: A rare cause of renal failure in children

    Directory of Open Access Journals (Sweden)

    Indira Agarwal

    2017-01-01

    Full Text Available Anti-glomerular basement membrane (GBM disease is a rare cause of acute renal failure and known to have bad prognosis regarding renal functions recovery and patient survival specially when diagnosed late and presents with severe renal failure that requires dialysis. We report a case of 11-year-old child with acute renal failure secondary to anti-GBM disease and associated with antineutrophil cytoplasmic antibody-positive vasculitis. He was treated with plasmapheresis, steroids, and cyclophosphamide with recovery of his kidney functions.

  19. Long-term effects as the cause of failure in electronic components

    International Nuclear Information System (INIS)

    Renz, H.; Kreichgauer, H.

    1989-01-01

    After a brief presentation of the utilisation properties of electronic components, their failure rates are discussed with particular reference to the socalled bath-tub curve. The main emphasis is on the construction and manufacture of integrated circuits and the possible types and causes of failure arising from the individual manufacturing stages (layout faults, internal corrosion, masking and etching errors, leakage currents, inadequate heat removal, etc.). A technical insurance assessment is then provided of the long-term failures associated with technological matters. (orig.) [de

  20. Heterogeneous response of cardiac sympathetic function to cardiac resynchronization therapy in heart failure documented by 11[C]-hydroxy-ephedrine and PET/CT

    International Nuclear Information System (INIS)

    Capitanio, Selene; Nanni, Cristina; Marini, Cecilia; Bonfiglioli, Rachele; Martignani, Cristian; Dib, Bassam; Fuccio, Chiara; Boriani, Giuseppe; Picori, Lorena; Boschi, Stefano; Morbelli, Silvia

    2015-01-01

    Introduction: Cardiac resynchronization therapy (CRT) is an accepted treatment in patients with end-stage heart failure. PET permits the absolute quantification of global and regional homogeneity in cardiac sympathetic innervation. We evaluated the variation of cardiac adrenergic activity in patients with idiopathic heart failure (IHF) disease (NYHA III–IV) after CRT using 11 C-hydroxyephedrine (HED) PET/CT. Methods: Ten IHF patients (mean age = 68; range = 55–81; average left ventricular ejection fraction 26 ± 4%) implanted with a resynchronization device underwent three HED PET/CT studies: PET 1 one week after inactive device implantation; PET 2, one week after PET 1 under stimulated rhythm; PET 3, at 3 months under active CRT. A dedicated software (PMOD 3.4 version) was used to estimate global and regional cardiac uptake of HED through 17 segment polar maps. Results: At baseline, HED uptake was heterogeneously distributed throughout the left ventricle with a variation coefficient of 18 ± 5%. This variable markedly decreased after three months CRT (12 ± 5%, p < 0.01). Interestingly, subdividing the 170 myocardial segments (17 segments of each patient multiplied by the number of patients) into two groups, according to the median value of tracer uptake expressed as % of maximal myocardial uptake (76%), we observed a different behaviour depending on baseline innervation: HED uptake significantly increased only in segments with “impaired innervation” (SUV 2.61 ± 0.92 at PET1 and 3.05 ± 1.67 at three months, p < 0.01). Conclusion: As shown by HED PET/CT uptake and distribution, improvement in homogeneity of myocardial neuronal function reflected a selective improvement of tracer uptake in regions with more severe neuronal damage. Advances in Knowledge: These finding supported the presence of a myocardial regional variability in response of cardiac sympathetic system to CRT and a systemic response involving remote tissues with rich adrenergic innervation

  1. Cardiac rehabilitation

    Science.gov (United States)

    ... rehab; Heart failure - cardiac rehab References Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: ... of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  2. American Heart Association’s Life’s Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function

    Science.gov (United States)

    Folsom, Aaron R.; Shah, Amil M.; Lutsey, Pamela L.; Roetker, Nicholas S.; Alonso, Alvaro; Avery, Christy L.; Miedema, Michael D.; Konety, Suma; Chang, Patricia P.; Solomon, Scott D.

    2015-01-01

    BACKGROUND Many people may underappreciate the role of lifestyle in avoiding heart failure. We estimated whether greater adherence in middle age to American Heart Association’s Life’s Simple 7 guidelines -- on smoking, body mass, physical activity, diet, cholesterol, blood pressure, and glucose -- is associated with lower lifetime risk of heart failure and greater preservation of cardiac structure and function in old age. METHODS We studied the population-based Atherosclerosis Risk in Communities Study cohort of 13,462 adults aged 45-64 years in 1987-89. From the 1987-89 risk factor measurements, we created a Life’s Simple 7 score (range 0-14, giving 2 points for ideal, 1 point for intermediate, and 0 points for poor components). We identified 2,218 incident heart failure events using surveillance of hospital discharge and death codes through 2011. In addition, in 4,855 participants free of clinical cardiovascular disease in 2011-13, we performed echocardiography from which we quantified left ventricular hypertrophy and diastolic dysfunction. RESULTS One in four participants (25.5%) developed heart failure through age 85. Yet, this lifetime heart failure risk was 14.4% for those with a middle-age Life’s Simple 7 score of 10-14 (optimal), 26.8% for a score of 5-9 (average), and 48.6% for a score of 0-4 (inadequate). Among those with no clinical cardiovascular event, the prevalence of left ventricular hypertrophy in late life was approximately 40% as common, and diastolic dysfunction was approximately 60% as common, among those with an optimal middle-age Life’s Simple 7 score compared with an inadequate score. CONCLUSIONS Greater achievement of American Heart Association’s Life’s Simple 7 in middle-age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function. PMID:25908393

  3. Dependency Analysis Guidance Nordic/German Working Group on Common Cause Failure analysis. Phase 2, Development of Harmonized Approach and Applications for Common Cause Failure Quantification

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Guenter; Johanson, Gunnar; Lindberg, Sandra; Vaurio, Jussi

    2009-03-15

    The Regulatory Code SSMFS 2008:1 of Swedish Radiation Safety Authority (SSM) includes requirements regarding the performance of probabilistic safety assessments (PSA), as well as PSA activities in general. Therefore, the follow-up of these activities is part of the inspection tasks of SSM. According to the SSMFS 2008:1, the safety analyses shall be based on a systematic identification and evaluation of such events, event sequences and other conditions which may lead to a radiological accident. The research report Nordic/German Working Group on Common cause Failure analysis. Phase 2 project report: Development of Harmonized Approach and Applications for Common Cause Failure Quantification has been developed under a contract with the Nordic PSA Group (NPSAG) and its German counterpart VGB, with the aim to create a common experience base for defence and analysis of dependent failures i.e. Common Cause Failures CCF. Phase 2 in this project if a deepened data analyses of CCF events and a demonstration on how the so called impact vectors can be constructed and on how CCF parameters are estimated. The word Guidance in the report title is used in order to indicate a common methodological guidance accepted by the NPSAG, based on current state of the art concerning the analysis of dependent failures and adapted to conditions relevant for Nordic sites. This will make it possible for the utilities to perform cost effective improvements and analyses. The report presents a common attempt by the authorities and the utilities to create a methodology and experience base for defence and analysis of dependent failures. The performed benchmark application has shown how important the interpretation of base data is to obtain robust CCF data and data analyses results. Good features were found in all benchmark approaches. The obtained experiences and approaches should now be used in harmonised procedures. A next step could be to develop and agree on event and formula driven impact vector

  4. Dependency Analysis Guidance Nordic/German Working Group on Common Cause Failure analysis. Phase 2, Development of Harmonized Approach and Applications for Common Cause Failure Quantification

    International Nuclear Information System (INIS)

    Becker, Guenter; Johanson, Gunnar; Lindberg, Sandra; Vaurio, Jussi

    2009-03-01

    The Regulatory Code SSMFS 2008:1 of Swedish Radiation Safety Authority (SSM) includes requirements regarding the performance of probabilistic safety assessments (PSA), as well as PSA activities in general. Therefore, the follow-up of these activities is part of the inspection tasks of SSM. According to the SSMFS 2008:1, the safety analyses shall be based on a systematic identification and evaluation of such events, event sequences and other conditions which may lead to a radiological accident. The research report Nordic/German Working Group on Common cause Failure analysis. Phase 2 project report: Development of Harmonized Approach and Applications for Common Cause Failure Quantification has been developed under a contract with the Nordic PSA Group (NPSAG) and its German counterpart VGB, with the aim to create a common experience base for defence and analysis of dependent failures i.e. Common Cause Failures CCF. Phase 2 in this project if a deepened data analyses of CCF events and a demonstration on how the so called impact vectors can be constructed and on how CCF parameters are estimated. The word Guidance in the report title is used in order to indicate a common methodological guidance accepted by the NPSAG, based on current state of the art concerning the analysis of dependent failures and adapted to conditions relevant for Nordic sites. This will make it possible for the utilities to perform cost effective improvements and analyses. The report presents a common attempt by the authorities and the utilities to create a methodology and experience base for defence and analysis of dependent failures. The performed benchmark application has shown how important the interpretation of base data is to obtain robust CCF data and data analyses results. Good features were found in all benchmark approaches. The obtained experiences and approaches should now be used in harmonised procedures. A next step could be to develop and agree on event and formula driven impact vector

  5. ICDE project report: collection and analysis of common-cause failure of check valves

    International Nuclear Information System (INIS)

    Theiss, Klaus; Hessel, Philippe; Werner, Wolfgang

    2003-05-01

    This report documents a study performed on the set of Common Cause Failure (CCF) events of Check Valves (CVs). The events studied here were derived from the International CCF Data Exchange (ICDE) database. Organizations from Canada, Finland, France, Germany, Netherlands, Sweden, Switzerland and the United States contributed with data to this data exchange. This study examines 94 CCF events of CVs reported in the ICDE database by tabulating the data and observing trends. The database contains general information about event attributes like root cause, coupling factor, detection method and corrective action taken. As part of this study, most of these events were reviewed in more detail and characterized by failure cause and failure symptom categories. The study itself begins with an overview of the entire data set in chapter 5. Charts are provided for each of the above-mentioned event attributes. This chapter forms the baseline for chapter 6. The intention of chapter 6 is to give the reader a deeper qualitative insight in the database content beyond that obtained from using the event coding only. Chapter 7 contains the summary of the study results and the conclusions derived from. Approximately 8% of all ICDE events of CVs were complete CCFs (all redundant components had failed). The number of partial CCF events (at least two of the redundant components failed) accounted for 24%. In the remaining 68% of the ICDE events, less than two components had failed completely, and the other components of the observed group only suffered from small defects, incipient degradation or were not affected at all. However, it was found that for more than 75% of the ICDE events the causal factors had a high probability to be shared by all the redundant components. 88 of the 94 reported ICDE events were reviewed in some more detail in Section 6 of this report with respect to failure causes, failure symptoms and failure mechanism. All events classified with a low 'shared cause factor

  6. Panhypopituitarism presenting as life-threatening heart failure caused by an inherited microdeletion in 1q25 including LHX4.

    Science.gov (United States)

    Filges, Isabel; Bischof-Renner, Andrea; Röthlisberger, Benno; Potthoff, Christian; Glanzmann, René; Günthard, Joëlle; Schneider, Jacques; Huber, Andreas R; Zumsteg, Urs; Miny, Peter; Szinnai, Gabor

    2012-02-01

    Clinical presentation of hypopituitarism in the neonate may be variable, ranging from absent to severe nonspecific symptoms and may be life-threatening in patients with adrenocorticotropic hormone deficiency. The LIM homeobox gene 4 (LHX4) transcription factor regulates early embryonic development of the anterior pituitary gland. Autosomal dominant mutations in LHX4 cause congenital hypopituitarism with variable combined pituitary hormone deficiency (CPHD). We report on a neonate with unexplained heart failure and minor physical anomalies, suggesting a midline defect. She was diagnosed with complete CPHD. Cardiac function was rescued by replacement with hydrocortisone and thyroxine; hypoglycaemia stopped under growth hormone therapy. Magnetic resonance imaging revealed a dysgenetic pituitary gland suggesting an early developmental defect. Array comparative genomic hybridization showed a maternally inherited 1.5-megabase microdeletion in 1q25.2q25.3, including the LHX4 gene. Haploinsufficiency of LHX4 likely explains the predominant pituitary phenotype in the proposita and we suggest variable intrafamilial penetrance of the inherited microdeletion. To the best of our knowledge, we are the first to report on heart failure as a rare nonspecific symptom of treatable CPHD in the newborn. Variably penetrant pituitary insufficiency, including this severe and atypical presentation, can be correlated with LHX4 insufficiency and highlights the role of LHX4 for pituitary development.

  7. Cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report

    Directory of Open Access Journals (Sweden)

    Dinesh Rao

    2014-03-01

    Full Text Available Introduction: Incidence of sudden cardiac death (SCD has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India. Methods: The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred. Results: A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127, followed closely by the age group 60-69 (28.43%; n-58. Male to female ratio was around 10:1. The maximum number of deaths (n=78 was within few hours (6 hours after the onset of signs and symptoms. In 24 (11.8% cases major narrowing was noted in both the main coronaries, in 87 (42.6% cases in the left anterior descending coronary artery (LAD, and in 18 (51.5% cases in the right coronary artery (RCA. The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86% and myocardial infarction (n-104; 50.9%. most of the SCDs occurred in the place of residence (n-80; 39.2% followed closely by death in hospital (n-49; 24.01%. Conclusion: Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1. 

  8. Scrub typhus causing neonatal hepatitis with acute liver failure-A case series.

    Science.gov (United States)

    Vajpayee, Shailja; Gupta, R K; Gupta, M L

    2017-05-01

    Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

  9. The mechanism and characteristics of ground movement and strata failure caused by mining

    Energy Technology Data Exchange (ETDEWEB)

    Tianquan, L. (Central Coal Mining Research Institute, Beijing (China))

    1988-01-01

    Analyzes strata movement and ground subsidence caused by underground coal mining. Five types of strata failure during and after underground coal mining are comparatively evaluated: caving zone, fractured zone, bending zone, arched caving, bending with continuous ground movement, sinkhole formation. Effects of coal seam thickness, dip angle, coal panel dimensions, rock stratification and mechanical properties on dimensions and distribution of failure zones in rock strata are investigated. Strata movement during level and steep seam mining is comparatively evaluated. Causes of continuous ground surface deformation and discontinuous deformation are analyzed. Rock strata properties and water influx, which influence sinkhole hazards, are discussed.

  10. Preliminary Analysis of the Common Cause Failure Events for Domestic Nuclear Power Plants

    International Nuclear Information System (INIS)

    Kang, Daeil; Han, Sanghoon

    2007-01-01

    It is known that the common cause failure (CCF) events have a great effect on the safety and probabilistic safety assessment (PSA) results of nuclear power plants (NPPs). However, the domestic studies have been mainly focused on the analysis method and modeling of CCF events. Thus, the analysis of the CCF events for domestic NPPs were performed to establish a domestic database for the CCF events and to deliver them to the operation office of the international common cause failure data exchange (ICDE) project. This paper presents the analysis results of the CCF events for domestic nuclear power plants

  11. A COCAP program for the statistical analysis of common cause failure parameters

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Baehyeuk; Jae, Moosung [Hanyang Univ., Seoul (Korea, Republic of). Dept. of Nuclear Engineering

    2016-03-15

    Probabilistic Safety Assessment (PSA) based applications and regulations are becoming more important in the field of nuclear energy. According to the results of a PSA in Korea, the common cause failure evaluates CDF (Core Damage Frequency) as one of the significant factors affecting redundancy of NPPs. The purpose of the study is to develop a COCAP (Common Cause Failure parameter Analysis for PSA) program for the accurate use of the alpha factor model parameter data provided by other countries and for obtaining the indigenous CCF data of NPPs in Korea through Bayesian updating.

  12. External dacryocystorhinostomy in consultants and fellows - a comparison of the causes of failure.

    Science.gov (United States)

    Sullivan, L; Fearnley, T; Al-Maskari, A; El-Hindy, N; Kalantzis, G; Chang, B Y

    2015-01-01

    Failure of primary dacryocystorhinostomy (DCR) often requires revision surgery to inspect the cause of failure and re-establish anatomic patency. This study aims to specifcally compare the anatomical causes of failure noted during revision DCR of primary external DCR (EX-DCR) and compare the difference between consultants and fellows. A retrospective review of 37 patients who underwent revision of a primary external approach DCR over a 7-year-period in a University Hospital. All primary surgery was performed by either a consultant surgeon or senior oculoplastic fellow. Details of the initial pathology prior to primary DCR and grade of operating surgeon were collected along with perioperative surgical findings. The cause of failure of the initial surgery was classified according to perioperative findings. Failure was classified as either inappropriately sized/located ostium or fibrous/membranous soft tissue obstruction of the newly created ostium. The cause of failure of the initial surgery was soft tissue obstruction in 43.3% and an inappropriately sized/located ostium in 56.7%. In those patients whose primary surgery was performed by a consultant, 73.3% were found to have a soft tissue obstruction and 26.7% were found to have an inappropriately sized/ located ostium. In contrast, if initial surgery was performed by a fellow, 22.7% were found to have a soft tissue obstruction and 77.3% an inappropriately sized/ located ostium (p =0.002). Where the primary surgeon has been a trainee there is a trend toward inadequately sized or located ostium being the most likely causative factor in failure of primary EX-DCR.  Hippokratia 2015; 19 (3): 216-218.

  13. Quantitative 1H MR spectroscopy of the brain in patients with congestive heart failure before and after cardiac transplantation

    International Nuclear Information System (INIS)

    Lim, Soo Mee; Lee, Ho Kyu; Choi, Choong Gon; Lim, Tae Hwan; Lee, Jung Hee

    1999-01-01

    To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative 1 H MR spectroscopy ( 1 H-MRS). Ten patients with CHF underwent MRI and quantitative 1 H-MRS before and 1-2 and 4-9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal volunteers were included. No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on 1 H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo-Inositol(mI) in OGM were significantly lower before transplantation. After successful transplantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. Cerebral hypoperfusion in CHF can be evaluated using 1 H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation

  14. Higher dietary lycopene intake is associated with longer cardiac event-free survival in patients with heart failure.

    Science.gov (United States)

    Biddle, Martha; Moser, Debra; Song, Eun Kyeung; Heo, Seongkum; Payne-Emerson, Heather; Dunbar, Sandra B; Pressler, Susan; Lennie, Terry

    2013-08-01

    The antioxidant lycopene may be beneficial for patients with heart failure (HF). Processed tomato products are a major source of lycopene, although they are also high in sodium. Increased sodium intake may counter the positive antioxidant effect of lycopene. This was a prospective study of 212 patients with HF. Dietary intake of lycopene and sodium was obtained from weighted 4-day food diaries. Patients were grouped by the median split of lycopene of 2471 µg/day and stratified by daily sodium levels above and below 3 g/day. Patients were followed for 1 year to collect survival and hospitalization data. Cox proportional hazards modeling was used to compare cardiac event-free survival between lycopene groups within each stratum of sodium intake. Higher lycopene intake was associated with longer cardiac event-free survival compared with lower lycopene intake (p = 0.003). The worst cardiac event-free survival was observed in the low lycopene intake group regardless of sodium intake (> 3 g/day HR = 3.01; p = 0.027 and ≤ 3 g/day HR= 3.34; p = 0.023). These findings suggest that increased lycopene intake has the potential to improve cardiac event-free survival in patients with HF independent of sodium intake.

  15. Quantitative {sup 1}H MR spectroscopy of the brain in patients with congestive heart failure before and after cardiac transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Mee; Lee, Ho Kyu; Choi, Choong Gon; Lim, Tae Hwan [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Lee, Jung Hee [Asan Institute for Life Sciences, Seoul (Korea, Republic of)

    1999-12-01

    To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative {sup 1}H MR spectroscopy ({sup 1}H-MRS). Ten patients with CHF underwent MRI and quantitative {sup 1}H-MRS before and 1-2 and 4-9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal volunteers were included. No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on {sup 1}H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo-Inositol(mI) in OGM were significantly lower before transplantation. After successful transplantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. Cerebral hypoperfusion in CHF can be evaluated using {sup 1}H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation.

  16. Epigenome-Wide Association Study Identifies Cardiac Gene Patterning and a Novel Class of Biomarkers for Heart Failure.

    Science.gov (United States)

    Meder, Benjamin; Haas, Jan; Sedaghat-Hamedani, Farbod; Kayvanpour, Elham; Frese, Karen; Lai, Alan; Nietsch, Rouven; Scheiner, Christina; Mester, Stefan; Bordalo, Diana Martins; Amr, Ali; Dietrich, Carsten; Pils, Dietmar; Siede, Dominik; Hund, Hauke; Bauer, Andrea; Holzer, Daniel Benjamin; Ruhparwar, Arjang; Mueller-Hennessen, Matthias; Weichenhan, Dieter; Plass, Christoph; Weis, Tanja; Backs, Johannes; Wuerstle, Maximilian; Keller, Andreas; Katus, Hugo A; Posch, Andreas E

    2017-10-17

    Biochemical DNA modification resembles a crucial regulatory layer among genetic information, environmental factors, and the transcriptome. To identify epigenetic susceptibility regions and novel biomarkers linked to myocardial dysfunction and heart failure, we performed the first multi-omics study in myocardial tissue and blood of patients with dilated cardiomyopathy and controls. Infinium human methylation 450 was used for high-density epigenome-wide mapping of DNA methylation in left-ventricular biopsies and whole peripheral blood of living probands. RNA deep sequencing was performed on the same samples in parallel. Whole-genome sequencing of all patients allowed exclusion of promiscuous genotype-induced methylation calls. In the screening stage, we detected 59 epigenetic loci that are significantly associated with dilated cardiomyopathy (false discovery corrected P ≤0.05), with 3 of them reaching epigenome-wide significance at P ≤5×10 -8 . Twenty-seven (46%) of these loci could be replicated in independent cohorts, underlining the role of epigenetic regulation of key cardiac transcription regulators. Using a staged multi-omics study design, we link a subset of 517 epigenetic loci with dilated cardiomyopathy and cardiac gene expression. Furthermore, we identified distinct epigenetic methylation patterns that are conserved across tissues, rendering these CpGs novel epigenetic biomarkers for heart failure. The present study provides to our knowledge the first epigenome-wide association study in living patients with heart failure using a multi-omics approach. © 2017 American Heart Association, Inc.

  17. Experimental and Human Evidence for Lipocalin-2 (Neutrophil Gelatinase-Associated Lipocalin [NGAL]) in the Development of Cardiac Hypertrophy and heart failure.

    Science.gov (United States)

    Marques, Francine Z; Prestes, Priscilla R; Byars, Sean G; Ritchie, Scott C; Würtz, Peter; Patel, Sheila K; Booth, Scott A; Rana, Indrajeetsinh; Minoda, Yosuke; Berzins, Stuart P; Curl, Claire L; Bell, James R; Wai, Bryan; Srivastava, Piyush M; Kangas, Antti J; Soininen, Pasi; Ruohonen, Saku; Kähönen, Mika; Lehtimäki, Terho; Raitoharju, Emma; Havulinna, Aki; Perola, Markus; Raitakari, Olli; Salomaa, Veikko; Ala-Korpela, Mika; Kettunen, Johannes; McGlynn, Maree; Kelly, Jason; Wlodek, Mary E; Lewandowski, Paul A; Delbridge, Lea M; Burrell, Louise M; Inouye, Michael; Harrap, Stephen B; Charchar, Fadi J

    2017-06-14

    Cardiac hypertrophy increases the risk of developing heart failure and cardiovascular death. The neutrophil inflammatory protein, lipocalin-2 (LCN2/NGAL), is elevated in certain forms of cardiac hypertrophy and acute heart failure. However, a specific role for LCN2 in predisposition and etiology of hypertrophy and the relevant genetic determinants are unclear. Here, we defined the role of LCN2 in concentric cardiac hypertrophy in terms of pathophysiology, inflammatory expression networks, and genomic determinants. We used 3 experimental models: a polygenic model of cardiac hypertrophy and heart failure, a model of intrauterine growth restriction and Lcn2 -knockout mouse; cultured cardiomyocytes; and 2 human cohorts: 114 type 2 diabetes mellitus patients and 2064 healthy subjects of the YFS (Young Finns Study). In hypertrophic heart rats, cardiac and circulating Lcn2 was significantly overexpressed before, during, and after development of cardiac hypertrophy and heart failure. Lcn2 expression was increased in hypertrophic hearts in a model of intrauterine growth restriction, whereas Lcn2 -knockout mice had smaller hearts. In cultured cardiomyocytes, Lcn2 activated molecular hypertrophic pathways and increased cell size, but reduced proliferation and cell numbers. Increased LCN2 was associated with cardiac hypertrophy and diastolic dysfunction in diabetes mellitus. In the YFS, LCN2 expression was associated with body mass index and cardiac mass and with levels of inflammatory markers. The single-nucleotide polymorphism, rs13297295, located near LCN2 defined a significant cis -eQTL for LCN2 expression. Direct effects of LCN2 on cardiomyocyte size and number and the consistent associations in experimental and human analyses reveal a central role for LCN2 in the ontogeny of cardiac hypertrophy and heart failure. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  18. ICDE project report: collection and analysis of common-cause failures of batteries

    International Nuclear Information System (INIS)

    2003-12-01

    This report documents a study performed on the set of Common Cause Failure (CCF) events of batteries (BT). the events studied here were derived from the International CCF Data Exchange (ICDE) database, with contributions from organizations from several countries. 50 events in the ICDE database were studied by tabulating the data and observing the trends. The data span a period from 1980 through 2000. The database contains general information about event attributes such as root cause, coupling factor, common cause component group (CCCG) size, and corrective action. The objective of the report was also to develop the failure mechanisms and phenomena involved in the events, their relationship to the root causes, and possibilities for improvement

  19. Causes of liver failure and impact analysis of prognostic risk factors

    Directory of Open Access Journals (Sweden)

    WU Xiaoqing

    2013-04-01

    Full Text Available ObjectiveTo perform a retrospective analysis of patients with liver failure to investigate the causative factors and related risk factors that may affect patient prognosis. MethodsThe clinical, demographic, and laboratory data of 79 consecutive patients diagnosed with liver failure and treated at our hospital between January 2010 and January 2012 (58 males and 21 females; age range: 16-74 years old were collected from the medical records. To identify risk factors of liver failure, the patient variables were assessed by Student’s t-test (continuous variables or Chi-squared test (categorical variables. Multivariate logistic regression analysis was used to investigate the relation between patient outcome and independent risk factors. ResultsThe 79 cases of liver failure were grouped according to disease severity: acute liver failure (n=6; 5 died, subacute liver failure (n=35; 19 died, and chronic liver failure (n=38; 28 died. The overall rate of death was 66%. The majority of cases (81% were related to hepatitis B virus infection. While the three groups of liver failure severity did not show significant differences in sex, mean age, occupation, presence of potassium disorder, total bilirubin (TBil or total cholesterol (CHO at admission, or lowest recorded level of CHO during hospitalization, there were significant intergroup differences in highest recorded TBil level, prothrombin activity (PTA at admission, and highest and lowest recorded PTA, and highest recorded level of CHO. Five independent risk factors were identified: the highest recorded TBil level during hospitalization, presence of infection, hepatorenal syndrome, gastrointestinal bleeding, and hepatic encephalopathy. ConclusionThe major cause of liver failure in this cohort of patients was hepatitis infection, and common biomarkers of liver function, such as TBil, CHO and PTA, may indicate patients with poor prognosis despite clinical intervention. Complications should be addressed as

  20. Risk-based decision making to manage water quality failures caused by combined sewer overflows

    Science.gov (United States)

    Sriwastava, A. K.; Torres-Matallana, J. A.; Tait, S.; Schellart, A.

    2017-12-01

    Regulatory authorities set certain environmental permit for water utilities such that the combined sewer overflows (CSO) managed by these companies conform to the regulations. These utility companies face the risk of paying penalty or negative publicity in case they breach the environmental permit. These risks can be addressed by designing appropriate solutions such as investing in additional infrastructure which improve the system capacity and reduce the impact of CSO spills. The performance of these solutions is often estimated using urban drainage models. Hence, any uncertainty in these models can have a significant effect on the decision making process. This study outlines a risk-based decision making approach to address water quality failure caused by CSO spills. A calibrated lumped urban drainage model is used to simulate CSO spill quality in Haute-Sûre catchment in Luxembourg. Uncertainty in rainfall and model parameters is propagated through Monte Carlo simulations to quantify uncertainty in the concentration of ammonia in the CSO spill. A combination of decision alternatives such as the construction of a storage tank at the CSO and the reduction in the flow contribution of catchment surfaces are selected as planning measures to avoid the water quality failure. Failure is defined as exceedance of a concentration-duration based threshold based on Austrian emission standards for ammonia (De Toffol, 2006) with a certain frequency. For each decision alternative, uncertainty quantification results into a probability distribution of the number of annual CSO spill events which exceed the threshold. For each alternative, a buffered failure probability as defined in Rockafellar & Royset (2010), is estimated. Buffered failure probability (pbf) is a conservative estimate of failure probability (pf), however, unlike failure probability, it includes information about the upper tail of the distribution. A pareto-optimal set of solutions is obtained by performing mean

  1. Radiation necrosis causing failure of automatic ventilation during sleep with central sleep apnea

    International Nuclear Information System (INIS)

    Udwadia, Z.F.; Athale, S.; Misra, V.P.; Wadia, N.H.

    1987-01-01

    A patient operated upon for a midline cerebellar hemangioblastoma developed failure of automatic respiration during sleep, together with central sleep apnea syndrome, approximately two years after receiving radiation therapy to the brain. Clinical and CT scan findings were compatible with a diagnosis of radiation necrosis as the cause of his abnormal respiratory control

  2. Investigating the Causes of Heart Failure based on Persian Medicine Point of View

    Directory of Open Access Journals (Sweden)

    R Ghods

    2017-07-01

    CONCLUSION: Several factors are mentioned as the cause of heart failure or heart weakness in PM, only a few of which are considered in modern medicine. However, some of these less considered theories can be used as new assumptions to prevent and control this disease

  3. The difference in causes of early and late ultrafiltration failure in peritoneal dialysis

    NARCIS (Netherlands)

    Smit, Watske; Parikova, Alena; Struijk, Dirk G.; Krediet, Raymond T.

    2005-01-01

    OBJECTIVE: Ultrafiltration failure (UFF) is a major complication of peritoneal dialysis. Although it seems associated with long-term treatment, it can also occur in recently started patients. To identify the causes of this complication in patients with early and late UFF we studied a group of 48

  4. Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

    Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.

  5. Root cause analysis of pump valve failures of three membrane pump systems

    NARCIS (Netherlands)

    Buijs, L.J.; Eijk, A.; Hooft, L. van

    2014-01-01

    This paper will present the root cause analysis and the solution of fatigue failures of the pump valves of three membrane pump systems installed on a chemical plant of Momentive in Pernis, the Netherlands. The membrane pumps were installed approximately 30 years ago. Each system has encountered

  6. A modified GO-FLOW methodology with common cause failure based on Discrete Time Bayesian Network

    International Nuclear Information System (INIS)

    Fan, Dongming; Wang, Zili; Liu, Linlin; Ren, Yi

    2016-01-01

    Highlights: • Identification of particular causes of failure for common cause failure analysis. • Comparison two formalisms (GO-FLOW and Discrete Time Bayesian network) and establish the correlation between them. • Mapping the GO-FLOW model into Bayesian network model. • Calculated GO-FLOW model with common cause failures based on DTBN. - Abstract: The GO-FLOW methodology is a success-oriented system reliability modelling technique for multi-phase missions involving complex time-dependent, multi-state and common cause failure (CCF) features. However, the analysis algorithm cannot easily handle the multiple shared signals and CCFs. In addition, the simulative algorithm is time consuming when vast multi-state components exist in the model, and the multiple time points of phased mission problems increases the difficulty of the analysis method. In this paper, the Discrete Time Bayesian Network (DTBN) and the GO-FLOW methodology are integrated by the unified mapping rules. Based on these rules, the multi operators can be mapped into DTBN followed by, a complete GO-FLOW model with complex characteristics (e.g. phased mission, multi-state, and CCF) can be converted to the isomorphic DTBN and easily analyzed by utilizing the DTBN. With mature algorithms and tools, the multi-phase mission reliability parameter can be efficiently obtained via the proposed approach without considering the shared signals and the various complex logic operation. Meanwhile, CCF can also arise in the computing process.

  7. Neurotransmission to parasympathetic cardiac vagal neurons in the brain stem is altered with left ventricular hypertrophy-induced heart failure.

    Science.gov (United States)

    Cauley, Edmund; Wang, Xin; Dyavanapalli, Jhansi; Sun, Ke; Garrott, Kara; Kuzmiak-Glancy, Sarah; Kay, Matthew W; Mendelowitz, David

    2015-10-01

    Hypertension, cardiac hypertrophy, and heart failure (HF) are widespread and debilitating cardiovascular diseases that affect nearly 23 million people worldwide. A distinctive hallmark of these cardiovascular diseases is autonomic imbalance, with increased sympathetic activity and decreased parasympathetic vagal tone. Recent device-based approaches, such as implantable vagal stimulators that stimulate a multitude of visceral sensory and motor fibers in the vagus nerve, are being evaluated as new therapeutic approaches for these and other diseases. However, little is known about how parasympathetic activity to the heart is altered with these diseases, and this lack of knowledge is an obstacle in the goal of devising selective interventions that can target and selectively restore parasympathetic activity to the heart. To identify the changes that occur within the brain stem to diminish the parasympathetic cardiac activity, left ventricular hypertrophy was elicited in rats by aortic pressure overload using a transaortic constriction approach. Cardiac vagal neurons (CVNs) in the brain stem that generate parasympathetic activity to the heart were identified with a retrograde tracer and studied using patch-clamp electrophysiological recordings in vitro. Animals with left cardiac hypertrophy had diminished excitation of CVNs, which was mediated both by an augmented frequency of spontaneous inhibitory GABAergic neurotransmission (with no alteration of inhibitory glycinergic activity) as well as a diminished amplitude and frequency of excitatory neurotransmission to CVNs. Opportunities to alter these network pathways and neurotransmitter receptors provide future targets of intervention in the goal to restore parasympathetic activity and autonomic balance to the heart in cardiac hypertrophy and other cardiovascular diseases. Copyright © 2015 the American Physiological Society.

  8. Heart failure-induced changes of voltage-gated Ca2+ channels and cell excitability in rat cardiac postganglionic neurons.

    Science.gov (United States)

    Tu, Huiyin; Liu, Jinxu; Zhang, Dongze; Zheng, Hong; Patel, Kaushik P; Cornish, Kurtis G; Wang, Wei-Zhong; Muelleman, Robert L; Li, Yu-Long

    2014-01-15

    Chronic heart failure (CHF) is characterized by decreased cardiac parasympathetic and increased cardiac sympathetic nerve activity. This autonomic imbalance increases the risk of arrhythmias and sudden death in patients with CHF. We hypothesized that the molecular and cellular alterations of cardiac postganglionic parasympathetic (CPP) neurons located in the intracardiac ganglia and sympathetic (CPS) neurons located in the stellate ganglia (SG) possibly link to the cardiac autonomic imbalance in CHF. Rat CHF was induced by left coronary artery ligation. Single-cell real-time PCR and immunofluorescent data showed that L (Ca(v)1.2 and Ca(v)1.3), P/Q (Ca(v)2.1), N (Ca(v)2.2), and R (Ca(v)2.3) types of Ca2+ channels were expressed in CPP and CPS neurons, but CHF decreased the mRNA and protein expression of only the N-type Ca2+ channels in CPP neurons, and it did not affect mRNA and protein expression of all Ca2+ channel subtypes in the CPS neurons. Patch-clamp recording confirmed that CHF reduced N-type Ca2+ currents and cell excitability in the CPP neurons and enhanced N-type Ca2+ currents and cell excitability in the CPS neurons. N-type Ca2+ channel blocker (1 μM ω-conotoxin GVIA) lowered Ca2+ currents and cell excitability in the CPP and CPS neurons from sham-operated and CHF rats. These results suggest that CHF reduces the N-type Ca2+ channel currents and cell excitability in the CPP neurons and enhances the N-type Ca2+ currents and cell excitability in the CPS neurons, which may contribute to the cardiac autonomic imbalance in CHF.

  9. Serial measurements of high sensitive cardiac troponin I in patients with acutely decompensated heart failure treated with carperitide or nitrates.

    Science.gov (United States)

    Sato, Yukihito; Nishi, Kiyoto; Saijo, Sayaka; Tanada, Yohei; Goto, Taisuke; Takahashi, Naoki; Yamamoto, Erika; Fukuhara, Rei; Miyamoto, Tadashi; Taniguchi, Ryoji; Fujiwara, Hisayoshi; Takatsu, Yoshiki

    2010-07-01

    In patients with acutely decompensated heart failure (ADHF), elevated serum concentration of cardiac troponin is an independent predictor of adverse cardiac events. In ADHF with a preserved systolic blood pressure, treatment with intravenous vasodilator is recommended. However, the effect of vasodilators on troponin concentrations has not been elucidated well. Serial high sensitive cardiac troponin I (hs-TnI) was measured in 36 patients presenting with ADHF and preserved systolic blood pressure, of whom 20 were treated with atrial natriuretic peptide (ANP) and 16 with nitrates. The concentrations of hs-TnI ranged from 0.069+/-0.114ng/ml at baseline to 0.076+/-0.121ng/ml at 5h, 0.062+/-0.106ng/ml at 1 day, and 0.056+/-0.089ng/ml at day 7 (n=36,ns). The relative change in hs-TnI between baseline and at 5h, day 1 and day 7 were 1.13+/-0.43, 0.95+/-0.44 and 0.93+/-0.64 in patients treated with ANP, and 1.02+/-0.19, 0.95+/-0.31 and 1.19+/-1.38 in patients treated with nitrates (ns; ANP versus nitrates). On day 7, a hs-TnI change, >20% decrease from baseline, was observed in 55% patients with ANP versus 56% patients with nitrates (ns). The cardiac event rates were similar in both groups. In ADHF patients with preserved systolic blood pressure, the administration of intravenous vasodilators did not decrease hs-TnI over the first 7 days. Treatments with ANP and nitrates were associated with similar short-term decreases in hs-TnI and long-term adverse cardiac events. Copyright 2010 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  10. Renal denervation improves cardiac function in rats with chronic heart failure: Effects on expression of β-adrenoceptors

    Science.gov (United States)

    Zheng, Hong; Liu, Xuefei; Sharma, Neeru M.

    2016-01-01

    Chronic activation of the sympathetic drive contributes to cardiac remodeling and dysfunction during chronic heart failure (HF). The present study was undertaken to assess whether renal denervation (RDN) would abrogate the sympathoexcitation in HF and ameliorate the adrenergic dysfunction and cardiac damage. Ligation of the left coronary artery was used to induce HF in Sprague-Dawley rats. Four weeks after surgery, RDN was performed, 1 wk before the final measurements. At the end of the protocol, cardiac function was assessed by measuring ventricular hemodynamics. Rats with HF had an average infarct area >30% of the left ventricle and left ventricular end-diastolic pressure (LVEDP) >20 mmHg. β1- and β2-adrenoceptor proteins in the left ventricle were reduced by 37 and 49%, respectively, in the rats with HF. RDN lowered elevated levels of urinary excretion of norepinephrine and brain natriuretic peptide levels in the hearts of rats with HF. RDN also decreased LVEDP to 10 mmHg and improved basal dP/dt to within the normal range in rats with HF. RDN blunted loss of β1-adrenoceptor (by 47%) and β2-adrenoceptor (by 100%) protein expression and improved isoproterenol (0.5 μg/kg)-induced increase in +dP/dt (by 71%) and −dP/dt (by 62%) in rats with HF. RDN also attenuated the increase in collagen 1 expression in the left ventricles of rats with HF. These findings demonstrate that RDN initiated in chronic HF condition improves cardiac function mediated by adrenergic agonist and blunts β-adrenoceptor expression loss, providing mechanistic insights for RDN-induced improvements in cardiac function in the HF condition. PMID:27288440

  11. Regenerative therapy and tissue engineering for the treatment of end-stage cardiac failure: new developments and challenges.

    Science.gov (United States)

    Finosh, G T; Jayabalan, Muthu

    2012-01-01

    Regeneration of myocardium through regenerative therapy and tissue engineering is appearing as a prospective treatment modality for patients with end-stage heart failure. Focusing on this area, this review highlights the new developments and challenges in the regeneration of myocardial tissue. The role of various cell sources, calcium ion and cytokine on the functional performance of regenerative therapy is discussed. The evolution of tissue engineering and the role of tissue matrix/scaffold, cell adhesion and vascularisation on tissue engineering of cardiac tissue implant are also discussed.

  12. Cardiac MRI and Transthoracic Echocardiography of Left Ventricular Myocardial Noncompaction in A Patient with Congestive Heart Failure: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Byun, Joo Nam [Chosun University Hospital College of Medicine, Gwangju (Korea, Republic of); Kim, Dong Hun [Soonchunhyang University Hospital Bucheon College of Medicine, Bucheon (Korea, Republic of)

    2010-11-15

    We report a case of a 38-year-old male presenting with new-onset dyspnea, that was diagnosed as left ventricular noncompaction by transthoracic echocardiographic and cardiac MR. The tests revealed left ventricular systolic dysfunction with prominent trabeculations associated with deep intertrabecular recesses and an enddiastolic noncompacted to compacted ratio of 2.5 in the whole apical wall and mid-ventricular anterolateral and inferolateral walls. Delayed gadolinium contrast-enhanced MRI revealed subepicardial mid-wall hyperenhancement of the midventricular anteroseptal and inferoseptal walls, which suggested myocardial fibrosis. We review the pathophysiology, clinical characteristics, and diagnostic approach of the left ventricular noncompaction associated with congestive heart failure

  13. Loss-of-activity-mutation in the cardiac chloride-bicarbonate exchanger AE3 causes short QT syndrome

    DEFF Research Database (Denmark)

    Thorsen, Kasper; Dam, Vibeke S.; Kjaer-Sorensen, Kasper

    2017-01-01

    unrelated families with SQTS. The mutation causes reduced surface expression of AE3 and reduced membrane bicarbonate transport. Slc4a3 knockdown in zebrafish causes increased cardiac pHi, short QTc, and reduced systolic duration, which is rescued by wildtype but not mutated SLC4A3. Mechanistic analyses...

  14. Cardiac myxoma: An uncommon cause of recurrent stroke in uncommon age

    Directory of Open Access Journals (Sweden)

    Harish Kumar

    2015-01-01

    Full Text Available Atrial fibrillation is the most common cause of cardiogenic emboli in stroke, responsible for over 50% cases of total stroke patients. Myxoma is responsible only in few cases. A stroke caused by left atrial myxoma commonly occur in young females. This patient presented with the repeated attack of stroke in the age of 80 years. However, it is the most common benign cardiac tumor found more frequently. In young adults with stroke or transient ischemic attack than in older patients. Age of the patient and unusual cause of recurrent stroke make this case report interesting. An 80-year-old male with no other conventional vascular risk factors such as hypertension, diabetes, or hyperlipidemia presented with left hemiparesis. Infarction over the right middle cerebral artery was disclosed on a magnetic resonance imaging study. The patient was a known case of right hemiparesis 3 years back, which was improved. The cause of repeated attack of stroke was left atrial myxoma, diagnosed by two-dimensional echocardiography.

  15. Prenatal diagnosis of concurrent facial and cerebral vascular malformation which caused congestive heart failure

    Directory of Open Access Journals (Sweden)

    Behnaz Moradi

    2017-12-01

    Full Text Available Arteriovenous malformations (AVMs are rarely reported antenatally. Most in utero diagnosis of vascular malformation is related to vein of Galen malformation (VGM. We describe a case of simultaneously diagnosed pial arteriovenous fistula (AVF and facial vascular malformation in a 20 weeks old fetus. The dilated intracranial venous pouch appeared as a midline anechoic structure which was misdiagnosed as a VGM in her previous ultrasound exam. Another AVM was diagnosed in the same side of fetal face which fed by a branch of external carotid artery and communicated with the mentioned pial AVF. High output cardiac failure and hydrops were evident. To our knowledge this is the first report of prenatally detected combination of facial and cerebral vascular malformations at such as early pregnancy week.

  16. Finite Element Creep-Fatigue Analysis of a Welded Furnace Roll for Identifying Failure Root Cause

    Science.gov (United States)

    Yang, Y. P.; Mohr, W. C.

    2015-11-01

    Creep-fatigue induced failures are often observed in engineering components operating under high temperature and cyclic loading. Understanding the creep-fatigue damage process and identifying failure root cause are very important for preventing such failures and improving the lifetime of engineering components. Finite element analyses including a heat transfer analysis and a creep-fatigue analysis were conducted to model the cyclic thermal and mechanical process of a furnace roll in a continuous hot-dip coating line. Typically, the roll has a short life, modeling heat convection from hot air inside the furnace. The creep-fatigue analysis was performed by inputting the predicted temperature history and applying mechanical loads. The analysis results showed that the failure was resulted from a creep-fatigue mechanism rather than a creep mechanism. The difference of material properties between the filler metal and the base metal is the root cause for the roll failure, which induces higher creep strain and stress in the interface between the weld and the HAZ.

  17. Causes of Contractor's Business Failure in Developing Countries: The Case of Palestine

    Directory of Open Access Journals (Sweden)

    Sherif Mohamed

    2006-12-01

    Full Text Available The construction industry has unique characteristics that sharply distinguish it from other sectors of the economy. It is fragmented, very sensitive to the economic cycles and political environment, and has a significantly high rate of business failure. Business failure, collapse and bankruptcy are common terms in the industry due to the many risks inherited in how the industry operates. Throughout the world, the relative ease of entry gives rise to a large number of contracting firms competing fiercely in the market exposing many of them to business failure, Palestine is no exception. The objectives of this paper are to report on a research study which aims at exploring the causes of contractor's business failure in Palestine, and investigating their severity from the contractor's point of view. The study's results shows that the main causes of business failure are delay in collecting debt from clients (donors, border closure, heavy dependence on bank loans and payment of high interest on these loans, lack of capital, absence of industry regulations, low profit margin due to high competition, awarding contracts by client to the lowest bidder, and lack of experience in contract management. Based on these findings, recommendations to the Palestinian National Authority (PNA and local contractors are presented in this paper.

  18. Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts.

    Science.gov (United States)

    Hammersley, Daniel; Arora, Ankur; Dissanayake, Madhava; Sengupta, Nabarun

    2017-01-02

    An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment. 2017 BMJ Publishing Group Ltd.

  19. Uncertainties and quantification of common cause failure rates and probabilities for system analyses

    International Nuclear Information System (INIS)

    Vaurio, Jussi K.

    2005-01-01

    Simultaneous failures of multiple components due to common causes at random times are modelled by constant multiple-failure rates. A procedure is described for quantification of common cause failure (CCF) basic event probabilities for system models using plant-specific and multiple-plant failure-event data. Methodology is presented for estimating CCF-rates from event data contaminated with assessment uncertainties. Generalised impact vectors determine the moments for the rates of individual systems or plants. These moments determine the effective numbers of events and observation times to be input to a Bayesian formalism to obtain plant-specific posterior CCF-rates. The rates are used to determine plant-specific common cause event probabilities for the basic events of explicit fault tree models depending on test intervals, test schedules and repair policies. Three methods are presented to determine these probabilities such that the correct time-average system unavailability can be obtained with single fault tree quantification. Recommended numerical values are given and examples illustrate different aspects of the methodology

  20. Expanding arch aneurysm causing a "kink" in a Bentall graft and heart failure.

    Science.gov (United States)

    Al-Mohaissen, Maha A; Skarsgard, Peter; Khoo, Clarence; Virani, Sean A; Munt, Brad; Leipsic, Jonathon; Ignaszewski, Andrew

    2012-07-01

    Marfan syndrome is associated with a high incidence of aortic root aneurysm and life-threatening aortic dissection. With the successful use of surgical aortic root replacement, dissection-related mortality has been significantly reduced. We present the case of a patient with Marfan syndrome who presented with heart failure secondary to an unusual graft-related complication 14 years after a Bentall procedure. Investigations revealed a supra-aortic stenosis resulting from a kink in the Bentall graft caused by pressure from an expanding aortic arch aneurysm. The patient underwent surgery with improvement in his ejection fraction and heart failure symptoms.

  1. Successful Treatment of Fibrosing Organising Pneumonia Causing Respiratory Failure with Mycophenolic Acid.

    Science.gov (United States)

    Paul, Christina; Lin-Shaw, Ammy; Joseph, Mariamma; Kwan, Keith; Sergiacomi, Gianluigi; Mura, Marco

    2016-01-01

    Organising pneumonia (OP) is usually promptly responsive to corticosteroid treatment. We describe a series of 3 cases of severe, progressive, biopsy-proven fibrosing OP causing respiratory failure. All cases presented with peribronchial and subpleural consolidations, had a fibro-inflammatory infiltrative component in the alveolar septa, and only had a partial and unsatisfactory response to corticosteroids. However, they responded to mycophenolic acid (MPA) treatment with resolution of respiratory failure as well as clinical and functional improvement. MPA as an additional treatment option for aggressive forms of fibrosing OP and interstitial lung disease needs to be further explored. © 2016 S. Karger AG, Basel.

  2. ICDE project report on collection and analysis of common-cause failures of centrifugal pumps

    International Nuclear Information System (INIS)

    2000-01-01

    Several member countries of OECD/NEA decided to establish the International Common-Cause Failure Data Exchange (ICDE) Project to encourage multilateral co-operation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The project was initiated in August 1994 in Sweden and was discussed at meetings in both Sweden and France in 1995. A coding benchmark exercise was defined which was evaluated at meetings held in Germany and in the US in 1996. Subsequently, the exchange of centrifugal pump data was defined; the first phase of this exchange was evaluated at meetings in Switzerland and in France in 1997. The objectives of the ICDE Project are: - to collect and analyse CCF events in the long term so as to better understand such events, their causes, and their prevention, - to generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences, - to establish a mechanism for the efficient feedback of experience gained on CCF phenomena, including the development of defences against their occurrence, such as indicators for risk based inspections. The ICDE Project is envisaged as including all possible events of interest, comprising complete, partial and incipient CCF events, called 'ICDE events' in the following. The Project covers the key components of the main safety systems, like centrifugal pumps, diesel generators, motor operated valves, power operated relief valves, safety relief valves, check valves, RPS circuit breakers, batteries and transmitters. Data are collected in an MS ACCESS based databank implemented and maintained at ES-Konsult, Sweden, by NEA appointed clearinghouse. The databank is regularly updated. The clearinghouse and the project group operate it. In the modelling of common-cause failures in systems consisting of several redundant components, two kinds of events are distinguished: a) Unavailability of a

  3. A robust Bayesian approach to modeling epistemic uncertainty in common-cause failure models

    International Nuclear Information System (INIS)

    Troffaes, Matthias C.M.; Walter, Gero; Kelly, Dana

    2014-01-01

    In a standard Bayesian approach to the alpha-factor model for common-cause failure, a precise Dirichlet prior distribution models epistemic uncertainty in the alpha-factors. This Dirichlet prior is then updated with observed data to obtain a posterior distribution, which forms the basis for further inferences. In this paper, we adapt the imprecise Dirichlet model of Walley to represent epistemic uncertainty in the alpha-factors. In this approach, epistemic uncertainty is expressed more cautiously via lower and upper expectations for each alpha-factor, along with a learning parameter which determines how quickly the model learns from observed data. For this application, we focus on elicitation of the learning parameter, and find that values in the range of 1 to 10 seem reasonable. The approach is compared with Kelly and Atwood's minimally informative Dirichlet prior for the alpha-factor model, which incorporated precise mean values for the alpha-factors, but which was otherwise quite diffuse. Next, we explore the use of a set of Gamma priors to model epistemic uncertainty in the marginal failure rate, expressed via a lower and upper expectation for this rate, again along with a learning parameter. As zero counts are generally less of an issue here, we find that the choice of this learning parameter is less crucial. Finally, we demonstrate how both epistemic uncertainty models can be combined to arrive at lower and upper expectations for all common-cause failure rates. Thereby, we effectively provide a full sensitivity analysis of common-cause failure rates, properly reflecting epistemic uncertainty of the analyst on all levels of the common-cause failure model

  4. Preliminary review of critical shutdown heat removal items for common cause failure susceptibility on LMFBR's. [LMFBR

    Energy Technology Data Exchange (ETDEWEB)

    Allard, L.T.; Elerath, J.G.

    1976-02-01

    This document presents a common cause failure analysis for Critical LMFBR Shutdown Heat Removal Systems. The report is intended to outline a systematic approach to defining areas with significant potential for common causes of failure, and ultimately provide inputs to the reliability prediction model. A preliminary evaluation of postulatd single initiating causes resulting in multiple failures of LMFBR-SHRS items is presented in Appendix C. This document will be periodically updated to reflect new information and activity.

  5. The diagnosis of anthracycline-induced cardiac damage and heart failure

    Directory of Open Access Journals (Sweden)

    Jarosław Dudka

    2009-05-01

    Full Text Available Routine examinations during chemotherapy containing anthracyclines evaluate heart function before treatment and monitor cardiotoxic effects during and after therapy. A number of methods are useful in cardiac assessment, including electrocardiography, radiology techniques (RTG, CT, MRI, PET-CT, PET-MRI, echocardiography, radioisotope imaging techniques (scyntygraphy, MUGA, PET, and ultra-structure evaluation in biopsy samples. Nevertheless, there is a continuous need for new methods to predict future damage at the initial stages of cardiac changes. In recent years the therapeutic usefulness of biochemical blood parameters in anthracycline-treated patients has been assessed. The levels of cardiac troponines (cTnI, cTnT, natriuretic peptides (ANP, BNP, and endothelin 1 have been included in the studies. Heart-type fatty acid binding protein (H-FABP is another promising factor showing cardiomyocytic impairment. However, the clinical use of biochemical parameters in diagnosing anthracycline-related cardiotoxicity is still a controversial issue.

  6. Effects of valsartan combined with atorvastatin on cardiac function, myocardial enzymes and thyroxine levels in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Xiao-Gang Wang1

    2017-04-01

    Full Text Available Objective: To observe the effects of valsartan combined with atorvastatin on cardiac function, myocardial enzymes and thyroxine levels in patients with chronic heart failure (CHF. Methods: 90 cases of CHF cases were divided into observation group and control group according to the order of single and double number, 45 cases each. In the control group, atorvastatin was given on the basis of conventional therapy, and the observation group was given valsartan on the basis of the control group. After 6 months, the differences of cardiac function indexes (LVEF, LVEDD, LVESD, E/A, myocardial enzymes (LDH, AST, CK, CKMB and thyroxine (TT3, TT4, FT3, FT4, TSH in the two groups were observed. Results: After treatment, LVEF and E/A in both groups increased significantly (P0.05, the observation group TT3 and FT3 were respectively (1.37±0.33 mol/L and (2.61±0.69 pmol/L , higher than the control group, the difference was statistically significant (P<0.05. Conclusion: valsartan combined with atorvastatin in the treatment of CHF, can improve cardiac function and myocardial protection effect, and can effectively promote the recovery of thyroid hormone levels, better than the single use of atorvastatin.

  7. Predictors of response to cardiac resynchronization therapy in chronic heart failure patients

    Directory of Open Access Journals (Sweden)

    Mohamed Loutfi

    2016-12-01

    Full Text Available Cardiac resynchronization therapy (CRT is established in the management patients with moderate to severe symptoms due to left ventricular systolic dysfunction who present with signs of electrical dyssynchrony. There is wide variability in the clinical response and improvement in LVEF with CRT. Prediction of response to CRT is an important goal in order to tailor this therapy to patients most apt to derive benefit. Aim: The aim of the study was to assess and identify the best predictors of CRT response. Patients and methods: The study included 170 consecutive heart failure (HF patients in New York Heart Association (NYHA functional class III or IV and LVEF ⩽ 35%. Routine device and clinical follow-up, as well as CRT optimization, were performed at baseline and at 3-month intervals. Responders were defined as having an absolute reduction in left ventricular end-systolic diameter >15% and an improvement in LVEF >10%. Results: 170 patients were included [71.1% men; mean age 68.8 ± 9.7 years; 159 patients NYHA class III, 11 patients ambulatory NYHA class IV; 91 patients had non-ischemic cardiomyopathy (ICM – 79 patients had ICM; 55.3% of patients had LBBB; mean QRS duration 145 ± 25 ms; left ventricular ejection fraction 28.38 ± 7.2]. CRT-P was implanted in 65 patients and CRT-D was implanted in 105 patients. CRT response was achieved in 114 patients (67.1%. Mean LVEF improved from 28.38 ± 7.2% to 35.46 ± 9.3% (p = 0.001, mean LV end-diastolic diameter reduced from 67.91 ± 8.7 to 64.95 ± 8.9 mm (p 150 ms, non-ICM, TAPSE >15 mm, sinus rhythm, the absence of COPD and the absence of renal disease were the independent predictors of CRT response. We generated a new CRT score to predict responders to CRT. The score consists of maximum 9 points. The CRT response rate has been markedly different according to the CRT score: CRT response rate was 97.5% patients with CRT score >6 vs 40.7% if CRT score <6, p < 0

  8. The root cause analysis of 9DVN002ZV fan failure in Daya Bay Nuclear Power Station

    International Nuclear Information System (INIS)

    Guan Jianjun; Zhang Mingjia

    2005-01-01

    Extensive investigations and detailed analysis of the failure reason of 9DVN002ZV fan in Daya Bay Nuclear Power Station showed that the fan destroy was caused by the failure of non-drive end bear. The direct cause of this bearing' failure was its improper assembly caused by improper maintenance procedure, and the root cause was too small internal radial clearance after mounting. The factor affecting bearing internal radial clearance, the relationship between clearance and operating life time and fan failure process were discussed. (authors)

  9. ξ common cause failure model and method for defense effectiveness estimation

    International Nuclear Information System (INIS)

    Li Zhaohuan

    1991-08-01

    Two issues have been dealt. One is to develop an event based parametric model called ξ-CCF model. Its parameters are expressed in the fraction of the progressive multiplicities of failure events. By these expressions, the contribution of each multiple failure can be presented more clearly. It can help to select defense tactics against common cause failures. The other is to provide a method which is based on the operational experience and engineering judgement to estimate the effectiveness of defense tactics. It is expressed in terms of reduction matrix for a given tactics on a specific plant in the event by event form. The application of practical example shows that the model in cooperation with the method can simply estimate the effectiveness of defense tactics. It can be easily used by the operators and its application may be extended

  10. Failure to diagnose cardiac treatment rejection with Tc99m-PYP images

    International Nuclear Information System (INIS)

    McKillop, J.H.; McDougall, I.R.; Goris, M.L.; Mason, J.W.; Reitz, B.A.

    1981-01-01

    The possibility of diagnosing transplant rejection using Tc-99m-PYP imaging was examined in 12 cardiac transplant recipients. Two patients were studied on two occasions. The presence or absence of active rejection was established by endomyocardial biopsy. The intensity and pattern of myocardial uptake of the tracer did not differ significantly in the two patients studied at the time of rejection compared to the remainder. It is concluded that a single Tc-99m-PYP study cannot be used to diagnose cardiac transplant rejection

  11. Positive pressure ventilation in the management of acute and chronic cardiac failure: a systematic review and meta-analysis.

    Science.gov (United States)

    Nadar, Sunil; Prasad, Neeraj; Taylor, Rod S; Lip, Gregory Y H

    2005-03-18

    Chronic heart failure (CHF) is a common condition and is associated with excess morbidity and mortality, in spite of the many advances in its treatment. Chronic stable heart failure is also associated with an increased incidence of sleep-related breathing disorders, such as central sleep apnoea (CSA) and Cheyne Stokes respiration (CSR). Continuous positive airways pressure (CPAP) has been shown to alleviate the symptoms of CHF, improve left ventricular function and oxygenation. To a certain extent, CPAP also abolishes sleep-related breathing disorders in patients with chronic heart failure. In patients with acute pulmonary oedema, the use of positive pressure ventilation improves cardiac haemodynamic indices, as well as symptoms and oxygenation, and is associated with a lower need for intubation. However, some studies have cast doubts about its safety and suggest a higher rate of myocardial infarction associated with its use. In our opinion, non-invasive positive pressure ventilation and CPAP offers an adjunctive mode of therapy in patients with acute pulmonary oedema and chronic heart failure, who may not be suitable for intubation and in those not responsive to conventional therapies. Non-invasive ventilation also helps to improve oxygenation in those patients with exhaustion and respiratory acidosis. Many trials are still ongoing and the results of these studies would throw more light on the present role of non-invasive ventilation in the management of CHF.

  12. Cardiac Ablation of Rheb1 Induces Impaired Heart Growth, Endoplasmic Reticulum-Associated Apoptosis and Heart Failure in Infant Mice

    Science.gov (United States)

    Cao, Yunshan; Tao, Lichan; Shen, Shutong; Xiao, Junjie; Wu, Hang; Li, Beibei; Wu, Xiangqi; Luo, Wen; Xiao, Qi; Hu, Xiaoshan; Liu, Hailang; Nie, Junwei; Lu, Shuangshuang; Yuan, Baiyin; Han, Zhonglin; Xiao, Bo; Yang, Zhongzhou; Li, Xinli

    2013-01-01

    Ras homologue enriched in brain 1 (Rheb1) plays an important role in a variety of cellular processes. In this study, we investigate the role of Rheb1 in the post-natal heart. We found that deletion of the gene responsible for production of Rheb1 from cardiomyocytes of post-natal mice resulted in malignant arrhythmias, heart failure, and premature death of these mice. In addition, heart growth impairment, aberrant metabolism relative gene expression, and increased cardiomyocyte apoptosis were observed in Rheb1-knockout mice prior to the development of heart failure and arrhythmias. Also, protein kinase B (PKB/Akt) signaling was enhanced in Rheb1-knockout mice, and removal of phosphatase and tensin homolog (Pten) significantly prolonged the survival of Rheb1-knockouts. Furthermore, signaling via the mammalian target of rapamycin complex 1 (mTORC1) was abolished and C/EBP homologous protein (CHOP) and phosphorylation levels of c-Jun N-terminal kinase (JNK) were increased in Rheb1 mutant mice. In conclusion, this study demonstrates that Rheb1 is important for maintaining cardiac function in post-natal mice via regulation of mTORC1 activity and stress on the endoplasmic reticulum. Moreover, activation of Akt signaling helps to improve the survival of mice with advanced heart failure. Thus, this study provides direct evidence that Rheb1 performs multiple important functions in the heart of the post-natal mouse. Enhancing Akt activity improves the survival of infant mice with advanced heart failure. PMID:24351823

  13. High Intensity Interval and Endurance Training Have Opposing Effects on Markers of Heart Failure and Cardiac Remodeling in Hypertensive Rats

    Science.gov (United States)

    Holloway, Tanya M.; Bloemberg, Darin; da Silva, Mayne L.; Simpson, Jeremy A.; Quadrilatero, Joe; Spriet, Lawrence L.

    2015-01-01

    There has been re-emerging interest and significant work dedicated to investigating the metabolic effects of high intensity interval training (HIIT) in recent years. HIIT is considered to be a time efficient alternative to classic endurance training (ET) that elicits similar metabolic responses in skeletal muscle. However, there is a lack of information on the impact of HIIT on cardiac muscle in disease. Therefore, we determined the efficacy of ET and HIIT to alter cardiac muscle characteristics involved in the development of diastolic dysfunction, such as ventricular hypertrophy, fibrosis and angiogenesis, in a well-established rodent model of hypertension-induced heart failure before the development of overt heart failure. ET decreased left ventricle fibrosis by ~40% (P HIIT did not decrease existing fibrosis, and HIIT animals displayed a 20% increase in left ventricular mass (PHIIT also increased brain natriuretic peptide by 50% (PHIIT promoted a pathological adaptation in the left ventricle in the presence of hypertension, highlighting the need for further research on the widespread effects of HIIT in the presence of disease. PMID:25803693

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

    Directory of Open Access Journals (Sweden)

    Leng Xiaoyan

    2009-11-01

    Full Text Available Abstract Background Older heart failure (HF patients exhibit exercise intolerance during activities of daily living. We hypothesized that reduced lower extremity blood flow (LBF due to reduced forward cardiac output would contribute to submaximal exercise intolerance in older HF patients. Methods and Results Twelve HF patients both with preserved and reduced left ventricular ejection fraction (LVEF (aged 68 ± 10 years without large (aorta or medium sized (iliac or femoral artery vessel atherosclerosis, and 13 age and gender matched healthy volunteers underwent a sophisticated battery of assessments including a peak exercise oxygen consumption (peak VO2, b physical function, c cardiovascular magnetic resonance (CMR submaximal exercise measures of aortic and femoral arterial blood flow, and d determination of thigh muscle area. Peak VO2 was reduced in HF subjects (14 ± 3 ml/kg/min compared to healthy elderly subjects (20 ± 6 ml/kg/min (p = 0.01. Four-meter walk speed was 1.35 ± 0.24 m/sec in healthy elderly verses 0.98 ± 0.15 m/sec in HF subjects (p p ≤ 0.03. Conclusion During CMR submaximal bike exercise in the elderly with heart failure, mechanisms other than low cardiac output are responsible for reduced lower extremity blood flow.

  15. Stimulation of ganglionated plexus attenuates cardiac neural remodeling and heart failure progression in a canine model of acute heart failure post-myocardial infarction.

    Science.gov (United States)

    Luo, Da; Hu, Huihui; Qin, Zhiliang; Liu, Shan; Yu, Xiaomei; Ma, Ruisong; He, Wenbo; Xie, Jing; Lu, Zhibing; He, Bo; Jiang, Hong

    2017-12-01

    Heart failure (HF) is associated with autonomic dysfunction. Vagus nerve stimulation has been shown to improve cardiac function both in HF patients and animal models of HF. The purpose of this present study is to investigate the effects of ganglionated plexus stimulation (GPS) on HF progression and autonomic remodeling in a canine model of acute HF post-myocardial infarction. Eighteen adult mongrel male dogs were randomized into the control (n=8) and GPS (n=10) groups. All dogs underwent left anterior descending artery ligation followed by 6-hour high-rate (180-220bpm) ventricular pacing to induce acute HF. Transthoracic 2-dimensional echocardiography was performed at different time points. The plasma levels of norepinephrine, B-type natriuretic peptide (BNP) and Ang-II were measured using ELISA kits. C-fos and nerve growth factor (NGF) proteins expressed in the left stellate ganglion as well as GAP43 and TH proteins expressed in the peri-infarct zone were measured using western blot. After 6h of GPS, the left ventricular end-diastolic volume, end-systolic volume and ejection fraction showed no significant differences between the 2 groups, but the interventricular septal thickness at end-systole in the GPS group was significantly higher than that in the control group. The plasma levels of norepinephrine, BNP, Ang-II were increased 1h after myocardial infarction while the increase was attenuated by GPS. The expression of c-fos and NGF proteins in the left stellate ganglion as well as GAP43 and TH proteins in cardiac peri-infarct zone in GPS group were significantly lower than that in control group. GPS inhibits cardiac sympathetic remodeling and attenuates HF progression in canines with acute HF induced by myocardial infarction and ventricular pacing. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Root cause analysis of SI line-seated thermal sleeve separation failures

    International Nuclear Information System (INIS)

    Jo, Jong Chull; Jhung, Myung Jo; Kim, Hho Jung

    2004-01-01

    At conventional pressurized water reactors, a thermal sleeve (named simply 'sleeve' hereafter) is seated inside the nozzle part of each Safety Injection (SI) branch pipe to prevent and relieve potential excessive transient thermal stress in the nozzle wall when a cold water is injected during the safety injection mode Recently, mechanical failures that the sleeves are separated from the SI branch pipe and fall into the connected cold leg main pipe were occurred in sequence at Yonggwang units 5 and 6 and Ulchin unit 5. There were many activities and efforts to figure out the causes of those failures with experts' reasoning, but the proposed causes were derived from superficial views rather than physically concrete grounds or analysis results. The prerequisites to find out the root causes of failure mechanism will be to identify the flow situation in the pipe junction area connecting the cold leg with the SI pipe and to know the vibration characteristics of sleeves. This paper investigates the flow field in the pipe junction thru a numerical simulation and vibration characteristics of thermal sleeves thru a modal analysis, from which the root causes of sleeve separation mechanism are analyzed

  17. High intensity interval and endurance training have opposing effects on markers of heart failure and cardiac remodeling in hypertensive rats.

    Directory of Open Access Journals (Sweden)

    Tanya M Holloway

    Full Text Available There has been re-emerging interest and significant work dedicated to investigating the metabolic effects of high intensity interval training (HIIT in recent years. HIIT is considered to be a time efficient alternative to classic endurance training (ET that elicits similar metabolic responses in skeletal muscle. However, there is a lack of information on the impact of HIIT on cardiac muscle in disease. Therefore, we determined the efficacy of ET and HIIT to alter cardiac muscle characteristics involved in the development of diastolic dysfunction, such as ventricular hypertrophy, fibrosis and angiogenesis, in a well-established rodent model of hypertension-induced heart failure before the development of overt heart failure. ET decreased left ventricle fibrosis by ~40% (P < 0.05, and promoted a 20% (P<0.05 increase in the left ventricular capillary/fibre ratio, an increase in endothelial nitric oxide synthase protein (P<0.05, and a decrease in hypoxia inducible factor 1 alpha protein content (P<0.05. In contrast, HIIT did not decrease existing fibrosis, and HIIT animals displayed a 20% increase in left ventricular mass (P<0.05 and a 20% decrease in cross sectional area (P<0.05. HIIT also increased brain natriuretic peptide by 50% (P<0.05, in the absence of concomitant angiogenesis, strongly suggesting pathological cardiac remodeling. The current data support the longstanding belief in the effectiveness of ET in hypertension. However, HIIT promoted a pathological adaptation in the left ventricle in the presence of hypertension, highlighting the need for further research on the widespread effects of HIIT in the presence of disease.

  18. ELABELA-APJ axis protects from pressure overload heart failure and angiotensin II-induced cardiac damage.

    Science.gov (United States)

    Sato, Teruki; Sato, Chitose; Kadowaki, Ayumi; Watanabe, Hiroyuki; Ho, Lena; Ishida, Junji; Yamaguchi, Tomokazu; Kimura, Akinori; Fukamizu, Akiyoshi; Penninger, Josef M; Reversade, Bruno; Ito, Hiroshi; Imai, Yumiko; Kuba, Keiji

    2017-06-01

    Elabela/Toddler/Apela (ELA) has been identified as a novel endogenous peptide ligand for APJ/Apelin receptor/Aplnr. ELA plays a crucial role in early cardiac development of zebrafish as well as in maintenance of self-renewal of human embryonic stem cells. Apelin was the first identified APJ ligand, and exerts positive inotropic heart effects and regulates the renin-angiotensin system. The aim of this study was to investigate the biological effects of ELA in the cardiovascular system. Continuous infusion of ELA peptide significantly suppressed pressure overload-induced cardiac hypertrophy, fibrosis and impaired contractility in mice. ELA treatment reduced mRNA expression levels of genes associated with heart failure and fibrosis. The cardioprotective effects of ELA were diminished in APJ knockout mice, indicating that APJ is the key receptor for ELA in the adult heart. Mechanistically, ELA downregulated angiotensin-converting enzyme (ACE) expression in the stressed hearts, whereas it showed little effects on angiotensin-converting enzyme 2 (ACE2) expression, which are distinct from the effects of Apelin. FoxM1 transcription factor, which induces ACE expression in the stressed hearts, was downregulated by ELA but not by Apelin. ELA antagonized angiotensin II-induced hypertension, cardiac hypertrophy, and fibrosis in mice. The ELA-APJ axis protects from pressure overload-induced heart failure possibly via suppression of ACE expression and pathogenic angiotensin II signalling. The different effects of ELA and Apelin on the expression of ACE and ACE2 implicate fine-tuned mechanisms for a ligand-induced APJ activation and downstream signalling. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email: journals.permissions@oup.com.

  19. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    Energy Technology Data Exchange (ETDEWEB)

    Karian, V.E.; Burrows, P.E.; Connor, L. [Dept. of Radiology, Children' s Hospital, Boston, MA (United States); Zurakowski, D. [Dept. of Biostatistics, Children' s Hospital, Boston, MA (United States); Mason, K.P. [Dept. of Anesthesiology, Children' s Hospital, Boston, MA (United States)

    1999-11-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  20. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    International Nuclear Information System (INIS)

    Karian, V.E.; Burrows, P.E.; Connor, L.; Zurakowski, D.; Mason, K.P.

    1999-01-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  1. Neurohormonal activation and diagnostic value of cardiac peptides in patients with suspected mild heart failure

    DEFF Research Database (Denmark)

    Mikkelsen, Kirsten V.; Bie, Peter; Møller, Jacob E.

    2006-01-01

    accuracy of cardiac peptides to detect any left ventricular dysfunction (LVD) in patients referred from primary care with suspected HF before institution of medical therapy. METHODS: Of 166 referred patients 150 were consecutively included (14 were excluded and two refused consent). Echocardiography...

  2. Diabetes Mellitus, Microalbuminuria, and Subclinical Cardiac Disease: Identification and Monitoring of Individuals at Risk of Heart Failure.

    Science.gov (United States)

    Swoboda, Peter P; McDiarmid, Adam K; Erhayiem, Bara; Ripley, David P; Dobson, Laura E; Garg, Pankaj; Musa, Tarique A; Witte, Klaus K; Kearney, Mark T; Barth, Julian H; Ajjan, Ramzi; Greenwood, John P; Plein, Sven

    2017-07-17

    Patients with type 2 diabetes mellitus and elevated urinary albumin:creatinine ratio (ACR) have increased risk of heart failure. We hypothesized this was because of cardiac tissue changes rather than silent coronary artery disease. In a case-controlled observational study 130 subjects including 50 ACR+ve diabetes mellitus patients with persistent microalbuminuria (ACR >2.5 mg/mol in males and >3.5 mg/mol in females, ≥2 measurements, no previous renin-angiotensin-aldosterone therapy, 50 ACR-ve diabetes mellitus patients and 30 controls underwent cardiovascular magnetic resonance for investigation of myocardial fibrosis, ischemia and infarction, and echocardiography. Thirty ACR+ve patients underwent further testing after 1-year treatment with renin-angiotensin-aldosterone blockade. Cardiac extracellular volume fraction, a measure of diffuse fibrosis, was higher in diabetes mellitus patients than controls (26.1±3.4% and 23.3±3.0% P =0.0002) and in ACR+ve than ACR-ve diabetes mellitus patients (27.2±4.1% versus 25.1±2.9%, P =0.004). ACR+ve patients also had lower E' measured by echocardiography (8.2±1.9 cm/s versus 8.9±1.9 cm/s, P =0.04) and elevated high-sensitivity cardiac troponin T 18% versus 4% ≥14 ng/L ( P =0.05). Rate of silent myocardial ischemia or infarction were not influenced by ACR status. Renin-angiotensin-aldosterone blockade was associated with increased left ventricular ejection fraction (59.3±7.8 to 61.5±8.7%, P =0.03) and decreased extracellular volume fraction (26.5±3.6 to 25.2±3.1, P =0.01) but no changes in diastolic function or high-sensitivity cardiac troponin T levels. Asymptomatic diabetes mellitus patients with persistent microalbuminuria have markers of diffuse cardiac fibrosis including elevated extracellular volume fraction, high-sensitivity cardiac troponin T, and diastolic dysfunction, which may in part be reversible by renin-angiotensin-aldosterone blockade. Increased risk in these patients may be mediated by

  3. Isolated Non-Compaction of the Left Ventricle in a Patient with New-Onset Heart Failure: Morphologic and Functional Evaluation with Cardiac Multidetector Computed Tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon [Soonchuhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kim, Seok Yeon [Seoul Medical Center, Seoul (Korea, Republic of); Schoepf, U. Joseph [Medical University of South Carolina, SC (United States)

    2012-03-15

    We describe a case of new-onset heart failure in a patient in whom cardiac CT enabled the non-invasive diagnosis of isolated non-compaction and associated functional abnormalities of the left ventricle with the concomitant evaluation of coronary arteries. This case highlights the utility of cardiac CT for the morphological and functional evaluation of the heart as a single imaging modality.

  4. Questioning the Role of Requirements Engineering in the Causes of Safety-Critical Software Failures

    Science.gov (United States)

    Johnson, C. W.; Holloway, C. M.

    2006-01-01

    Many software failures stem from inadequate requirements engineering. This view has been supported both by detailed accident investigations and by a number of empirical studies; however, such investigations can be misleading. It is often difficult to distinguish between failures in requirements engineering and problems elsewhere in the software development lifecycle. Further pitfalls arise from the assumption that inadequate requirements engineering is a cause of all software related accidents for which the system fails to meet its requirements. This paper identifies some of the problems that have arisen from an undue focus on the role of requirements engineering in the causes of major accidents. The intention is to provoke further debate within the emerging field of forensic software engineering.

  5. The causes, consequences, and treatment of left or right heart failure

    Directory of Open Access Journals (Sweden)

    Peteiro J

    2011-04-01

    Full Text Available Pablo Pazos-López, Jesús Peteiro-Vázquez, Ana Carcía-Campos, Lourdes García-Bueno, Juan Pablo Abugattas de Torres, Alfonso Castro-BeirasDepartment of Cardiology, Complejo hospitalario Universitario A Coruña, A Coruña, SpainAbstract: Chronic heart failure (HF is a cardiovascular disease of cardinal importance because of several factors: a an increasing occurrence due to the aging of the population, primary and secondary prevention of cardiovascular events, and modern advances in therapy, b a bad prognosis: around 65% of patients are dead within 5 years of diagnosis, c a high economic cost: HF accounts for 1% to 2% of total health care expenditure. This review focuses on the main causes, consequences in terms of morbidity, mortality and costs and treatment of HF.Keywords: heart failure, cause, consequence, treatment

  6. Chagas disease as a cause of heart failure and ventricular arrhythmias in patients long removed from endemic areas: an emerging problem in Europe.

    Science.gov (United States)

    Vannucchi, Vieri; Tomberli, Benedetta; Zammarchi, Lorenzo; Fornaro, Alessandra; Castelli, Gabriele; Pieralli, Filippo; Berni, Andrea; Yacoub, Sophie; Bartoloni, Alessandro; Olivotto, Iacopo

    2015-12-01

    Chagas disease is a parasitic disease caused by the protozoan Trypanosoma cruzi. In endemic areas (South and Central America), Chagas disease represents a relevant public health issue, and is the most frequent cause of cardiomyopathy. In nonendemic areas, such as Europe, Chagas disease represents an emerging problem following the establishment of sizeable communities from Brazil and Bolivia. Chagas cardiomyopathy represents the most frequent and serious complication of chronic Chagas disease, affecting about 20-30% of patients, potentially leading to heart failure, arrhythmias, thromboembolism, stroke and sudden death. Because late complications of Chagas disease may develop several years or even decades after the acute infection, it may be extremely challenging to reach the correct diagnosis in patients long removed from the countries of origin. We report two examples of Chagas cardiomyopathy in South American women permanently residing in Italy for more than 20 years, presenting with cardiac manifestations ranging from left ventricular dysfunction and heart failure to isolated ventricular arrhythmias. The present review emphasizes that Chagas disease should be considered as a potential diagnosis in patients from endemic areas presenting with 'idiopathic' cardiac manifestations, even when long removed from their country of origin, with potential implications for treatment and control of Chagas disease transmission.

  7. Propionibacterium acnes as a cause of lung abscess in a cardiac transplant recipient.

    Science.gov (United States)

    Veitch, David; Abioye, Abu; Morris-Jones, Stephen; McGregor, Alastair

    2015-12-16

    A 29-year-old man was admitted with fevers, cough, left-sided chest pain and lethargy for 1 week. He had a cardiac transplant 10 years prior and was on immunosuppressive drugs. He was found to have a pulmonary lesion and went on to develop a lung abscess. Propionibacterium acnes was identified on matrix-assisted laser desorption ionisation mass spectrometry-time of flight and 16s rRNA gene sequencing after drainage. He was curatively treated with co-trimoxazole and co-amoxiclav. He divulged a longstanding history of seborrhoeic dermatitis with frequent flares leading to large volumes of squames collecting on his bed sheets. We hypothesise this was a possible route of entry: inhalation of the Propionibacterium. This case highlights how a common commensal bacterium, P. acnes, was able to cause pathology in an immunosuppressed patient. This is the only case of a patient with transplantation developing a P. acnes pulmonary infection and the only case of P. acnes causing these clinical features to be reported in the literature. 2015 BMJ Publishing Group Ltd.

  8. Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroid-stimulating hormone receptor antibody after ablative therapy.

    Science.gov (United States)

    Matsumoto, Tadashi; Miyakoshi, Kei; Saisho, Yoshifumi; Ishii, Tomohiro; Ikenoue, Satoru; Kasuga, Yoshifumi; Kadohira, Ikuko; Sato, Seiji; Momotani, Naoko; Minegishi, Kazuhiro; Yoshimura, Yasunori

    2013-01-01

    High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.

  9. What caused Chicago bank failures in the Great Depression? A look at the 1920s.

    OpenAIRE

    Natacha Postel-Vinay

    2015-01-01

    This paper reassesses the causes of Chicago bank failures during the Great Depression by tracking the evolution of their balance sheets in the 1920s. I find that all Chicago banks suffered tremendous deposit withdrawals; however banks that failed earlier in the 1930s had invested more in mortgages in the 1920s. The main problem with mortgages was their lack of liquidity, not their quality. Banks heavily engaged in mortgages did not have enough liquid assets to face the withdrawals and failed....

  10. Classic Bartter syndrome: a rare cause of failure to thrive in a child

    OpenAIRE

    Vieira, Helena; Mendes, Leonor; Mendes, Patricia; da Silva, José Esteves

    2012-01-01

    Bartter syndrome is a group of rare autosomal-recessive disorders caused by a defect in distal tubule transport of sodium and chloride. Blood gases and plasma electrolytes raise suspicion of this diagnosis and the definitive diagnosis is made by genetic study. Early treatment improves prognosis. The authors present the case of an 11-month-old child with early failure to thrive and severe regurgitation. Blood gases revealed hypochloraemic metabolic alkalosis, hyponatraemia and hypokalaemia. Bl...

  11. Common-cause failure analysis of McGuire Unit 2 auxiliary feedwater system

    International Nuclear Information System (INIS)

    Rasmuson, D.M.; Shepherd, J.C.; Fowler, R.D.; Summitt, R.L.; Logan, B.W.

    1982-01-01

    A powerful method for qualitative common cause failure analysis (CCFA) of nuclear power plant systems was developed by EG and G Idaho at the Idaho National Engineering Laboratory. As a cooperative project to demonstrate and evaluate the usefulness of the method, the Duke Power Company agreed to allow a CCFA of the auxiliary feedwater system (AFWS) in their McGuire Nuclear Station Unit 2. The results of the CCFA are the subject of this discussion

  12. Effect of milrinone on the cardiac function and N-terminal pro-brain natriuretic peptide levels in patients with senile refractory heart failure

    Directory of Open Access Journals (Sweden)

    Jiao-Na Wei1

    2017-06-01

    Full Text Available Objective: To study the effect of milrinone on the cardiac function and N-terminal probrain natriuretic peptide (NT-proBNP levels in patients with senile refractory heart failure. Methods: 90 patients with senile refractory heart failure who were treated in our hospital between August 2013 and August 2016 were collected and divided into control group (n=45 and observation group (n=45 according to the random number table. The control group received regular clinical treatment, and the observation group received regular + milrinone treatment. The cardiac function and serum NT-proBN contents were compared between two groups of patients before and after treatment. Results: Before treatment, the differences in ultrasound and serum cardiac function indexes and serum NT-proBN levels were not statistically significant between two groups of patients. After treatment, ultrasound serum cardiac function parameter LVEDD level in observation group was lower than that in control group while CI and SV levels were higher than those in control group; serum cardiac function indexes Cys-C, GDF-15, sST2 and H-FABP contents were lower than those in control group; serum NT-proBNP content was lower than that in control group. Conclusion: Milrinone therapy can optimize the cardiac function and reduce the serum NT-proBN levels in patients with senile refractory heart failure.

  13. Acute-on-chronic liver failure: causes, clinical characteristics and predictors of mortality

    International Nuclear Information System (INIS)

    Ali, A.; Luck, N.H.

    2017-01-01

    Objective: To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF). Study Design: Cross-sectional study. Place and Duration of Study:Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016. Methodology:All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test. Results: Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 +-13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score =>13 (p=0.010), model for end-stage liver disease (MELD) score =>30 (p=0.001), age >40 years (p=0.036), organ failures (OF) =>3 (p 3, CTP =>13, MELD =>30, age >40 years, PSE, renal failure and urosepsis. (author)

  14. Indicators of Subarachnoid Hemorrhage as a Cause of Sudden Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Joseph Zachariah

    2016-03-01

    Full Text Available Subarachnoid hemorrhage (SAH may present with cardiac arrest (SAH-CA. We report a case of SAH-CA to assist providers in distinguishing SAH as an etiology of cardiac arrest despite electrocardiogram findings that may be suggestive of a cardiac etiology. SAH-CA is associated with high rates of return of spontaneous circulation, but overall poor outcome. An initially non-shockable cardiac rhythm and the absence of brain stem reflexes are important clues in indentifying SAH-CA.

  15. Identification of Modeling Approaches To Support Common-Cause Failure Analysis

    International Nuclear Information System (INIS)

    Korsah, Kofi; Wood, Richard Thomas

    2015-01-01

    Experience with applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The impact of CCF vulnerability is to inhibit I&C modernization and, thereby, challenge the long-term sustainability of existing plants. For new plants and advanced reactor concepts, the issue of CCF vulnerability for highly integrated digital I&C systems imposes a design burden resulting in higher costs and increased complexity. The regulatory uncertainty regarding which mitigation strategies are acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. The conditions that constrain the transition to digital I&C technology by the U.S. nuclear industry require crosscutting research to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for usage in Nuclear Power Plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is conducting an investigation into mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive technical basis for establishing the qualification of digital technology for nuclear power applications. This report documents the investigation of modeling approaches for representing failure of I&C systems. Failure models are used when there is a need to analyze how the probability of success (or failure) of a system depends on the success (or failure) of individual elements. If these failure models are extensible to represent CCF, then they can be employed to support analysis of CCF vulnerabilities and mitigation strategies. Specifically, the research findings documented in this report identify modeling approaches that

  16. Identification of Modeling Approaches To Support Common-Cause Failure Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Korsah, Kofi [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wood, Richard Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-06-01

    Experience with applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The impact of CCF vulnerability is to inhibit I&C modernization and, thereby, challenge the long-term sustainability of existing plants. For new plants and advanced reactor concepts, the issue of CCF vulnerability for highly integrated digital I&C systems imposes a design burden resulting in higher costs and increased complexity. The regulatory uncertainty regarding which mitigation strategies are acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. The conditions that constrain the transition to digital I&C technology by the U.S. nuclear industry require crosscutting research to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for usage in Nuclear Power Plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is conducting an investigation into mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive technical basis for establishing the qualification of digital technology for nuclear power applications. This report documents the investigation of modeling approaches for representing failure of I&C systems. Failure models are used when there is a need to analyze how the probability of success (or failure) of a system depends on the success (or failure) of individual elements. If these failure models are extensible to represent CCF, then they can be employed to support analysis of CCF vulnerabilities and mitigation strategies. Specifically, the research findings documented in this report identify modeling approaches that

  17. Impact of etiology on the outcomes in heart failure patients treated with cardiac resynchronization therapy: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yanmei Chen

    Full Text Available BACKGROUND: Cardiac resynchronization therapy (CRT has been extensively demonstrated to benefit heart failure patients, but the role of underlying heart failure etiology in the outcomes was not consistently proven. This meta-analysis aimed to determine whether efficacy and effectiveness of CRT is affected by underlying heart failure etiology. METHODS AND RESULTS: Searches of MEDLINE, EMBASE and Cochrane databases were conducted to identify RCTs and observational studies that reported clinical and functional outcomes of CRT in ischemic cardiomyopathy (ICM and non-ischemic cardiomyopathy (NICM patients. Efficacy of CRT was assessed in 7 randomized controlled trials (RCTs with 7072 patients and effectiveness of CRT was evaluated in 14 observational studies with 3463 patients In the pooled analysis of RCTs, we found that CRT decreased mortality or heart failure hospitalization by 29% in ICM patients (95% confidence interval [CI], 21% to 35%, and by 28% (95% CI, 18% to 37% in NICM patients. No significant difference was observed between the 2 etiology groups (P = 0.55. In the pooled analysis of observational studies, however, we found that ICM patients had a 54% greater risk for mortality or HF hospitalization than NICM patients (relative risk: 1.54; 95% CI: 1.30-1.83; P<0.001. Both RCTs and observational studies demonstrated that NICM patients had greater echocardiographic improvements in the left ventricular ejection fraction and end-systolic volume, as compared with ICM patients (both P<0.001. CONCLUSION: CRT might reduce mortality or heart failure hospitalization in both ICM and NICM patients similarly. The improvement of the left ventricular function and remodeling is greater in NICM patients.

  18. Probabilistic common cause failure modeling for auxiliary feedwater system after the introduction of flood barriers

    International Nuclear Information System (INIS)

    Zheng, Xiaoyu; Yamaguchi, Akira; Takata, Takashi

    2013-01-01

    Causal inference is capable of assessing common cause failure (CCF) events from the viewpoint of causes' risk significance. Authors proposed the alpha decomposition method for probabilistic CCF analysis, in which the classical alpha factor model and causal inference are integrated to conduct a quantitative assessment of causes' CCF risk significance. The alpha decomposition method includes a hybrid Bayesian network for revealing the relationship between component failures and potential causes, and a regression model in which CCF parameters (global alpha factors) are expressed by explanatory variables (causes' occurrence frequencies) and parameters (decomposed alpha factors). This article applies this method and associated databases needed to predict CCF parameters of auxiliary feedwater (AFW) system when defense barriers against internal flood are introduced. There is scarce operation data for functionally modified safety systems and the utilization of generic CCF databases is of unknown uncertainty. The alpha decomposition method has the potential of analyzing the CCF risk of modified AFW system reasonably based on generic CCF databases. Moreover, the sources of uncertainty in parameter estimation can be studied. An example is presented to demonstrate the process of applying Bayesian inference in the alpha decomposition process. The results show that the system-specific posterior distributions for CCF parameters can be predicted. (author)

  19. Long-term mortality from cardiac causes after adjuvant hypofractionated vs. conventional radiotherapy for localized left-sided breast cancer.

    Science.gov (United States)

    Chan, Elisa K; Woods, Ryan; Virani, Sean; Speers, Caroline; Wai, Elaine S; Nichol, Alan; McBride, Mary L; Tyldesley, Scott

    2015-01-01

    Ongoing concern remains regarding cardiac injury with hypofractionated whole breast/chest-wall radiotherapy (HF-WBI) compared to conventional radiotherapy (CF-WBI) in left-sided breast cancer patients. The purpose was to determine if cardiac mortality increases with HF-WBI relative to CF-WBI. Between 1990 and 1998, 5334 women with early-stage breast cancer received post-operative radiotherapy to the breast/chest wall alone. A population-based database recorded baseline patient, tumor and treatment factors. Baseline cardiovascular risk factors were identified from hospital administrative records. A propensity-score model balanced risk factors between radiotherapy groups. Cause of death was coded as breast cancer, cardiac or other cause. Cumulative mortality from each cause after radiotherapy was estimated using a competing risk approach. For left-sided cases, median follow-up was 14.2 years. 485 women received CF-WBI, 2221 women received HF-WBI. There was no difference in 15-year mortality from cardiac causes: 4.8% with HF-WBI and 4.2% with CF-WBI (p=0.74), even after propensity-score adjustment (p=0.45). There was no difference in breast cancer mortality or other cause mortality. For right-sided cases, there was no difference in mortality for the three causes of death. At 15-years follow-up, cardiac mortality is not statistically different among left-sided breast cancer patients treated with HF-WBI or CF-WBI. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Long-term mortality from cardiac causes after adjuvant hypofractionated vs. conventional radiotherapy for localized left-sided breast cancer

    International Nuclear Information System (INIS)

    Chan, Elisa K.; Woods, Ryan; Virani, Sean; Speers, Caroline; Wai, Elaine S.; Nichol, Alan; McBride, Mary L.; Tyldesley, Scott

    2015-01-01

    Background and purpose: Ongoing concern remains regarding cardiac injury with hypofractionated whole breast/chest-wall radiotherapy (HF-WBI) compared to conventional radiotherapy (CF-WBI) in left-sided breast cancer patients. The purpose was to determine if cardiac mortality increases with HF-WBI relative to CF-WBI. Materials and methods: Between 1990 and 1998, 5334 women with early-stage breast cancer received post-operative radiotherapy to the breast/chest wall alone. A population-based database recorded baseline patient, tumor and treatment factors. Baseline cardiovascular risk factors were identified from hospital administrative records. A propensity-score model balanced risk factors between radiotherapy groups. Cause of death was coded as breast cancer, cardiac or other cause. Cumulative mortality from each cause after radiotherapy was estimated using a competing risk approach. Results: For left-sided cases, median follow-up was 14.2 years. 485 women received CF-WBI, 2221 women received HF-WBI. There was no difference in 15-year mortality from cardiac causes: 4.8% with HF-WBI and 4.2% with CF-WBI (p = 0.74), even after propensity-score adjustment (p = 0.45). There was no difference in breast cancer mortality or other cause mortality. For right-sided cases, there was no difference in mortality for the three causes of death. Conclusions: At 15-years follow-up, cardiac mortality is not statistically different among left-sided breast cancer patients treated with HF-WBI or CF-WBI

  1. Molecular and cellular characterization of cardiac overload-induced hypertrophy and failure

    NARCIS (Netherlands)

    Umar, Soban

    2009-01-01

    In neonatal rat ventricular cardiomyocytes (NRVCs), we activated integrins by RGD to test whether integrin stimulation produced hypertrophy. Effect of RGD was compared with pro-hypertrophic effects of phenylephrine (chapter 2). Ventricular failure is associated with disturbed collagen turnover.

  2. The cognitive basis of effective team performance: features of failure and success in simulated cardiac resuscitation.

    Science.gov (United States)

    Shetty, Pallavi; Cohen, Trevor; Patel, Bhavesh; Patel, Vimla L

    2009-11-14

    Despite a body of research on teams in other fields relatively little is known about measuring teamwork in healthcare. The aim of this study is to characterize the qualitative dimensions of team performance during cardiac resuscitation that results in good and bad outcomes. We studied each team's adherence to Advanced Cardiac Life Support (ACLS) protocol for ventricular fibrillation/tachycardia and identified team behaviors during simulated critical events that affected their performance. The process was captured by a developed task checklist and a validated team work coding system. Results suggest that deviation from the sequence suggested by the ACLS protocol had no impact on the outcome as the successful team deviated more from this sequence than the unsuccessful team. It isn't the deviation from the protocol per se that appears to be important, but how the leadership flexibly adapts to the situational changes with deviations is the crucial factor in team competency.

  3. An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard.

    Science.gov (United States)

    Banerjee, Dipanjan; Thompson, Christine; Kell, Charlene; Shetty, Rajesh; Vetteth, Yohan; Grossman, Helene; DiBiase, Aria; Fowler, Michael

    2017-05-01

    Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort. We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF. After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF. The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P  = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% ( P  = .0001), and the percentage of patients receiving our interventions, such as patient education

  4. Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

    NARCIS (Netherlands)

    Ahmed, Ali; Bourge, Robert C.; Fonarow, Gregg C.; Patel, Kanan; Morgan, Charity J.; Fleg, Jerome L.; Aban, Inmaculada B.; Love, Thomas E.; Yancy, Clyde W.; Deedwania, Prakash; van Veldhuisen, Dirk J.; Filippatos, Gerasimos S.; Anker, Stefan D.; Allman, Richard M.

    BACKGROUND: Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after

  5. High-sensitivity cardiac troponin I and risk of heart failure in patients with suspected acute coronary syndrome: a cohort study.

    Science.gov (United States)

    Stelzle, Dominik; Shah, Anoop S V; Anand, Atul; Strachan, Fiona E; Chapman, Andrew R; Denvir, Martin A; Mills, Nicholas L; McAllister, David A

    2018-01-01

    Heart failure may occur following acute myocardial infarction, but with the use of high-sensitivity cardiac troponin assays we increasingly diagnose patients with minor myocardial injury. Whether troponin concentrations remain a useful predictor of heart failure in patients with acute coronary syndrome is uncertain. We identified all consecutive patients (n = 4748) with suspected acute coronary syndrome (61 ± 16 years, 57% male) presenting to three secondary and tertiary care hospitals. Cox-regression models were used to evaluate the association between high-sensitivity cardiac troponin I concentration and subsequent heart failure hospitalization. C-statistics were estimated to evaluate the predictive value of troponin for heart failure hospitalization. Over 2071 years of follow-up there were 83 heart failure hospitalizations. Patients with troponin concentrations above the upper reference limit (URL) were more likely to be hospitalized with heart failure than patients below the URL (118/1000 vs. 17/1000 person years, adjusted hazard ratio: 7.0). Among patients with troponin concentrations acute coronary syndrome. The strongest associations were observed in patients with troponin concentrations in the normal reference range, in whom high-sensitivity cardiac troponin assays identify those at increased risk of heart failure who may benefit from further investigation and treatment. © The Author 2017. Published on behalf of the European Society of Cardiology

  6. Diencephalic syndrome: a frequently neglected cause of failure to thrive in infants.

    Science.gov (United States)

    Kim, Ahlee; Moon, Jin Soo; Yang, Hye Ran; Chang, Ju Young; Ko, Jae Sung; Seo, Jeong Kee

    2015-01-01

    Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was 18±10.5 months, and diagnosis after symptom onset was made at the mean age of 11±9.7 months. The mean z score was -3.15±1.14 for weight, -0.12±1.05 for height, 1.01±1.58 for head circumference, and -1.76±1.97 for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.

  7. Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model

    Science.gov (United States)

    Orini, Michele; Mincholé, Ana; Monasterio, Violeta; Cygankiewicz, Iwona; Bayés de Luna, Antonio; Martínez, Juan Pablo

    2017-01-01

    Background Sudden cardiac death (SCD) and pump failure death (PFD) are common endpoints in chronic heart failure (CHF) patients, but prevention strategies are different. Currently used tools to specifically predict these endpoints are limited. We developed risk models to specifically assess SCD and PFD risk in CHF by combining ECG markers and clinical variables. Methods The relation of clinical and ECG markers with SCD and PFD risk was assessed in 597 patients enrolled in the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study. ECG indices included: turbulence slope (TS), reflecting autonomic dysfunction; T-wave alternans (TWA), reflecting ventricular repolarization instability; and T-peak-to-end restitution (ΔαTpe) and T-wave morphology restitution (TMR), both reflecting changes in dispersion of repolarization due to heart rate changes. Standard clinical indices were also included. Results The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, ΔαTpe and TMR. For PFD, the indices were diabetes, NYHA class, ΔαTpe and TS. Using a model with only clinical variables, the hazard ratios (HRs) for SCD and PFD for patients in the high-risk group (fifth quintile of risk score) with respect to patients in the low-risk group (first and second quintiles of risk score) were both greater than 4. HRs for SCD and PFD increased to 9 and 11 when using a model including only ECG markers, and to 14 and 13, when combining clinical and ECG markers. Conclusion The inclusion of ECG markers capturing complementary pro-arrhythmic and pump failure mechanisms into risk models based only on standard clinical variables substantially improves prediction of SCD and PFD in CHF patients. PMID:29020031

  8. Relationship between quantitative cardiac neuronal imaging with ¹²³I-meta-iodobenzylguanidine and hospitalization in patients with heart failure.

    Science.gov (United States)

    Parker, Matthew W; Sood, Nitesh; Ahlberg, Alan W; Jacobson, Arnold F; Heller, Gary V; Lundbye, Justin B

    2014-09-01

    Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by (123)I-meta-iodobenzylguanidine ((123)I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between (123)I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using (123)I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships.

  9. Analysis approach for common cause failure on non-safety digital control system

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Goo; Oh, Eungse [Korea Hydro and Nuclear Power Co. Ltd., Daejeon (Korea, Republic of)

    2014-05-15

    The effects of common cause failure (CCF) on safety digital instrumentation and control (I and C) system had been considered in defense in depth and diversity coping analysis with safety analysis method. For the non-safety system, single failure had been considered for safety analysis. IEEE Std. 603-1991, Clause 5.6.3.1(2), 'Isolation' states that no credible failure on the non-safety side of an isolation device shall prevent any portion of a safety system from meeting its minimum performance requirements during and following any design basis event requiring that safety function. The software CCF is one of the credible failure on the non-safety side. In advanced digital I and C system, same hardware component is used for different control system and the defect in manufacture or common external event can generate CCF. Moreover, the non-safety I and C system uses complex software for its various function and software quality assurance for the development process is less severe than safety software for the cost effective design. Therefore the potential defects in software cannot be ignored and the effect of software CCF on non-safety I and C system is needed to be evaluated. This paper proposes the general process and considerations for the analysis of CCF on non-safety I and C system.

  10. Regional and ethnic differences among patients with heart failure in Asia: the Asian sudden cardiac death in heart failure registry.

    Science.gov (United States)

    Lam, Carolyn S P; Teng, Tiew-Hwa Katherine; Tay, Wan Ting; Anand, Inder; Zhang, Shu; Shimizu, Wataru; Narasimhan, Calambur; Park, Sang Weon; Yu, Cheuk-Man; Ngarmukos, Tachapong; Omar, Razali; Reyes, Eugene B; Siswanto, Bambang B; Hung, Chung-Lieh; Ling, Lieng H; Yap, Jonathan; MacDonald, Michael; Richards, A Mark

    2016-11-01

    To characterize regional and ethnic differences in heart failure (HF) across Asia. We prospectively studied 5276 patients with stable HF and reduced ejection fraction (≤40%) from 11 Asian regions (China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore, Taiwan, and Thailand). Mean age was 59.6 ± 13.1 years, 78.2% were men, and mean body mass index was 24.9 ± 5.1 kg/m 2 . Majority (64%) of patients had two or more comorbid conditions such as hypertension (51.9%), coronary artery disease (CAD, 50.2%), or diabetes (40.4%). The prevalence of CAD was highest in Southeast Asians (58.8 vs. 38.2% in Northeast Asians). Compared with Chinese ethnicity, Malays (adjusted odds ratio [OR] 1.97, 95% CI 1.63-2.38) and Indians (OR 1.44, 95% CI 1.24-1.68) had higher odds of CAD, whereas Koreans (OR 0.38, 95% CI 0.29-0.50) and Japanese (OR 0.44, 95% CI 0.36-0.55) had lower odds. The prevalence of hypertension and diabetes was highest in Southeast Asians (64.2 and 49.3%, respectively) and high-income regions (59.7 and 46.2%, respectively). There was significant interaction between ethnicity and region, where the adjusted odds were 3.95 (95% CI 2.51-6.21) for hypertension and 4.91 (95% CI 3.07-7.87) for diabetes among Indians from high- vs. low-income regions; and 2.60 (95% CI 1.66-4.06) for hypertension and 2.62 (95% CI 1.73-3.97) for diabetes among Malays from high- vs. low-income regions. These first prospective multi-national data from Asia highlight the significant heterogeneity among Asian patients with stable HF, and the important influence of both ethnicity and regional income level on patient characteristics. NCT01633398. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  11. Presentation of common cause failures in fault tree structure of Krsko PSA : an historical overview

    International Nuclear Information System (INIS)

    Vrbanic, I.; Kosutic, I.; Vukovic, I.; Simic, Z.

    2003-01-01

    Failure of multiple components due to a common cause represents one of the most important issues in evaluation of system reliability or unavailability. The frequency of such events has relatively low expectancy, when compared to random failures, which affect individual components. However, in many cases the consequence is a direct loss of safety system or mitigative safety function. For this reason, the modeling of a common cause failure (CCF) and its presentation in fault tree structure is of the uttermost importance in probabilistic safety analyses (PSA). During the past decade, PSA model of Krsko NPP has undergone many small changes and a couple of major ones in fulfilling its basic purpose, which was serving as a tool for providing an appropriate information on the risk associated with actual plant design and operation. All changes to Krsko PSA model were undertaken in order to make it a better tool and / or to make it represent the plant in more accurate manner. The paper provides an overview of changes in CCF modeling in the fault tree structure from the initial PSA model development till present. (author)

  12. Adrenal Insufficiency as a Cause of Acute Liver Failure: A Case Report

    Directory of Open Access Journals (Sweden)

    Jamshid Vafaeimanesh

    2013-01-01

    Full Text Available Introduction. Many diseases and conditions can contribute to elevated liver enzymes. Common causes include viral and autoimmune hepatitis, fatty liver, and bile duct diseases, but, in uncommon cases like liver involvement in endocrine disorders, liver failure is also seen. Adrenal insufficiency is the rarest endocrine disorder complicating the liver. In the previously reported cases of adrenal insufficiency, mild liver enzymes elevation was seen but we report a case with severe elevated liver enzymes and liver failure due to adrenal insufficiency. Based on our knowledge, this is the first report in this field. Case Report. A 39-year-old woman was referred to emergency ward due to drowsiness and severe fatigue. Her laboratory tests revealed prothrombin time: 21 sec, alanine aminotransferase (ALT: 2339 IU/L, aspartate aminotransferase (AST: 2002 IU/L, and ALP: 90 IU/L. No common cause of liver involvement was discovered, and eventually, with diagnosis of adrenal insufficiency and corticosteroid therapy, liver enzymes and function became normal. Finally, the patient was discharged with good general condition. Conclusion. With this report, we emphasize adrenal insufficiency (primary or secondary as a reason of liver involvement in unexplainable cases and recommend that any increase in the liver enzymes, even liver failure, in these patients should be observed.

  13. Estimation Procedure of Common Cause Failure Parameters for CAFE-PSA

    International Nuclear Information System (INIS)

    Kang, Dae Il; Hwang, M. J.; Han, S. H.

    2009-03-01

    Detailed common cause failure (CCF) analysis generally needs the data for CCF events from other nuclear power plants because the CCF events rarely occur. Since 2002, KAERI has participated in the international common cause failure data exchange (ICDE) project to get data for CCF events. The operation office of the ICDE project sent about 400 CCF event data for emergency diesel generators, motor operated valves, check valves, pumps, and breakers to KAERI in 2009. However, there was no program available to analyze the ICDE CCF event data. Therefore, we developed the CAFE-PSA (common CAuse Failure Event analysis program for PSA) to estimate CCF parameters by using the ICDE CCF event data. With CAFE-PSA, the CCF events in the ICDE database can be qualitatively and quantitatively analyzed. The qualitative analysis results of the ICDE CCF data, by using the CAFE-PSA, showed that the major root cause of CCF events, for motor operated valves, check valves, and pumps, was the fault of their internal parts, and that for emergency diesel generators and breakers was the inadequacy of design/manufacture or construction. The quantitative analysis results of the ICDE CCF data, by using the CAFE-PSA, showed that the estimated Alpha Factors of components, mentioned above, were lower than those previously used in the PSA for domestic nuclear power plants, but were higher than those in USNRC 2007 CCF data. Through performing qualitative and quantitative analysis of the ICDE CCF data, by using the CAFE-PSA, a plan for coping with CCF events for design and operation of nuclear power plants can be produced and reasonable values for CCF parameters can be estimated. In addition, it is expected that the technical adequacy of PSA can be improved

  14. Analyses of cardiac blood cells and serum proteins with regard to cause of death in forensic autopsy cases.

    Science.gov (United States)

    Quan, Li; Ishikawa, Takaki; Michiue, Tomomi; Li, Dong-Ri; Zhao, Dong; Yoshida, Chiemi; Chen, Jian-Hua; Komatsu, Ayumi; Azuma, Yoko; Sakoda, Shigeki; Zhu, Bao-Li; Maeda, Hitoshi

    2009-04-01

    To investigate hematological and serum protein profiles of cadaveric heart blood with regard to the cause of death, serial forensic autopsy cases (n=308, >18 years of age, within 48 h postmortem) were examined. Red blood cells (Rbc), hemoglobin (Hb), platelets (Plt), white blood cells (Wbc), total protein (TP) and albumin (Alb) were examined in bilateral cardiac blood. Blood cell counts, collected after turning the bodies at autopsy, approximated to the clinical values. Postmortem changes were not significant for these markers. In non-head blunt injury cases, Rbc counts, Hb, TP and Alb levels in bilateral cardiac blood were lower in subacute deaths (survival time, 1-12 h) than in acute deaths (survival time hematology analyzer than by using a blood smear test, suggesting Rbc fragmentation caused by deep burns, while increases in Wbc count and decreases in Alb levels were seen for subacute deaths. For asphyxiation, Rbc count, Hb, TP and Alb levels in bilateral cardiac blood were higher than other groups, and TP and Alb levels in the right cardiac blood were higher for hanging than for strangulation. These findings suggest that analyses of blood cells and proteins are useful for investigating the cause of death.

  15. Classic Bartter syndrome: a rare cause of failure to thrive in a child.

    Science.gov (United States)

    Vieira, Helena; Mendes, Leonor; Mendes, Patricia; da Silva, José Esteves

    2012-06-28

    Bartter syndrome is a group of rare autosomal-recessive disorders caused by a defect in distal tubule transport of sodium and chloride. Blood gases and plasma electrolytes raise suspicion of this diagnosis and the definitive diagnosis is made by genetic study. Early treatment improves prognosis. The authors present the case of an 11-month-old child with early failure to thrive and severe regurgitation. Blood gases revealed hypochloraemic metabolic alkalosis, hyponatraemia and hypokalaemia. Blood pressure was normal and polyuria was documented. She began therapy with potassium chloride supplementation and indomethacin. There was clinical improvement and plasma potassium and bicarbonate normalised. The molecular study confirmed it was the classic form of Bartter syndrome. Despite being rare in clinical practice, which may lead to unnecessary medical investigation and diagnosis delay, in a child with failure to thrive, hypochloraemic metabolic alkalosis and hypokalaemia, this diagnosis must be considered.

  16. Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

    Science.gov (United States)

    Santana, Adriell Ramalho; Amorim, Fábio Ferreira; Soares, Paulo Henrique Alves; de Moura, Edmilson Bastos; Maia, Marcelo de Oliveira

    2012-01-01

    Interstitial lung diseases belong to a group of diseases that typically exhibit a subacute or chronic progression but that may cause acute respiratory failure. The male patient, who was 37 years of age and undergoing therapy for non-Hodgkin's lymphoma, was admitted with cough, fever, dyspnea and acute hypoxemic respiratory failure. Mechanical ventilation and antibiotic therapy were initiated but were associated with unfavorable progression. Thoracic computed tomography showed bilateral pulmonary "ground glass" opacities. Methylprednisolone pulse therapy was initiated with satisfactory response because the patient had used three drugs related to organizing pneumonia (cyclophosphamide, doxorubicin and rituximab), and the clinical and radiological symptoms were suggestive. Organizing pneumonia may be idiopathic or linked to collagen diseases, drugs and cancer and usually responds to corticosteroid therapy. The diagnosis was anatomopathological, but the patient's clinical condition precluded performing a lung biopsy. Organizing pneumonia should be a differential diagnosis in patients with apparent pneumonia and a progression that is unfavorable to antimicrobial treatment. PMID:23917942

  17. External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations.

    Science.gov (United States)

    Ghasemi, Hassan; Asghari Asl, Sajedeh; Yarmohammadi, Mohammad Ebrahim; Jafari, Farhad; Izadi, Pupak

    2017-01-01

    External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. Totally, 113 patients underwent external DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.

  18. Possible genetic implications in the response to cardiac resynchronisation therapy in a patient affected by heart failure

    Directory of Open Access Journals (Sweden)

    Natalia Pezzali

    2011-06-01

    Full Text Available This report presents a case of a patient with idiopathic dilated cardiomyopathy and severe left ventricular systolic dysfunction who underwent cardiac resynchronisation therapy (CRT. During the follow-up a progressive increase in left ventricular ejection fraction was observed, as well as clinical improvement. No cardiovascular events occurred during the follow-up, except for appropriate Implantable Cardioverter Defibrillator (ICD bursts for fast ventricular tachycardia. Genotyping for adrenoceptor gene polymorphisms detected that the patient was Glu27Glu homozygous carrier. There’s a large interindividual variability in response to CRT. Despite attempts to identify factors having an impact on this therapy, only QRS duration is accepted according to guidelines. Beta-adrenoceptors polymorphisms, modulating sympathetic drive in heart failure and left ventricular remodelling, may have a role in identifying patients with a better response to CRT, in order to target and individualise the patients’ treatment.

  19. Why did high-dose rosuvastatin not improve cardiac remodeling in chronic heart failure? Mechanistic insights from the UNIVERSE study.

    Science.gov (United States)

    Ashton, Emma; Windebank, Emma; Skiba, Marina; Reid, Christopher; Schneider, Hans; Rosenfeldt, Franklin; Tonkin, Andrew; Krum, Henry

    2011-02-03

    Statins are often prescribed for prevention of atherosclerotic outcomes in patients who have chronic heart failure (CHF), if this has an ischaemic etiology. These agents may also possess additional properties, independent of effects on blood lipid levels, which may have an effect on cardiac remodeling. However, beneficial effects were not observed in the recent UNIVERSE trial. We prospectively planned a sub-study of UNIVERSE to explore relevant mechanistic effects of rosuvastatin, including effects on collagen turnover and plasma coenzyme Q10 (CoQ) levels. Additionally, CoQ levels in CHF patients receiving chronic statin therapy were measured. CoQ levels were significantly reduced after 26 weeks of rosuvastatin statin therapy (n = 32), compared to placebo (n = 37) in CHF patients in UNIVERSE trial. Patients with CHF (n = 56) matched for age, gender and severity of disease who had been taking statins for 12 months or longer had CoQ levels of 847 ± 344 nmol/L, significantly lower than 1065.4 ± 394 nmol/L in UNIVERSE patients at baseline (p = 0.0001). Serum types I and III N-terminal procollagen peptide (PINP and PIIINP), measures of collagen turnover which can contribute to cardiac fibrosis were significantly increased in the rosuvastatin group compared to baseline in UNIVERSE patients (PINP: p = 0.03, PIIINP: p = 0.001). In conclusion putative beneficial effects of statin therapy on cardiac remodeling in UNIVERSE may have been negated by increases in collagen turnover markers as well as a reduction in plasma CoQ levels in these patients with CHF. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction.

    Science.gov (United States)

    Kiuchi, Shunsuke; Hisatake, Shinji; Kabuki, Takayuki; Oka, Takashi; Dobashi, Shintaro; Fujii, Takahiro; Ikeda, Takanori

    2018-01-27

    Cardiac sympathetic nerve activity is known to play a key role in the development and progression of heart failure (HF). Azelnidipine, an L-type calcium channel blocker (CCB), inhibits the sympathetic nerve activity of the central system. In contrast, cilnidipine, an N-type CCB, inhibits the sympathetic nerve activity of the peripheral system. CCBs are recommended as class IIa in patients with HF preserved ejection fraction (HFpEF); however, there are no comparative data on the difference in effect of cilnidipine and azelnidipine in patients with HFpEF and hypertension. We investigated the difference in effect of azelnidipine compared with cilnidipine in patients with HFpEF. Twenty-four consecutive HF patients who received angiotensin II type1a receptor blocker and beta blocker from April 2013 to January 2015 were enrolled. Cilnidipine was switched to azelnidipine during the follow-up period. Blood pressures, heart rate, blood tests, echocardiography, and 123 I-metaiodobenzylguanidine (MIBG) cardiac-scintigraphy were measured before and after 6 months from azelnidipine administration. B-type natriuretic peptide tended to decrease after switching to azelnidipine; however, there were no significant differences between the pre-state and post-state (pre-state: 118.5 pg/mL and post-state: 78.4 pg/mL, P = 0.137). Other laboratory findings, including catecholamine, also did not change significantly. In echocardiography, there were no significant differences in systolic and diastolic functions at the pre-state and post-state. As for MIBG, there were no significant changes in heart/mediastinum ratio. However, washout rate was significantly reduced (pre-state: 42.9 and post-state: 39.6, P = 0.030). Azelnidipine improved the dysfunction of cardiac sympathetic nerve activity compared with cilnidipine in patients with HFpEF.

  1. Effects of percutaneous renal sympathetic denervation on cardiac function and exercise tolerance in patients with chronic heart failure.

    Science.gov (United States)

    Gao, Jun-Qing; Xie, Yun; Yang, Wei; Zheng, Jian-Pu; Liu, Zong-Jun

    2017-01-01

    Sympathetic hyperactivity, a vital factor in the genesis and development of heart failure (HF), has been reported to be effectively reduced by percutaneous renal denervation (RDN), which may play an important role in HF treatment. To determine the effects of percutaneous RDN on cardiac function in patients with chronic HF (CHF). Fourteen patients (mean age 69.6 years; ejection fraction [EF] <45%) with CHF received bilateral RDN. Adverse cardiac events, blood pressure (BP), and biochemical parameters were assessed before and six months after percutaneous operation. Patients also underwent echocardiographic assessment of cardiac function and 6-min walk test before and at six months after percutaneous operation. The distance achieved by the 14 patients in the 6-min walk test increased significantly from 152.9±38.0 m before RDN to 334.3±94.4 m at six months after RDN (p<0.001), while EF increased from 36.0±4.1% to 43.8±7.9% (p=0.003) on echocardiography. No RDN-related complications were observed during the follow-up period. In 6-month follow-up, systolic BP decreased from 138.6±22.1 mmHg to 123.2±10.5 mmHg (p=0.026) and diastolic BP from 81.1±11.3 mmHg to 72.9±7.5 mmHg (p=0.032). Creatinine levels did not change significantly (1.3±0.65 mg/dl to 1.2±0.5 mg/dl, p=0.8856). RDN is potentially an effective technique for the treatment of severe HF that can significantly increase EF and improve exercise tolerance. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. A prediction model for 5-year cardiac mortality in patients with chronic heart failure using {sup 123}I-metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Kenichi; Matsuo, Shinro [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Nakata, Tomoaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine (Cardiology), Sapporo (Japan); Hakodate-Goryoukaku Hospital, Department of Cardiology, Hakodate (Japan); Yamada, Takahisa [Osaka Prefectural General Medical Center, Department of Cardiology, Osaka (Japan); Yamashina, Shohei [Toho University Omori Medical Center, Department of Cardiovascular Medicine, Tokyo (Japan); Momose, Mitsuru [Tokyo Women' s Medical University, Department of Nuclear Medicine, Tokyo (Japan); Kasama, Shu [Cardiovascular Hospital of Central Japan, Department of Cardiology, Shibukawa (Japan); Matsui, Toshiki [Social Insurance Shiga General Hospital, Department of Cardiology, Otsu (Japan); Travin, Mark I. [Albert Einstein Medical College, Department of Cardiology and Nuclear Medicine, Montefiore Medical Center, Bronx, NY (United States); Jacobson, Arnold F. [GE Healthcare, Medical Diagnostics, Princeton, NJ (United States)

    2014-09-15

    Prediction of mortality risk is important in the management of chronic heart failure (CHF). The aim of this study was to create a prediction model for 5-year cardiac death including assessment of cardiac sympathetic innervation using data from a multicenter cohort study in Japan. The original pooled database consisted of cohort studies from six sites in Japan. A total of 933 CHF patients who underwent {sup 123}I-metaiodobenzylguanidine (MIBG) imaging and whose 5-year outcomes were known were selected from this database. The late MIBG heart-to-mediastinum ratio (HMR) was used for quantification of cardiac uptake. Cox proportional hazard and logistic regression analyses were used to select appropriate variables for predicting 5-year cardiac mortality. The formula for predicting 5-year mortality was created using a logistic regression model. During the 5-year follow-up, 205 patients (22 %) died of a cardiac event including heart failure death, sudden cardiac death and fatal acute myocardial infarction (64 %, 30 % and 6 %, respectively). Multivariate logistic analysis selected four parameters, including New York Heart Association (NYHA) functional class, age, gender and left ventricular ejection fraction, without HMR (model 1) and five parameters with the addition of HMR (model 2). The net reclassification improvement analysis for all subjects was 13.8 % (p < 0.0001) by including HMR and its inclusion was most effective in the downward reclassification of low-risk patients. Nomograms for predicting 5-year cardiac mortality were created from the five-parameter regression model. Cardiac MIBG imaging had a significant additive value for predicting cardiac mortality. The prediction formula and nomograms can be used for risk stratifying in patients with CHF. (orig.)

  3. Complex bladder-exstrophy-epispadias management: Causes of failure of initial bladder closure

    Directory of Open Access Journals (Sweden)

    Kouame Dibi Bertin

    2014-01-01

    Full Text Available The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0, concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0. The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.

  4. Power distribution gradients in WWER type cores and fuel failure root causes

    Energy Technology Data Exchange (ETDEWEB)

    Mikuš, Ján M., E-mail: JanMikus.nrc@hotmail.com

    2014-02-15

    Highlights: • Power (fission rate) distribution gradients can represent fuel failure root causes. • Positions with above gradients were investigated in WWER type cores on reactor LR-0. • Above gradients were evaluated near core heterogeneities and construction materials. • Results can be used for code validation and fuel failure occurrence investigation. - Abstract: Neutron flux non-uniformity and gradients of neutron current resulting in corresponding power (fission rate) distribution changes can represent root causes of the fuel failure. Such situation can be expected in vicinity of some core heterogeneities and construction materials. Since needed data cannot be obtained from nuclear power plant (NPP), results of some benchmark type experiments performed on light water, zero-power research reactor LR-0 were used for investigation of the above phenomenon. Attention was focused on determination of the spatial power distribution changes in fuel assemblies (FAs): Containing fuel rods (FRs) with Gd burnable absorber in WWER-440 and WWER-1000 type cores, Neighboring the core blanket and dummy steel assembly simulators on the periphery of the WWER-440 standard and low leakage type cores, resp., Neighboring baffle in WWER-1000 type cores, and Neighboring control rod (CR) in WWER-440 type cores, namely (a) power peak in axial power distribution in periphery FRs of the adjacent FAs near the area between CR fuel part and butt joint to the CR absorbing part and (b) decrease in radial power distribution in FRs near CR absorbing part. An overview of relevant experimental results from reactor LR-0 and some information concerning leaking FAs on NPP Temelín are presented. Obtained data can be used for code validation and subsequently for the fuel failure occurrence investigation.

  5. [Cardiac cachexia].

    Science.gov (United States)

    Miján, Alberto; Martín, Elvira; de Mateo, Beatriz

    2006-05-01

    Chronic heart failure (CHF), especially affecting the right heart, frequently leads to malnutrition. If the latter is severe and is combined to other factors, it may lead to cardiac cachexia. This one is associated to increased mortality and lower survival of patients suffering from it. The causes of cardiac cachexia are diverse, generally associated to maintenance of a negative energy balance, with increasing evidence of its multifactorial origin. Neurohumoral, inflammatory, immunological, and metabolic factors, among others, are superimposed in the patient with CHF, leading to involvement and deterioration of several organs and systems, since this condition affects both lean (or active cellular) mass and adipose and bone tissue osteoporosis. Among all, the most pronounced deterioration may be seen at skeletal muscle tissue, at both structural and functional levels, the heart not being spared. As for treatment, it should be based on available scientific evidence. Assessment of nutritional status of any patient with CHF is a must, with the requirement of nutritional intervention in case of malnutrition. In this situation, especially if accompanied by cardiac cachexia, it is required to modify energy intake and oral diet quality, and to consider the indication of specific complementary or alternative artificial nutrition. Besides, the causal relationship of the beneficial role of moderate physical exertion is increasing, as well as modulation of metabolic and inflammatory impairments observed in cardiac cachexia with several drugs, leading to a favorable functional and structural response in CHF patients.

  6. On the value of redundancy subject to common-cause failures: Toward the resolution of an on-going debate

    International Nuclear Information System (INIS)

    Hoepfer, V.M.; Saleh, J.H.; Marais, K.B.

    2009-01-01

    Common-cause failures (CCF) are one of the more critical and challenging issues for system reliability and risk analyses. Academic interest in modeling CCF, and more broadly in modeling dependent failures, has steadily grown over the years in the number of publications as well as in the sophistication of the analytical tools used. In the past few years, several influential articles have shed doubts on the relevance of redundancy arguing that 'redundancy backfires' through common-cause failures, and that the latter dominate unreliability, thus defeating the purpose of redundancy. In this work, we take issue with some of the results of these publications. In their stead, we provide a nuanced perspective on the (contingent) value of redundancy subject to common-cause failures. First, we review the incremental reliability and MTTF provided by redundancy subject to common-cause failures. Second, we introduce the concept and develop the analytics of the 'redundancy-relevance boundary': we propose this redundancy-relevance boundary as a design-aid tool that provides an answer to the following question: what level of redundancy is relevant or advantageous given a varying prevalence of common-cause failures? We investigate the conditions under which different levels of redundancy provide an incremental MTTF over that of the single component in the face of common-cause failures. Recognizing that redundancy comes at a cost, we also conduct a cost-benefit analysis of redundancy subject to common-cause failures, and demonstrate how this analysis modifies the redundancy-relevance boundary. We show how the value of redundancy is contingent on the prevalence of common-cause failures, the redundancy level considered, and the monadic cost-benefit ratio. Finally we argue that general unqualified criticism of redundancy is misguided, and efforts are better spent for example on understanding and mitigating the potential sources of common-cause failures rather than deriding the concept

  7. TVP1022 attenuates cardiac remodeling and kidney dysfunction in experimental volume overload-induced congestive heart failure.

    Science.gov (United States)

    Abassi, Zaid A; Barac, Yaron D; Kostin, Sawa; Roguin, Ariel; Ovcharenko, Elena; Awad, Hoda; Blank, Ayelet; Bar-Am, Orit; Amit, Tamar; Schaper, Jutta; Youdim, Moussa; Binah, Ofer

    2011-07-01

    Despite the availability of many pharmacological and mechanical therapies, the mortality rate among patients with congestive heart failure (CHF) remains high. We tested the hypothesis that TVP1022 (the S-isomer of rasagiline; Azilect), a neuroprotective and cytoprotective molecule, is also cardioprotective in the settings of experimental CHF in rats. In rats with volume overload-induced CHF, we investigated the therapeutic efficacy of TVP1022 (7.5 mg/kg) on cardiac function, structure, biomarkers, and kidney function. Treatment with TVP1022 for 7 days before CHF induction prevented the increase in left ventricular end-diastolic area and end-systolic area, and the decrease in fractional shortening measured 14 days after CHF induction. Additionally, TVP1022 pretreatment attenuated CHF-induced cardiomyocyte hypertrophy, fibrosis, plasma and ventricular B-type natriuretic peptide levels, and reactive oxygen species expression. Further, in CHF rats, TVP1022 decreased cytochrome c and caspase 3 expression, thereby contributing to the cardioprotective efficacy of the drug. TVP1022 also enhanced the urinary Na(+) excretion and improved the glomerular filtration rate. Similar cardioprotective effects were obtained when TVP1022 was given to rats after CHF induction. TVP1022 attenuated the adverse functional, structural, and molecular alterations in CHF, rendering this drug a promising candidate for improving cardiac and renal function in this disease state.

  8. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H.; Pedersen, Susanne S.; Meine, Mathias

    2016-01-01

    of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12-20 %) who experienced poor health status at baseline improved to stable good health status....... The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination...

  9. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    C.Y. Hua

    2017-09-01

    Full Text Available Chronic heart failure (CHF is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP, and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all P<0.05. The physical and mental quality of life was also significantly improved by CCM (P<0.01 or P<0.05. Compared with usual care, CCM significantly increased the LVEF (P<0.01, decreased the NT-proBNP level (P<0.01, and enhanced exercise capacity (P<0.001. In conclusion, CCM improved the self-care, quality of life and cardiac function of patients with CHF compared with usual care.

  10. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature.

    Science.gov (United States)

    Anantha Narayanan, Mahesh; DeZorzi, Christopher; Akinapelli, Abhilash; Mahfood Haddad, Toufik; Smer, Aiman; Baskaran, Janani; Biddle, William P

    2015-01-01

    Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.

  11. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Mahesh Anantha Narayanan

    2015-01-01

    Full Text Available Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.

  12. Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats.

    Science.gov (United States)

    Wurtinger, Gabriel; Henrich, Estelle; Hildebrandt, Nicolai; Wiedemann, Nicola; Schneider, Matthias; Hassdenteufel, Esther

    2017-12-20

    Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity.

  13. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    Energy Technology Data Exchange (ETDEWEB)

    Dou Jianhong; Xia Ling; Zhang Yu; Shou Guofa [Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027 (China); Wei Qing; Liu Feng; Crozier, Stuart [School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Brisbane, Queensland 4072 (Australia)], E-mail: xialing@zju.edu.cn

    2009-01-21

    Asynchronous electrical activation, induced by bundle branch block (BBB), can cause reduced ventricular function. However, the effects of BBB on the mechanical function of heart are difficult to assess experimentally. Many heart models have been developed to investigate cardiac properties during BBB but have mainly focused on the electrophysiological properties. To date, the mechanical function of BBB has not been well investigated. Based on a three-dimensional electromechanical canine heart model, the mechanical properties of complete left and right bundle branch block (LBBB and RBBB) were simulated. The anatomical model as well as the fiber orientations of a dog heart was reconstructed from magnetic resonance imaging (MRI) and diffusion tensor MRI (DT-MRI). Using the solutions of reaction-diffusion equations and with a strategy of parallel computation, the asynchronous excitation propagation and intraventricular conduction in BBB was simulated. The mechanics of myocardial tissues were computed with time-, sarcomere length-dependent uniaxial active stress initiated at the time of depolarization. The quantification of mechanical intra- and interventricular asynchrony of BBB was then investigated using the finite-element method with an eight-node isoparametric element. The simulation results show that (1) there exists inter- and intraventricular systolic dyssynchrony during BBB; (2) RBBB may have more mechanical synchrony and better systolic function of the left ventricle (LV) than LBBB; (3) the ventricles always move toward the early-activated ventricle; and (4) the septum experiences higher stress than left and right ventricular free walls in BBB. The simulation results validate clinical and experimental recordings of heart deformation and provide regional quantitative estimates of ventricular wall strain and stress. The present work suggests that an electromechanical heart model, incorporating real geometry and fiber orientations, may be helpful for better

  14. Trial application of the candidate root cause categorization scheme and preliminary assessment of selected data bases for the root causes of component failures program

    International Nuclear Information System (INIS)

    Bruske, S.Z.; Cadwallader, L.C.; Stepina, P.L.

    1985-04-01

    The objective of the Nuclear Regulatory Commission's (NRC) Root Causes of Component Failures Program is to develop and apply a categorization scheme for identifying root causes of failures for components that comprise safety and safety support systems of nuclear power plants. Results from this program will provide valuable input in the areas of probabilistic risk assessment, reliability assurance, and application of risk assessments in the inspection program. This report presents the trial application and assessment of the candidate root cause categorization scheme to three failure data bases: the In-Plant Reliability Data System (IPRDS), the Licensee Event Report (LER) data base, and the Nuclear Plant Reliability Data System (NPRDS). Results of the trial application/assessment show that significant root cause information can be obtained from these failure data bases

  15. Salt-induced changes in cardiac phosphoproteome in a rat model of chronic renal failure.

    Directory of Open Access Journals (Sweden)

    Zhengxiu Su

    Full Text Available Heart damage is widely present in patients with chronic kidney disease. Salt diet is the most important environmental factor affecting development of chronic renal failure and cardiovascular diseases. The proteins involved in chronic kidney disease -induced heart damage, especially their posttranslational modifications, remain largely unknown to date. Sprague-Dawley rats underwent 5/6 nephrectomy (chronic renal failure model or sham operation were treated for 2 weeks with a normal-(0.4% NaCl, or high-salt (4% NaCl diet. We employed TiO2 enrichment, iTRAQ labeling and liquid-chromatography tandem mass spectrometry strategy for phosphoproteomic profiling of left ventricular free walls in these animals. A total of 1724 unique phosphopeptides representing 2551 non-redundant phosphorylation sites corresponding to 763 phosphoproteins were identified. During normal salt feeding, 89 (54% phosphopeptides upregulated and 76 (46% phosphopeptides downregulated in chronic renal failure rats relative to sham rats. In chronic renal failure rats, high salt intake induced upregulation of 84 (49% phosphopeptides and downregulation of 88 (51% phosphopeptides. Database searches revealed that most of the identified phospholproteins were important signaling molecules such as protein kinases, receptors and phosphatases. These phospholproteins were involved in energy metabolism, cell communication, cell differentiation, cell death and other biological processes. The Search Tool for the Retrieval of Interacting Genes analysis revealed functional links among 15 significantly regulated phosphoproteins in chronic renal failure rats compared to sham group, and 23 altered phosphoproteins induced by high salt intake. The altered phosphorylation levels of two proteins involved in heart damage, lamin A and phospholamban were validated. Expression of the downstream genes of these two proteins, desmin and SERCA2a, were also analyzed.

  16. The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.

    Science.gov (United States)

    Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia

    2016-01-20

    The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.

  17. Renal and post-renal causes of acute renal failure in children

    International Nuclear Information System (INIS)

    Jamal, A.; Ramzan, A.

    2004-01-01

    Objective: To identify the causes of acute renal failure (ARF) in pediatric population along with the identification of the age and gender most affected by the failure. Subjects and Methods: The study included children under the age of 12 years who presented with signs and symptoms suggestive of ARF (oliguria/anuria, vomiting, acidotic breathing etc.) along with raised blood urea nitrogen (BUN) serum creatinine and metabolic acidosis as shown by arterial blood gases (ABGs). Patients were divided into two group on the basis of age; group A consisting of 0-2 years and group B from >2 years. Patients presenting with transient pre-renal azotaemia were excluded from the study. After providing initial emergency cover, detailed history, physical examination and investigations were carried out according to a proforma specially designed to ascertain the cause of ARF. Patients were managed for ARF as per standard recommendations and investigations completed or repeated as and when required. Results: A total of 119 patients with ARF were admitted in the ward over a period of two years constituting 1.36% of the total admissions and 16.39% of the admissions due to renal pathology. Mean age of presentation was 4.5 years 16.7% of the patients under the age of 5 years. Male predominance was noted in all ages with an overall male to female ratio of 2.3:1. Most common cause leading to ARF in younger age group was found to be hemolytic uremic syndrome [25(54.34%)] followed by septicemia [7(15.21 %)]. In older patients renal calculus disease was the most common [22(30.13%)] underlying pathology followed by pre-existing, undiagnosed chronic renal failure [16(21.91 %)]. Conclusion: ARF is fairly cotton in children especially under the age of 5 years showing a male predominance. More than 90% of the cases can be prevented by improving primary health care and by early and prompt treatment of infections. (author)

  18. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery.

    Science.gov (United States)

    Song, Minju; Kim, Hyeon-Cheol; Lee, Woocheol; Kim, Euiseong

    2011-11-01

    This study examined the clinical causes of failure and the limitation of a previous endodontic treatment by an inspection of the root apex and resected root surface at 26× magnification during endodontic microsurgery. The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All root-filled cases with symptomatic or asymptomatic apical periodontitis were enrolled in this study. All surgical procedures were performed by using an operating microscope. The surface of the apical root to be resected or the resected root surface after methylene blue staining was examined during the surgical procedure and recorded carefully with 26× magnification to determine the state of the previous endodontic treatment by using an operating microscope. Among the 557 cases with periapical surgery, 493 teeth were included in this study. With the exclusion of unknown cases, the most common possible cause of failure was perceived leakage around the canal filling material (30.4%), followed by a missing canal (19.7%), underfilling (14.2%), anatomical complexity (8.7%), overfilling (3.0%), iatrogenic problems (2.8%), apical calculus (1.8%), and cracks (1.2%). The frequency of possible failure causes differed according to the tooth position (P < .001). An appreciation of the root canal anatomy by using an operating microscope in nonsurgical endodontic treatment can make the prognosis more predictable and favorable. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Particles Alter Diesel Exhaust Gases-Induced Hypotension, Cardiac Arrhythmia,Conduction Disturbance, and Autonomic Imbalance in Heart Failure-Prone Rats

    Science.gov (United States)

    Epidemiologic studies indicate that acute exposures to vehicular traffic and particulate matter (PM) air pollution are key causes of fatal cardiac arrhythmia, especially in those with preexisting cardiovascular disease. Researchers point to electrophysiologic dysfunction and auto...

  20. TNF-α receptor 1 knockdown in the subfornical organ ameliorates sympathetic excitation and cardiac hemodynamics in heart failure rats.

    Science.gov (United States)

    Yu, Yang; Wei, Shun-Guang; Weiss, Robert M; Felder, Robert B

    2017-10-01

    In systolic heart failure (HF), circulating proinflammatory cytokines upregulate inflammation and renin-angiotensin system (RAS) activity in cardiovascular regions of the brain, contributing to sympathetic excitation and cardiac dysfunction. Important among these is the subfornical organ (SFO), a forebrain circumventricular organ that lacks an effective blood-brain barrier and senses circulating humors. We hypothesized that the tumor necrosis factor-α (TNF-α) receptor 1 (TNFR1) in the SFO contributes to sympathetic excitation and cardiac dysfunction in HF rats. Rats received SFO microinjections of a TNFR1 shRNA or a scrambled shRNA lentiviral vector carrying green fluorescent protein, or vehicle. One week later, some rats were euthanized to confirm the accuracy of the SFO microinjections and the transfection potential of the lentiviral vector. Other rats underwent coronary artery ligation (CL) to induce HF or a sham operation. Four weeks after CL, vehicle- and scrambled shRNA-treated HF rats had significant increases in TNFR1 mRNA and protein, NF-κB activity, and mRNA for inflammatory mediators, RAS components and c-Fos protein in the SFO and downstream in the hypothalamic paraventricular nucleus, along with increased plasma norepinephrine levels and impaired cardiac function, compared with vehicle-treated sham-operated rats. In HF rats treated with TNFR1 shRNA, TNFR1 was reduced in the SFO but not paraventricular nucleus, and the central and peripheral manifestations of HF were ameliorated. In sham-operated rats treated with TNFR1 shRNA, TNFR1 expression was also reduced in the SFO but there were no other effects. These results suggest a key role for TNFR1 in the SFO in the pathophysiology of systolic HF. NEW & NOTEWORTHY Activation of TNF-α receptor 1 in the subfornical organ (SFO) contributes to sympathetic excitation in heart failure rats by increasing inflammation and renin-angiotensin system activity in the SFO and downstream in the hypothalamic

  1. Effect of the adjuvant milrinone therapy on cardiac function, myocardial remodeling and RAAS system activity in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Jing Chen

    2017-09-01

    Full Text Available Objective: To explore the effect of the adjuvant milrinone therapy on cardiac function, myocardial remodeling and RAAS system activity in patients with chronic heart failure. Methods: A total of 110 patients with chronic heart failure who were treated in the hospital between January 2015 and January 2017 were divided into control group (n=55 and observation group (n=55 by random number table method. Control group received conventional therapy for chronic heart failure, and the observation group received milrinone on the basis of conventional therapy. The differences in ultrasound cardiac function and myocardial remodeling index levels as well as serum RAAS index contents were compared between the two groups before and after treatment. Results: Before treatment, the differences in ultrasound cardiac function and myocardial remodeling index levels as well as serum RAAS index contents were not statistically significant between the two groups. After treatment, CO and SV levels of both groups of patients were significantly higher than those before treatment while LADd, LVEDd, LVPWT, IVST and LVMI levels as well as serum PRA, AngⅡ and ALD contents were significantly lower than those before treatment, and CO and SV levels of observation group were significantly higher than those of control group while LADd, LVEDd, LVPWT, IVST and LVMI levels as well as serum PRA, AngⅡ and ALD contents were significantly lower than those of control group. Conclusion: Adjuvant milrinone therapy can effectively enhance the cardiac function, inhibit the myocardial remodeling and decrease the RAAS system activity in patients with chronic heart failure.

  2. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    OBJECTIVE: To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF. DESIGN: The NRP was used to identify...

  3. Effect of cardiac resynchronization therapy-defibrillator implantation on health status in patients with mild versus moderate symptoms of heart failure

    DEFF Research Database (Denmark)

    Versteeg, Henneke; van den Broek, Krista C; Theuns, Dominic A M J

    2011-01-01

    Indications for cardiac resynchronization therapy (CRT) have expanded to include patients with mild congestive heart failure (CHF) symptoms (New York Heart Association [NYHA] functional class II) because of a demonstrated morbidity reduction in this subset of patients. However, little is known...

  4. Influence of the definition of acute renal failure post-cardiac surgery on incidence, patient identification, and identification of risk factors

    NARCIS (Netherlands)

    Noyez, L.

    2011-01-01

    OBJECTIVE: Acute renal failure post-cardiac surgery (RF) is a major complication and is associated with increased postoperative morbidity and mortality. Early recognition and identification of risk factors for RF is therefore important. However, several definitions of RF are used. The intention of

  5. Resuscitation of sudden cardiac death caused by acute epileptic seizures: A case report

    Directory of Open Access Journals (Sweden)

    Dana-Oliviana Geavlete

    2016-03-01

    Full Text Available Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving.

  6. Defense-in-depth for common cause failure of nuclear power plant safety system software

    International Nuclear Information System (INIS)

    Tian Lu

    2012-01-01

    This paper briefly describes the development of digital I and C system in nuclear power plant, and analyses the viewpoints of NRC and other nuclear safety authorities on Software Common Cause Failure (SWCCF). In view of the SWCCF issue introduced by the digitized platform adopted in nuclear power plant safety system, this paper illustrated a diversified defence strategy for computer software and hardware. A diversified defence-in-depth solution is provided for digital safety system of nuclear power plant. Meanwhile, analysis on problems may be faced during application of nuclear safety license are analyzed, and direction of future nuclear safety I and C system development are put forward. (author)

  7. OECD/NEA International Common Cause Failure Data Exchange (ICDE) project - insights and lessons learnt

    International Nuclear Information System (INIS)

    Johanson, G.; Kreuser, A.; Pyy, P.; Rasmuson, D.; Werner, W.

    2006-01-01

    Events initiated by common-cause-failure (CCF) can significantly affect the availability and reliability of nuclear power plant safety systems. In recognition of this, CCF data are systematically collected and analysed in the International Common-Cause Data Exchange (ICDE) Project, which was initiated in August 1994. Since April 1998, the NEA has formally operated the project. Currently eleven countries participate in the project. The ICDE collects all events where two or more identical, redundant components of a group, fulfilling the same function, have failed or were impaired due to a shared cause (ICDE events). Complete CCFs, i. e. failure of all identical, redundant components in the group due to a shared cause are an important subset of the collected data. Currently, data exchange and analysis covers the following components: centrifugal pumps, diesel generators, motor-operated valves, safety and relief valves, check valves, reactor protection system components (level measurement, control rod drives, etc), circuit breakers, and batteries. The main findings of the ICDE reports issued by 2005 show averaged over all components that about two thirds of all complete CCF events involve faulty actions by plant personnel and contractors. The single largest contribution is from faulty testing and maintenance work due to deficient and/or incomplete procedures. Other important causes are insufficient testing and requalification of components or systems after maintenance, repair, modifications or backfitting work, as well as operator errors of commission. The probability that a reported ICDE event is a complete CCF decreases strongly with increasing number of redundant components, demonstrating the effectiveness of redundancy as a powerful defence against CCFs. However, complete CCFs cannot be completely prevented by high redundancy only. (orig.)

  8. Short-Term Caloric Restriction Suppresses Cardiac Oxidative Stress and Hypertrophy Caused by Chronic Pressure Overload.

    Science.gov (United States)

    Kobara, Miyuki; Furumori-Yukiya, Akiko; Kitamura, Miho; Matsumura, Mihoko; Ohigashi, Makoto; Toba, Hiroe; Nakata, Tetsuo

    2015-08-01

    Caloric restriction (CR) prevents senescent changes, in which reactive oxygen species (ROS) have a critical role. Left ventricular (LV) hypertrophy is a risk factor for cardiovascular diseases. We examined whether CR alters cardiac redox state and hypertrophy from chronic pressure overload. Male c57BL6 mice were subjected to ascending aortic constriction (AAC) with ad libitum caloric intake (AL + AAC group) or 40% restricted caloric intake (CR + AAC group). CR was initiated 2 weeks before AAC and was continued for 4 weeks. Two weeks after constriction, AAC increased LV wall thickness, impaired transmitral flow velocity, and augmented myocyte hypertrophy and fibrosis, in association with enhancement of BNP and collagen III expressions in the AL + AAC group. In the AL + AAC group, oxidative stress in cardiac tissue and mitochondria were enhanced, and NADPH oxidase activity and mitochondrial ROS production were elevated. These changes were significantly attenuated in the CR + AAC group. Additionally, in antioxidant systems, myocardial glutathione peroxidase and superoxide dismutase activities were enhanced in the CR + AAC group. Chronic pressure overload increased cardiac oxidative damage, in association with cardiac hypertrophy and fibrosis. Short-term CR suppressed oxidative stress and improved cardiac function, suggesting that short-term CR could be a useful strategy to prevent pressure overload-induced cardiac injury. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Long Non-Coding RNA Malat-1 Is Dispensable during Pressure Overload-Induced Cardiac Remodeling and Failure in Mice.

    Directory of Open Access Journals (Sweden)

    Tim Peters

    Full Text Available Long non-coding RNAs (lncRNAs are a class of RNA molecules with diverse regulatory functions during embryonic development, normal life, and disease in higher organisms. However, research on the role of lncRNAs in cardiovascular diseases and in particular heart failure is still in its infancy. The exceptionally well conserved nuclear lncRNA Metastasis associated in lung adenocarcinoma transcript 1 (Malat-1 is a regulator of mRNA splicing and highly expressed in the heart. Malat-1 modulates hypoxia-induced vessel growth, activates ERK/MAPK signaling, and scavenges the anti-hypertrophic microRNA-133. We therefore hypothesized that Malat-1 may act as regulator of cardiac hypertrophy and failure during cardiac pressure overload induced by thoracic aortic constriction (TAC in mice.Absence of Malat-1 did not affect cardiac hypertrophy upon pressure overload: Heart weight to tibia length ratio significantly increased in WT mice (sham: 5.78±0.55, TAC 9.79±1.82 g/mm; p<0.001 but to a similar extend also in Malat-1 knockout (KO mice (sham: 6.21±1.12, TAC 8.91±1.74 g/mm; p<0.01 with no significant difference between genotypes. As expected, TAC significantly reduced left ventricular fractional shortening in WT (sham: 38.81±6.53%, TAC: 23.14±11.99%; p<0.01 but to a comparable degree also in KO mice (sham: 37.01±4.19%, TAC: 25.98±9.75%; p<0.05. Histological hallmarks of myocardial remodeling, such as cardiomyocyte hypertrophy, increased interstitial fibrosis, reduced capillary density, and immune cell infiltration, did not differ significantly between WT and KO mice after TAC. In line, the absence of Malat-1 did not significantly affect angiotensin II-induced cardiac hypertrophy, dysfunction, and overall remodeling. Above that, pressure overload by TAC significantly induced mRNA levels of the hypertrophy marker genes Nppa, Nppb and Acta1, to a similar extend in both genotypes. Alternative splicing of Ndrg2 after TAC was apparent in WT (isoform ratio

  10. Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study.

    Science.gov (United States)

    Bonios, Michael J; Koliopoulou, Antigone; Wever-Pinzon, Omar; Taleb, Iosif; Stehlik, Josef; Xu, Weining; Wever-Pinzon, James; Catino, Anna; Kfoury, Abdallah G; Horne, Benjamin D; Nativi-Nicolau, Jose; Adamopoulos, Stamatis N; Fang, James C; Selzman, Craig H; Bax, Jeroen J; Drakos, Stavros G

    2018-04-01

    Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P =0.014). LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device. © 2018 American Heart Association, Inc.

  11. Common cause failure data collection and analysis for safety-related components of TRIGA SSR-14MW Pitesti, Romania

    International Nuclear Information System (INIS)

    Radu, G.; Mladin, D.

    2003-01-01

    This paper presents a study performed on the set of common cause failures (CCF) of safety-related components of the research reactor TRIGA SSR-14 MW Pitesti. The data collected cover a period of 20 years, from 1979 to 2000. The sources of data are Shift Supervisor Reports, Work Authorizations, and Reactor Log Books. Events collected are analyzed by failure mode and degrees of failure. Qualitative analysis of root causes, coupling factors and corrective actions and quantitative analysis of CCF events are studied. The objective of this work is to develop qualitative insights in the nature of the reported events and to build a site-specific common cause events database. (author)

  12. Identification of genetic markers for treatment success in heart failure patients: insight from cardiac resynchronization therapy.

    Science.gov (United States)

    Schmitz, Boris; De Maria, Renata; Gatsios, Dimitris; Chrysanthakopoulou, Theodora; Landolina, Maurizio; Gasparini, Maurizio; Campolo, Jonica; Parolini, Marina; Sanzo, Antonio; Galimberti, Paola; Bianchi, Michele; Lenders, Malte; Brand, Eva; Parodi, Oberdan; Lunati, Maurizio; Brand, Stefan-Martin

    2014-12-01

    Cardiac resynchronization therapy (CRT) can improve ventricular size, shape, and mass and reduce mitral regurgitation by reverse remodeling of the failing ventricle. About 30% of patients do not respond to this therapy for unknown reasons. In this study, we aimed at the identification and classification of CRT responder by the use of genetic variants and clinical parameters. Of 1421 CRT patients, 207 subjects were consecutively selected, and CRT responder and nonresponder were matched for their baseline parameters before CRT. Treatment success of CRT was defined as a decrease in left ventricular end-systolic volume >15% at follow-up echocardiography compared with left ventricular end-systolic volume at baseline. All other changes classified the patient as CRT nonresponder. A genetic association study was performed, which identified 4 genetic variants to be associated with the CRT responder phenotype at the allelic (Passociated with remodeling of the failing ventricle. © 2014 American Heart Association, Inc.

  13. Gαq protein carboxyl terminus imitation polypeptide GCIP-27 improves cardiac function in chronic heart failure rats.

    Directory of Open Access Journals (Sweden)

    Xiao Lan Lu

    Full Text Available Gαq protein carboxyl terminus imitation polypeptide (GCIP-27 has been shown to alleviate pathological cardiomyocyte hypertrophy induced by various factors. Pathological cardiac hypertrophy increases the morbidity and mortality of cardiovascular diseases while it compensates for poor heart function. This study was designed to investigate the effects of GCIP-27 on heart function in rats with heart failure induced by doxorubicin.Forty-eight rats were randomly divided into the following six groups receiving vehicle (control, doxorubicin (Dox, losartan (6 mg/kg, i.g. and three doses of GCIP-27 (10, 30, 90 μg/kg; i.p., bid, respectively. Heart failure was induced by Dox, which was administered at a 20 mg/kg cumulative dose. After 10 weeks of treatment, we observed that GCIP-27 (30, 90 μg/kg significantly increased ejection fraction, fraction shortening, stroke volume and sarcoplasmic reticulum Ca2+ ATPase activity of Dox-treated hearts. Additionally, GCIP-27 decreased myocardial injury, heart weight index and left ventricular weight index, fibrosis and serum cardiac troponin-I concentration in Dox-treated mice. Immunohistochemistry, western blotting and real-time PCR experiments indicated that GCIP-27 (10-90 μg/kg could markedly upregulate the protein expression of myocardial α-myosin heavy chain (MHC, Bcl-2, protein kinase C (PKC ε and phosphorylated extracellular signal-regulated kinase (p-ERK 1/2 as well as the mRNA expression of α-MHC, but downregulated the expression of β-MHC, Bax and PKC βII, and the mRNA expression levels of β-MHC in Dox-treated mice. It was also found that GCIP-27 (30, 90 μg/L decreased cell size and protein content of cardiomyocytes significantly in vitro by comparison of Dox group.GCIP-27 could effectively ameliorate heart failure development induced by Dox. PKC-ERK1/2 signaling might represent the underlying mechanism of the beneficial effects of GCIP-27.

  14. Random safety auditing, root cause analysis, failure mode and effects analysis.

    Science.gov (United States)

    Ursprung, Robert; Gray, James

    2010-03-01

    Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

  15. Causes of failure to control hypertension in people over 65 years of age

    Directory of Open Access Journals (Sweden)

    Alireza Khosravi

    2012-03-01

    Full Text Available BACKGROUND: Hypertension is a major cause of cardiovascular diseases whose prevalence increases by 10% for every 10 years after 50 years of age. This study aimed to investigate the causes of failure to control blood pressure in people aged over 65 years old. METHODS: This descriptive case-control study was conducted on 200 participants aged over 65 years old who were diagnosed with hypertension through a routine travel check-up for pilgrimage to Mecca in Amin Hospital, Isfahan, Iran during 2003. Following the medical examinations and blood pressure measurements according to the World Health Organization (WHO standards, the participants were divided into two groups of controlled blood pressure (case and uncontrolled blood pressure (control. A questionnaire was filled in for each participant and the data was analyzed using chi-square and student-t tests. RESULTS: The mean age was 70.7 ± 5.2 and 69 ± 4.9 in case and control groups, respectively. Less than half of the participants in the case group took anti-hypertensive medicine, out of which 87.5% were treated by a physician and 12.5% practiced self-therapy. In addition, 25% took their medicine regularly and 55% expressed a lack of motivation as the cause of discontinuing their medication. Furthermore, patients with controlled blood pressure had significantly better knowledge and performance than the case group (P < 0.05. CONCLUSION: The most common causes of failure to control blood pressure were poor knowledge, inappropriate practice in diet, stress, smoking, and irregular intake of medication. Keywords: Hypertension, Cardiovascular Diseases, Antihypertensive Agents, Diet Therapy    

  16. International common-cause failure data exchange. ICDE general coding guidelines - Technical note

    International Nuclear Information System (INIS)

    Johanson, Gunnar; Werner, Wolfgang; Concepcion Capote, Marina; Kreuser, Albert; Rasmuson, Dale; Jonsson, Esther; Pereira Pagan, Begona; Tirira, Jorge; Morris, Ian; Morales, Rosa; Oxberry, Anna; Kreuser, Albert

    2004-01-01

    Several Member countries of the Nuclear Energy Agency of the Organisation for Economic Co-operation and Development (OECD/NEA) have established the International Common-Cause Failure Data Exchange Project (ICDE Project) to encourage multilateral co-operation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The objectives of the ICDE Project are to: a) Collect and analyse CCF events over the long term so as to better understand such events, their causes, and their prevention; b) Generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences; c) Establish a mechanism for the efficient feedback of experience gained in connection with CCF phenomena, including the development of defences against their occurrence, such as indicators for risk based inspections; and d) Record event attributes to facilitate quantification of CCF frequencies when so decided by the Project Working Group. The ICDE Project is envisaged to comprise all possible events of interest, including both complete and partial ICDE events. The ICDE Project will cover the key components of the main safety systems. Presently, the components listed below are included in the ICDE Project. Data have been collected for the six first components in the list: Centrifugal pumps, Diesel generators, Motor operated valves, Safety relief valves/power operated relief valves, Check valves, Batteries, Level measurement, Breakers, Control rod drive assemblies. Others will be added to this list later on. In this component coding guidelines, explanations on the ICDE General coding format are given. The guide reflects present experience with the data format and with the collected data. Further interpretations and clarifications will be added, should they become necessary. For each component analysed in the ICDE project, separate coding guidance is provided in the appendices

  17. Estimation of the common cause failure probabilities on the component group with mixed testing scheme

    International Nuclear Information System (INIS)

    Hwang, Meejeong; Kang, Dae Il

    2011-01-01

    Highlights: ► This paper presents a method to estimate the common cause failure probabilities on the common cause component group with mixed testing schemes. ► The CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing. ► There are many CCCGs with specific mixed testing schemes in real plant operation. ► Therefore, a general formula which is applicable to both alternate periodic testing scheme and train level mixed testing scheme was derived. - Abstract: This paper presents a method to estimate the common cause failure (CCF) probabilities on the common cause component group (CCCG) with mixed testing schemes such as the train level mixed testing scheme or the alternate periodic testing scheme. In the train level mixed testing scheme, the components are tested in a non-staggered way within the same train, but the components are tested in a staggered way between the trains. The alternate periodic testing scheme indicates that all components in the same CCCG are tested in a non-staggered way during the planned maintenance period, but they are tested in a staggered way during normal plant operation. Since the CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing, CCF estimators have two kinds of formulas in accordance with the testing schemes. Thus, there are general formulas to estimate the CCF probability on the staggered testing scheme and non-staggered testing scheme. However, in real plant operation, there are many CCCGs with specific mixed testing schemes. Recently, Barros () and Kang () proposed a CCF factor estimation method to reflect the alternate periodic testing scheme and the train level mixed testing scheme. In this paper, a general formula which is applicable to both the alternate periodic testing scheme and the train level mixed testing scheme was derived.

  18. International Common Cause Failure Data Exchange (ICDE). General Coding Guidelines - Updated Version, October 2011

    International Nuclear Information System (INIS)

    Johanson, Gunnar; Werner, Wolfgang; Capote, Marina Concepcion; Kreuser, Albert

    2012-01-01

    Several OECD/NEA member countries have established the International Common-Cause Failure Data Exchange Project ('ICDE Project') to encourage multilateral cooperation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The objectives of the ICDE Project are to: a) Collect and analyse CCF events over the long term so as to better understand such events, their causes, and their prevention. b) Generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences. c) Establish a mechanism for the efficient feedback of experience gained in connection with CCF phenomena, including the development of defenses against their occurrence, such as indicators for risk based inspections. d) Record event attributes to facilitate quantification of CCF frequencies when so decided by the Project Working Group. The ICDE Project is envisaged to comprise all possible events of interest, including both complete and partial ICDE events. The ICDE Project will cover the key components of the main safety systems. Presently, the components listed below are included in the ICDE Project. Data have been collected for the six first components in the list: Centrifugal pumps, Diesel generators, Motor operated valves, Safety relief valves/power operated relief valves, Check valves, Batteries, Level measurement, Breakers, Control rod drive assemblies. Others will be added to this list later on. In this component coding guidelines, explanations on the ICDE general coding format are given. The guide reflects present experience with the data format and with the collected data. Further interpretations and clarifications will be added, should they become necessary. For each component analysed in the ICDE project, separate coding guidance is provided in the appendices ICDECG 01-06, specifying details relevant to the respective components

  19. HIV reservoirs and immune surveillance evasion cause the failure of structured treatment interruptions: a computational study.

    Directory of Open Access Journals (Sweden)

    Emiliano Mancini

    Full Text Available Continuous antiretroviral therapy is currently the most effective way to treat HIV infection. Unstructured interruptions are quite common due to side effects and toxicity, among others, and cannot be prevented. Several attempts to structure these interruptions failed due to an increased morbidity compared to continuous treatment. The cause of this failure is poorly understood and often attributed to drug resistance. Here we show that structured treatment interruptions would fail regardless of the emergence of drug resistance. Our computational model of the HIV infection dynamics in lymphoid tissue inside lymph nodes, demonstrates that HIV reservoirs and evasion from immune surveillance themselves are sufficient to cause the failure of structured interruptions. We validate our model with data from a clinical trial and show that it is possible to optimize the schedule of interruptions to perform as well as the continuous treatment in the absence of drug resistance. Our methodology enables studying the problem of treatment optimization without having impact on human beings. We anticipate that it is feasible to steer new clinical trials using computational models.

  20. Tsunamis caused by submarine slope failures along western Great Bahama Bank.

    Science.gov (United States)

    Schnyder, Jara S D; Eberli, Gregor P; Kirby, James T; Shi, Fengyan; Tehranirad, Babak; Mulder, Thierry; Ducassou, Emmanuelle; Hebbeln, Dierk; Wintersteller, Paul

    2016-11-04

    Submarine slope failures are a likely cause for tsunami generation along the East Coast of the United States. Among potential source areas for such tsunamis are submarine landslides and margin collapses of Bahamian platforms. Numerical models of past events, which have been identified using high-resolution multibeam bathymetric data, reveal possible tsunami impact on Bimini, the Florida Keys, and northern Cuba. Tsunamis caused by slope failures with terminal landslide velocity of 20 ms -1 will either dissipate while traveling through the Straits of Florida, or generate a maximum wave of 1.5 m at the Florida coast. Modeling a worst-case scenario with a calculated terminal landslide velocity generates a wave of 4.5 m height. The modeled margin collapse in southwestern Great Bahama Bank potentially has a high impact on northern Cuba, with wave heights between 3.3 to 9.5 m depending on the collapse velocity. The short distance and travel time from the source areas to densely populated coastal areas would make the Florida Keys and Miami vulnerable to such low-probability but high-impact events.

  1. Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure

    International Nuclear Information System (INIS)

    Koutelou, M.; Katsikis, A.; Livanis, E.; Georgiadis, M.; Voudris, V.; Flevari, P.; Kremastinos, D.; Theodorakis, G.

    2009-01-01

    We aimed at evaluating the combined use of heart rate variability (HRV), baroreflex sensitivity (BRS), and metaiodobenzylguanidine (MIBG) imaging in the risk stratification for sudden cardiac death (SCD) of patients with mild to moderate heart failure. Twenty-five patients (17 male and 8 female, mean age 63±5 years, mean left ventricular ejection fraction (LVEF) 36±3%) with a recently implanted cardioverter-defibrillator (ICD) and mild (NYHA I-II) heart failure due to either ischemic (n=15) or dilated (n=10) cardiomyopathy were studied. One week after ICD implantation they underwent baroreflex sensitivity (BRS) evaluation to bolus phenylephrine by the Oxford method, 24-h heart rate variability (HRV) assessment, and MIBG imaging. The mean patient follow-up was 32±10 months. Simple correlation and stepwise multiple regression analysis was performed to evaluate if the number of sustained ventricular tachycardia (cycle length <330 ms) or fibrillation episodes per month is related to one or more of MIBG, BRS, and HRV indexes and if MIBG % washout is related to HRV and/or BRS. The frequency of fast ventricular arrhythmic episodes (FVAE) demonstrated an inverse relation to BRS (p<0.0001), rMSSD (p=0.001), and pNN50 (p=0.0034), while it was positively related to low frequency (LF) (p<0.0001) and MIBG % washout (p=0.001). BRS, LF, rMSSD, and MIBG washout were also independent predictors of FVAE. MIBG washout was related to only one HRV marker (SDNN-I, p<0.0001), while no correlation was observed with BRS. In ICD recipients with well-compensated heart failure, autonomic markers derived from BRS, HRV, and MIBG studies are related to FVAE. These markers have limited inter-dependency and constitute useful means for SCD risk stratification in this subgroup of patients. (author)

  2. Cardiac Stress and Inflammatory Markers as Predictors of Heart Failure in Patients With Type 2 Diabetes: The ADVANCE Trial.

    Science.gov (United States)

    Ohkuma, Toshiaki; Jun, Min; Woodward, Mark; Zoungas, Sophia; Cooper, Mark E; Grobbee, Diederick E; Hamet, Pavel; Mancia, Giuseppe; Williams, Bryan; Welsh, Paul; Sattar, Naveed; Shaw, Jonathan E; Rahimi, Kazem; Chalmers, John

    2017-09-01

    This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes. A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP. Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers. © 2017 by the American Diabetes Association.

  3. Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain

    International Nuclear Information System (INIS)

    Erdogan, Zeynep; Silov, Güler; Özdal, Aysegül; Turhal, Özgül

    2013-01-01

    Myocardial perfusion imaging (MPI) with technetium-99m sestamibi ( 99m Tc MIBI) is considered a diagnostic technique that is widely used for the investigation of suspected coronary artery disease. Incidental inspection of an extracardiac activity is indirect, but important marker, which can identify a potentially treatable non-coronary cause for chest pain that may mimic cardiac symptoms. Here, we present an illustrative case in which significant enterogastroesophageal reflux of 99m Tc MIBI occurred during the cardiac imaging following prompt hepatobiliary clearance. Because, there was normal myocardial perfusion on MPI, presence of gastroesophageal reflux (GER) on GER scintigraphy and detection of mild inflammation with pathologically confirmed hyperplastic polyp by endoscopy, in view of the above findings we concluded that the probable cause of chest pain was reflux. (author)

  4. Class III antiarrhythmic agents in cardiac failure: lessons from clinical trials with a focus on the Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA).

    Science.gov (United States)

    Doval, H C

    1999-11-04

    The results of previous clinical trials, in a variety of clinical settings, showed that class I agents may consistently increase mortality in sharp contrast to the effects of beta blockers. Attention has therefore shifted to class III compounds for potential beneficial effects on long-term mortality among patients with underlying cardiac disease. Clinical trials with d-sotalol, the dextro isomer (devoid of beta blockade) of sotalol, showed increased mortality in patients with low ejection fraction after myocardial infarction and in those with heart failure; whereas in the case of dofetilide, the impact on mortality was neutral. Because of the complex effects of its actions as an alpha-adrenergic blocker and a class III agent, the impact on mortality of amiodarone in patients with heart failure is of particular interest. A meta-analysis of 13 clinical trials revealed significant reductions in all-cause and cardiac mortality among patients with heart failure or previous myocardial infarction. Among these were 5 controlled clinical trials that investigated the effects of amiodarone on mortality among patients with heart failure. None of these trials was large relative to the beta-blocker trials in the postinfarction patients. However, the larger 2 of the 5 amiodarone trials produced discordant effects on mortality, neutral in one and significantly positive in the other. Some of the differences may be accounted for by the differences in eligibility criteria and baseline characteristics. Future trials that may be undertaken to resolve the discrepancies may need to allow for the newer findings on the effects of concomitant beta blockers, implantable devices, and possibly, spironolactone. All these modalities of treatment have been shown in controlled clinical trials to augment survival in patients with impaired ventricular function or manifest heart failure. Additional trials, some of which are currently in progress, compare amiodarone with implantable devices and other

  5. Pacemaker lead fracture without an increase in lead impedance caused by cardiac fibroma

    Directory of Open Access Journals (Sweden)

    Daisuke Sato

    2013-12-01

    Full Text Available We report the case of a 64-year-old man who had a permanent pacemaker with a unipolar silicone electrode positioned in the right ventricle in 1989 for sinus node dysfunction. On a routine checkup in June 2011, a 28-mm-diameter mass was discovered, which appeared to adhere to the tricuspid valve and the ventricular lead. The size of the mass did not change for the next 6 months, and the lead impedance was maintained at around 500–600 Ω. Because pacing failure was observed in January 2012, he underwent an urgent pacemaker check; however, the lead impedance was found not to have increased greatly (689 Ω. Nevertheless, the pacemaker lead was noted to be fractured at the tricuspid level. His echocardiogram showed new severe tricuspid regurgitation and a floating mass around the lead. We extracted the fractured lead, enucleated the tumor, replaced the tricuspid valve, and placed an epicardial lead. Macroscopic examination revealed that the tumor surrounded the fractured lead and covered the stump. Pathological examination revealed that the tumor was composed of fibrous connective tissue. We presumed that electric current continued to flow through the stump of the fractured unipolar lead to the generator, and this might have caused the limited increase in lead impedance.

  6. BDD-based reliability evaluation of phased-mission systems with internal/external common-cause failures

    International Nuclear Information System (INIS)

    Xing, Liudong; Levitin, Gregory

    2013-01-01

    Phased-mission systems (PMS) are systems in which multiple non-overlapping phases of operations (or tasks) are accomplished in sequence for a successful mission. Examples of PMS abound in applications such as aerospace, nuclear power, and airborne weapon systems. Reliability analysis of a PMS must consider statistical dependence across different phases as well as dynamics in system configuration, failure criteria, and component behavior. This paper proposes a binary decision diagrams (BDD) based method for the reliability evaluation of non-repairable binary-state PMS with common-cause failures (CCF). CCF are simultaneous failure of multiple system elements, which can be caused by some external factors (e.g., lightning strikes, sudden changes in environment) or by propagated failures originating from some elements within the system. Both the external and internal CCF is considered in this paper. The proposed method is combinatorial, exact, and is applicable to PMS with arbitrary system structures and component failure distributions. An example with different CCF scenarios is analyzed to illustrate the application and advantages of the proposed method. -- Highlights: ► Non-repairable phased-mission systems with common-cause failures are analyzed. ► Common-cause failures caused by internal or external factors are considered. ► A combinatorial algorithm based on binary decision diagrams is suggested

  7. Lack of chemokine signaling through CXCR5 causes increased mortality, ventricular dilatation and deranged matrix during cardiac pressure overload.

    Directory of Open Access Journals (Sweden)

    Anne Waehre

    Full Text Available RATIONALE: Inflammatory mechanisms have been suggested to play a role in the development of heart failure (HF, but a role for chemokines is largely unknown. Based on their role in inflammation and matrix remodeling in other tissues, we hypothesized that CXCL13 and CXCR5 could be involved in cardiac remodeling during HF. OBJECTIVE: We sought to analyze the role of the chemokine CXCL13 and its receptor CXCR5 in cardiac pathophysiology leading to HF. METHODS AND RESULTS: Mice harboring a systemic knockout of the CXCR5 (CXCR5(-/- displayed increased mortality during a follow-up of 80 days after aortic banding (AB. Following three weeks of AB, CXCR5(-/- developed significant left ventricular (LV dilatation compared to wild type (WT mice. Microarray analysis revealed altered expression of several small leucine-rich proteoglycans (SLRPs that bind to collagen and modulate fibril assembly. Protein levels of fibromodulin, decorin and lumican (all SLRPs were significantly reduced in AB CXCR5(-/- compared to AB WT mice. Electron microscopy revealed loosely packed extracellular matrix with individual collagen fibers and small networks of proteoglycans in AB CXCR5(-/- mice. Addition of CXCL13 to cultured cardiac fibroblasts enhanced the expression of SLRPs. In patients with HF, we observed increased myocardial levels of CXCR5 and SLRPs, which was reversed following LV assist device treatment. CONCLUSIONS: Lack of CXCR5 leads to LV dilatation and increased mortality during pressure overload, possibly via lack of an increase in SLRPs. This study demonstrates a critical role of the chemokine CXCL13 and CXCR5 in survival and maintaining of cardiac structure upon pressure overload, by regulating proteoglycans essential for correct collagen assembly.

  8. A New Transgenic Mouse Model of Heart Failure and Cardiac Cachexia Raised by Sustained Activation of Met Tyrosine Kinase in the Heart

    Directory of Open Access Journals (Sweden)

    Valentina Sala

    2016-01-01

    Full Text Available Among other diseases characterized by the onset of cachexia, congestive heart failure takes a place of relevance, considering the high prevalence of this pathology in most European countries and in the United States, and is undergoing a rapid increase in developing countries. Actually, only few models of cardiac cachexia exist. Difficulties in the recruitment and follow-up of clinical trials implicate that new reproducible and well-characterized animal models are pivotal in developing therapeutic strategies for cachexia. We generated a new model of cardiac cachexia: a transgenic mouse expressing Tpr-Met receptor, the activated form of c-Met receptor of hepatocyte growth factor, specifically in the heart. We showed that the cardiac-specific induction of Tpr-Met raises a cardiac hypertrophic remodelling, which progresses into concentric hypertrophy with concomitant increase in Gdf15 mRNA levels. Hypertrophy progresses to congestive heart failure with preserved ejection fraction, characterized by reduced body weight gain and food intake and skeletal muscle wasting. Prevention trial by suppressing Tpr-Met showed that loss of body weight could be prevented. Skeletal muscle wasting was also associated with altered gene expression profiling. We propose transgenic Tpr-Met mice as a new model of cardiac cachexia, which will constitute a powerful tool to understand such complex pathology and test new drugs/approaches at the preclinical level.

  9. Comparing Two Different Approaches to the Modeling of the Common Cause Failures in Fault Trees

    International Nuclear Information System (INIS)

    Vukovic, I.; Mikulicic, V.; Vrbanic, I.

    2002-01-01

    The potential for common cause failures in systems that perform critical functions has been recognized as very important contributor to risk associated with operation of nuclear power plants. Consequentially, modeling of common cause failures (CCF) in fault trees has become one among the essential elements in any probabilistic safety assessment (PSA). Detailed and realistic representation of CCF potential in fault tree structure is sometimes very challenging task. This is especially so in the cases where a common cause group involves more than two components. During the last ten years the difficulties associated with this kind of modeling have been overcome to some degree by development of integral PSA tools with high capabilities. Some of them allow for the definition of CCF groups and their automated expanding in the process of Boolean resolution and generation of minimal cutsets. On the other hand, in PSA models developed and run by more traditional tools, CCF-potential had to be modeled in the fault trees explicitly. With explicit CCF modeling, fault trees can grow very large, especially in the cases when they involve CCF groups with 3 or more members, which can become an issue for the management of fault trees and basic events with traditional non-integral PSA models. For these reasons various simplifications had to be made. Speaking in terms of an overall PSA model, there are also some other issues that need to be considered, such as maintainability and accessibility of the model. In this paper a comparison is made between the two approaches to CCF modeling. Analysis is based on a full-scope Level 1 PSA model for internal initiating events that had originally been developed by a traditional PSA tool and later transferred to a new-generation PSA tool with automated CCF modeling capabilities. Related aspects and issues mentioned above are discussed in the paper. (author)

  10. Hypokalemic muscular paralysis causing acute respiratory failure due to rhabdomyolysis with renal tubular acidosis in a chronic glue sniffer.

    Science.gov (United States)

    Kao, K C; Tsai, Y H; Lin, M C; Huang, C C; Tsao, C Y; Chen, Y C

    2000-01-01

    A 34-year-old male was admitted to the emergency department with the development of quadriparesis and respiratory failure due to hypokalemia after prolonged glue sniffing. The patient was subsequently given mechanical ventilatory support for respiratory failure. He was weaned from the ventilator 4 days later after potassium replacement. Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in a protracted glue sniffing.

  11. Myocardial Infarction Causes Transient Cholinergic Transdifferentiation of Cardiac Sympathetic Nerves via gp130.

    Science.gov (United States)

    Olivas, Antoinette; Gardner, Ryan T; Wang, Lianguo; Ripplinger, Crystal M; Woodward, William R; Habecker, Beth A

    2016-01-13

    Sympathetic and parasympathetic control of the heart is a classic example of norepinephrine (NE) and acetylcholine (ACh) triggering opposing actions. Sympathetic NE increases heart rate and contractility through activation of β receptors, whereas parasympathetic ACh slows the heart through muscarinic receptors. Sympathetic neurons can undergo a developmental transition from production of NE to ACh and we provide evidence that mouse cardiac sympathetic nerves transiently produce ACh after myocardial infarction (MI). ACh levels increased in viable heart tissue 10-14 d after MI, returning to control levels at 21 d, whereas NE levels were stable. At the same time, the genes required for ACh synthesis increased in stellate ganglia, which contain most of the sympathetic neurons projecting to the heart. Immunohistochemistry 14 d after MI revealed choline acetyltransferase (ChAT) in stellate sympathetic neurons and vesicular ACh transporter immunoreactivity in tyrosine hydroxylase-positive cardiac sympathetic fibers. Finally, selective deletion of the ChAT gene from adult sympathetic neurons prevented the infarction-induced increase in cardiac ACh. Deletion of the gp130 cytokine receptor from sympathetic neurons prevented the induction of cholinergic genes after MI, suggesting that inflammatory cytokines induce the transient acquisition of a cholinergic phenotype in cardiac sympathetic neurons. Ex vivo experiments examining the effect of NE and ACh on rabbit cardiac action potential duration revealed that ACh blunted both the NE-stimulated decrease in cardiac action potential duration and increase in myocyte calcium transients. This raises the possibility that sympathetic co-release of ACh and NE may impair adaptation to high heart rates and increase arrhythmia susceptibility. Sympathetic neurons normally make norepinephrine (NE), which increases heart rate and the contractility of cardiac myocytes. We found that, after myocardial infarction, the sympathetic neurons

  12. Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation.

    Science.gov (United States)

    Sutherland, Natasha; Harrison, Alexander; Doherty, Patrick

    2018-05-17

    Exercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. The study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. Complete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (-34.13 m, p = 0.007), being retired (-36.41 m, p = 0.001) and being married/in a relationship (-32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). This study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority. Copyright © 2017. Published by Elsevier B.V.

  13. Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Nakata, Tomoaki; Wakabayashi, Takeru; Kyuma, Michifumi; Takahashi, Toru; Tsuchihashi, Kazufumi; Shimamoto, Kazuaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine (Cardiology), Sapporo (Japan)

    2005-02-01

    Although the benefits of treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well known, no method has as yet been established to predict the efficacy of drug therapy. This study tested whether cardiac{sup 123}I-metaiodobenzylguanidine (MIBG) activity is of prognostic value and can predict the improvement in heart failure patients resulting from treatment with ACE inhibitors and/or beta-blockers. Following quantification of the heart-to-mediastinum ratio (HMR) of MIBG activity, 88 patients with heart failure who were treated with ACE inhibitors and/or beta-blockers (treated group) and 79 patients with heart failure who were treated conventionally without the aforementioned agents, and who served as controls, were followed up for 43 months with a primary endpoint of cardiac death. The treated group had a significantly lower prevalence of cardiac death and a significantly lower mortality at 5 years compared with the control group (15% vs 37% and 21% vs 42%, p<0.05, respectively). Multivariate analysis revealed that significant predictors were HMR, age, nitrate use and ventricular tachycardia for the treated group, and HMR, nitrate use and NYHA class for the control group. The drug treatment significantly reduced mortality from 36% to 12% when HMR was 1.53 or more and from 53% to 37% when HMR was less than 1.53. The reduction in risk of mortality within 5 years in patients without a severe MIBG defect (67%) was twice that in patients with such a defect (32%) (p<0.05). The reduction in mortality risk achieved by using ACE inhibitors and/or beta-blockers is associated with the severity of impairment of cardiac MIBG uptake. Cardiac MIBG activity can consequently be of long-term prognostic value in predicting the effectiveness of such treatment in patients with heart failure. (orig.)

  14. Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure

    International Nuclear Information System (INIS)

    Nakata, Tomoaki; Wakabayashi, Takeru; Kyuma, Michifumi; Takahashi, Toru; Tsuchihashi, Kazufumi; Shimamoto, Kazuaki

    2005-01-01

    Although the benefits of treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well known, no method has as yet been established to predict the efficacy of drug therapy. This study tested whether cardiac 123 I-metaiodobenzylguanidine (MIBG) activity is of prognostic value and can predict the improvement in heart failure patients resulting from treatment with ACE inhibitors and/or beta-blockers. Following quantification of the heart-to-mediastinum ratio (HMR) of MIBG activity, 88 patients with heart failure who were treated with ACE inhibitors and/or beta-blockers (treated group) and 79 patients with heart failure who were treated conventionally without the aforementioned agents, and who served as controls, were followed up for 43 months with a primary endpoint of cardiac death. The treated group had a significantly lower prevalence of cardiac death and a significantly lower mortality at 5 years compared with the control group (15% vs 37% and 21% vs 42%, p<0.05, respectively). Multivariate analysis revealed that significant predictors were HMR, age, nitrate use and ventricular tachycardia for the treated group, and HMR, nitrate use and NYHA class for the control group. The drug treatment significantly reduced mortality from 36% to 12% when HMR was 1.53 or more and from 53% to 37% when HMR was less than 1.53. The reduction in risk of mortality within 5 years in patients without a severe MIBG defect (67%) was twice that in patients with such a defect (32%) (p<0.05). The reduction in mortality risk achieved by using ACE inhibitors and/or beta-blockers is associated with the severity of impairment of cardiac MIBG uptake. Cardiac MIBG activity can consequently be of long-term prognostic value in predicting the effectiveness of such treatment in patients with heart failure. (orig.)

  15. Non-compaction cardiomyopathy – an unusual cause of heart failure

    Directory of Open Access Journals (Sweden)

    Jure Dolenc

    2011-03-01

    Full Text Available Introduction: Non-compaction cardiomyopathy is a rare inborn anomaly caused by disorder of endomyocardial morphogenesis. The diagnosis is based on echocardiographic criteria. The prevalence in the adult population is not known. The symptoms are atypical. Three main groups of clinical signs exist: heart failure, thromobembolic events and arrhythmias. In the group of patients with reduced left ventricular function the prognosis is poor and the treatment options are limited. Patients and methods: In the recent 10 years, 7 patients with non-compaction cardiomyopathy were diagnosed at the Department of Cardiology of the University Medical Centre Ljubljana. Results: All seven patients were males, their mean age at the last follow-up being 39 ± 20.3 years (range 20 to 70 years. Five patients were diagnosed in adulthood. All of them fulfilled the echocardiographic diagnostic criteria of noncompaction cardiomyopathy. Five patients had depressed function of both ventricles, two patients had isolated left ventricular dysfunction. Three patients had decreased left ventricular ejection fraction, six patients showed left ventricular diastolic dysfunction. Only three patients had normal physical capacity. Two patients presented with clinical signs of overt heart failure. During follow-up, one patient died from heart failure. We observed thromboembolic events in one patient. Three patients suffered from nonsustained ventricular tachycardias and two patients had rhythm conduction abnormalities. Conclusions: Non-compaction cardiomyopathy is a rare disorder. We observed all common complications in our group of patients. The majority of patients displayed dysfunction of the affected ventricle and the dysfunction was more pronounced in older patients. Treatment of complications is an important factor in long-term survival of these patients.

  16. Causes of failure with Szabo technique – An analysis of nine cases

    Science.gov (United States)

    Jain, Rajendra Kumar; Padmanabhan, T.N.C.; Chitnis, Nishad

    2013-01-01

    Objective The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. Methods and results From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. Conclusion This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. PMID:23809379

  17. Causes of failure with Szabo technique - an analysis of nine cases.

    Science.gov (United States)

    Jain, Rajendra Kumar; Padmanabhan, T N C; Chitnis, Nishad

    2013-01-01

    The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  18. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study

    Directory of Open Access Journals (Sweden)

    Mohamed S. Kabbani

    2016-09-01

    Full Text Available Summary: Nosocomial urinary tract infection (UTI increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU in 2012, and we divided the patients into two groups: the UTI (UTI group and the non-UTI (control group. We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7% had UTIs after cardiac surgery (UTI group, and 384 (93% were free from UTIs (control group. All UTI cases were catheter-associated UTIs (CAUTIs. A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p < 0.001, presence of congenital abnormalities of kidney and urinary tract (CAKUT (p < 0.0041 and the presence of certain syndromes (Down, William, and Noonan (p < 0.02. Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%, Candida (24% and Escherichia coli (21%. Resistant organisms caused 34% of CAUTI. Two patients (7% died in the UTI group compared with the one patient (0.3% who died in the control group (p < 0.05. Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. Keywords: Urinary tract infection, Cardiac surgery, Nosocomial

  19. Reliability and Availability Analysis of Some Systems with Common-Cause Failures Using SPICE Circuit Simulation Program

    Directory of Open Access Journals (Sweden)

    Muhammad Taher Abuelma'atti

    1999-01-01

    Full Text Available The effectiveness of SPICE circuit simulation program in calculating probabilities, reliability, steady-state availability and mean-time to failure of repairable systems described by Markov models is demonstrated. Two examples are presented. The first example is a warm standby system with common-cause failures and human errors. The second example is a non-identical unit parallel system with common-cause failures. In both cases recourse to numerical solution is inevitable to obtain the Laplace transforms of the probabilities. Results obtained using SPICE are compared with previously published results obtained using the Laplace transform method. Full SPICE listings are included.

  20. Anesthetic-Induced Myocardial Preconditioning and Some Biochemical Markers for Cardiac and Coronary Failures after Aortocoronary Bypass Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2013-01-01

    Full Text Available Objective: to provide a rationale for the efficiency of sevoflurane-induced cardiac preconditioning (CPC, by assessing the pattern of recovery of heart rate and by estimating troponin I levels and changes in NT-proBNP concentrations in patients undergoing aortocoronary bypass surgery (ACBS under extracorporeal circulation (EC. Subjects and methods. Sixty patients aged 60.6±8 years (M±& were examined after elective ACBS using EC and divided into two groups of 30 patients each: 1 inhalation induction and maintenance of anesthesia (IIMA with sevoflurane and fentanyl, with CPC being simulated; 2 total intravenous anesthesia (TIA with propofol and fentanyl. Inhalation induction of sevoflurane anesthesia was performed in the IIMA group. Ten minutes before aortic ligation, the dose of the anesthetic was increased up to 2 MAC for CPC. Inhaled anesthetics were not used in the TIA group. The authors assessed the pattern of cardiac performance recovery and estimated the level of NT-proBNP 24 and 48 hours after tracheal intubation and that of troponin I following 24 hours of the intubation. Results. Defibrillation was required in one patient from the TIA group who developed ventricular fibrillation. The baseline levels of NT-proBNP were comparable in both groups. Following 24 hours, its level was more than thrice higher in the TIA group than that in the IIMA one (p<0.05. By the end of 2 days, the concentration of NT-proBNP continued to rise (up to 480% of the baseline level in the TIA group and returned to the preoperative values in the IIMA group (p=0.05. Twenty-four hours after tracheal intubation the level of troponin I was insignificantly higher in the TIA group than that in the IIMA group (p=0.1. Conclusion. Sevoflurane has cardioprotective properties in preventing and/or reducing the degree of heart failure after ACBS using EC. There is a need to continue the study in increased cohort to provide evidence that sevoflurane-induced CPC can lower

  1. Spiral Wave Initiation in Reaction-Diffusion-Mechanics Systems: A Model for the Onset of Reentrant Cardiac Arrhythmia

    NARCIS (Netherlands)

    Weise, L.D.

    2012-01-01

    Heart failure due to cardiac arrhythmias is a major cause of death in the industrialized world. Cardiac arrhythmia is often caused by spi- ral waves of electrical activity in the cardiac muscle. Therefore, it is a major task in cardiology to understand the mechanisms of spiral wave initiation in the

  2. What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

    Directory of Open Access Journals (Sweden)

    Lange Ove

    2011-05-01

    Full Text Available Abstract Background Optimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD. Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure. Methods Twelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services. Results Failing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients. Conclusions Treatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.

  3. Glucose ingestion causes cardiac repolarization disturbances in type 1 long QT syndrome patients and healthy subjects

    DEFF Research Database (Denmark)

    Hyltén-Cavallius, Louise; Iepsen, Eva W; Christiansen, Michael

    2017-01-01

    BACKGROUND: Both hypoglycemia and severe hyperglycemia constitute known risk factors for cardiac repolarization changes potentially leading to malignant arrhythmias. Patients with loss of function mutations in KCNQ1 are characterized by long QT syndrome (LQTS) and may be at increased risk...

  4. Sudden cardiac death in multiple sclerosis caused by active demyelination of the medulla oblongata

    NARCIS (Netherlands)

    Hengstman, G.J.D.; Kusters, B.

    2011-01-01

    Cardiovascular autonomic dysfunction is not uncommon in multiple sclerosis (MS) and is related to the involvement of the vegetative areas of cardiac innervations in the medulla oblongata. It has been suggested that this may contribute to the occurrence of sudden death in MS. In this case report, we

  5. Primary carnitine deficiency and pivalic acid exposure causing encephalopathy and fatal cardiac events

    DEFF Research Database (Denmark)

    Rasmussen, Jan; Nielsen, Olav W; Lund, Allan M

    2013-01-01

    Several episodes of sudden death among young Faroese individuals have been associated with primary carnitine deficiency (PCD). Patients suffering from PCD have low carnitine levels and can present with metabolic and/or cardiac complications. Pivalic acid exposure decreases carnitine levels...

  6. Takayasu's arteritis: A rare cause of cardiac death in a Caucasian teenage female patient

    NARCIS (Netherlands)

    S.A.M. Saïd (Salah); J.C. Koetsveld-Baart (J.); J.C. den Hollander (Jan)

    1997-01-01

    textabstractA Caucasian teenage Dutch schoolgirl with known chronic low visual acuity and albinism, presented with frank acute pulmonary oedema, died after 1 h of cardio-pulmonary resuscitation for bradyarrhythmia and cardiac arrest. Two weeks prior to presentation, during sport training, she

  7. Elevated Plasma Cardiac Troponin T Levels Caused by Skeletal Muscle Damage in Pompe Disease.

    Science.gov (United States)

    Wens, Stephan C A; Schaaf, Gerben J; Michels, Michelle; Kruijshaar, Michelle E; van Gestel, Tom J M; In 't Groen, Stijn; Pijnenburg, Joon; Dekkers, Dick H W; Demmers, Jeroen A A; Verdijk, Lex B; Brusse, Esther; van Schaik, Ron H N; van der Ploeg, Ans T; van Doorn, Pieter A; Pijnappel, W W M Pim

    2016-02-01

    Elevated plasma cardiac troponin T (cTnT) levels in patients with neuromuscular disorders may erroneously lead to the diagnosis of acute myocardial infarction or myocardial injury. In 122 patients with Pompe disease, the relationship between cTnT, cardiac troponin I, creatine kinase (CK), CK-myocardial band levels, and skeletal muscle damage was assessed. ECG and echocardiography were used to evaluate possible cardiac disease. Patients were divided into classic infantile, childhood-onset, and adult-onset patients. cTnT levels were elevated in 82% of patients (median 27 ng/L, normal values normal in all patients, whereas CK-myocardial band levels were increased in 59% of patients. cTnT levels correlated with CK levels in all 3 subgroups (Pmass index measured with echocardiography was normal in all the 3 subgroups. cTnT mRNA expression in skeletal muscle was not detectable in controls but was strongly induced in patients with Pompe disease. cTnT protein was identified by mass spectrometry in patient-derived skeletal muscle tissue. Elevated plasma cTnT levels in patients with Pompe disease are associated with skeletal muscle damage, rather than acute myocardial injury. Increased cTnT levels in Pompe disease and likely other neuromuscular disorders should be interpreted with caution to avoid unnecessary cardiac interventions. © 2016 American Heart Association, Inc.

  8. Exercise training in Tgαq*44 mice during the progression of chronic heart failure: cardiac vs. peripheral (soleus muscle) impairments to oxidative metabolism.

    Science.gov (United States)

    Grassi, Bruno; Majerczak, Joanna; Bardi, Eleonora; Buso, Alessia; Comelli, Marina; Chlopicki, Stefan; Guzik, Magdalena; Mavelli, Irene; Nieckarz, Zenon; Salvadego, Desy; Tyrankiewicz, Urszula; Skórka, Tomasz; Bottinelli, Roberto; Zoladz, Jerzy A; Pellegrino, Maria Antonietta

    2017-08-01

    Cardiac function, skeletal (soleus) muscle oxidative metabolism, and the effects of exercise training were evaluated in a transgenic murine model (Tgα q *44) of chronic heart failure during the critical period between the occurrence of an impairment of cardiac function and the stage at which overt cardiac failure ensues (i.e., from 10 to 12 mo of age). Forty-eight Tgα q *44 mice and 43 wild-type FVB controls were randomly assigned to control groups and to groups undergoing 2 mo of intense exercise training (spontaneous running on an instrumented wheel). In mice evaluated at the beginning and at the end of training we determined: exercise performance (mean distance covered daily on the wheel); cardiac function in vivo (by magnetic resonance imaging); soleus mitochondrial respiration ex vivo (by high-resolution respirometry); muscle phenotype [myosin heavy chain (MHC) isoform content; citrate synthase (CS) activity]; and variables related to the energy status of muscle fibers [ratio of phosphorylated 5'-AMP-activated protein kinase (AMPK) to unphosphorylated AMPK] and mitochondrial biogenesis and function [peroxisome proliferative-activated receptor-γ coactivator-α (PGC-1α)]. In the untrained Tgα q *44 mice functional impairments of exercise performance, cardiac function, and soleus muscle mitochondrial respiration were observed. The impairment of mitochondrial respiration was related to the function of complex I of the respiratory chain, and it was not associated with differences in CS activity, MHC isoforms, p-AMPK/AMPK, and PGC-1α levels. Exercise training improved exercise performance and cardiac function, but it did not affect mitochondrial respiration, even in the presence of an increased percentage of type 1 MHC isoforms. Factors "upstream" of mitochondria were likely mainly responsible for the improved exercise performance. NEW & NOTEWORTHY Functional impairments in exercise performance, cardiac function, and soleus muscle mitochondrial respiration

  9. Sensitivity study of state-of-the-art common cause failure analysis

    International Nuclear Information System (INIS)

    Guey, Ching

    2004-01-01

    Common cause failures (CCFs) have been touted as one of the major contributors of plant risk due to its pervasive nature and somewhat conservative approaches taken in most Probabilistic Risk Assessment (PRA) studies. The objectives of this study are twofold: First, to gain a better understanding on the impact of various CCF failure probability on the overall plant risk. Secondly, to appreciate the state-of-the-art CCF modelling and data limitations for applications to a full-scale plant risk assessment. The sensitivity study of varying the CCF parameters for different cases indicates that CCF data differences based on the various cases commonly adopted in the PRAs yield core damage frequency variations between 8.5% to -25.6% of the baseline case. It appears that only if CCFs are guaranteed to occur, the core damage frequency would change significantly, by approximately a factor of 5. This suggests that prevention of CCFs is more important than dwelling on the analytical differences in the finer interpretation of the operating experience to develop the CCF parameters. (author)

  10. Quantitative analysis of Common cause failures in systems with a high level of redundancies

    International Nuclear Information System (INIS)

    Pereira Pagan, B.; Lopez Fdez-Quevedo, C.; Gomez, F.; Cuallado, G.

    1996-01-01

    The importance of common cause failures in plants with systems featuring a high level of redundancies, and the difficulty implied by the lack of data on specific KWU design plants have been taken into account right from the beginning of the PSA. for this reason it has been necessary to analyse the different methodologies by establishing a procedure based on the documentation available, studying its applicability and solving problems arising from of the lack of information needed to make reliable statistical estimates. It was finally decided to systematically use the alpha parameter method. In case where this was not possible, the modified Beta factor method was used, and if there were no data available for the type of component considered, generic alpha values were used. this process required the definition of certain criteria to maintain coherent parameter estimates. The final result shows the impact of the number of redundancies considered in the estimated failure probability or rare. This process is valid for any size of system modelled. (Author)

  11. CFD research on runaway transient of pumped storage power station caused by pumping power failure

    International Nuclear Information System (INIS)

    Zhang, L G; Zhou, D Q

    2013-01-01

    To study runaway transient of pumped storage power station caused by pumping power failure, three dimensional unsteady numerical simulations were executed on geometrical model of the whole flow system. Through numerical calculation, the changeable flow configuration and variation law of some parameters such as unit rotate speed,flow rate and static pressure of measurement points were obtained and compared with experimental data. Numerical results show that runaway speed agrees well with experimental date and its error was 3.7%. The unit undergoes pump condition, brake condition, turbine condition and runaway condition with flow characteristic changing violently. In runaway condition, static pressure in passage pulses very strongly which frequency is related to runaway speed

  12. Functional failure modes cause-consequence logic suited for mobile robots used at scientific facilities

    CERN Document Server

    Khan, Douzi Imran; Bonnal, Pierre; Verma, A K

    2014-01-01

    The scientific facilities emitting ionizing radiation may have some significant failures and hazard issues, in and around their infrastructure. Significantly, this will also cause risks to workers and environment, which has led engineers to explore the use and implementation of mobile robots (MR), in order to reduce or eliminate such risks concerned with safety issues. Safe functioning of MR and the systems working at hazardous facilities is essential and therefore all the systems, structures and components (SSC) of a hazardous facility have to correspond to high reliability, availability, maintainability and safety (=RAMS) demands. RAMS characteristics have a causal relationship with the risks related to the facility systems availability, safety and life cycle costs. They also form the basis for the operating systems and MR performance, to carry out the desired functions. In this paper we have developed and presented a method for how to consider and model a SSC with respect to its desired functions and also ...

  13. Fuel pin failure root causes and power distribution gradients in WWER cores

    International Nuclear Information System (INIS)

    Mikus, J.

    2008-01-01

    The purpose of this work is to investigate the influence of some core heterogeneities and reactor construction materials on space power distribution in WWER type cores, especially from viewpoint of the values and gradient occurrence that could result in static loads with some consequences, e.g., fuel pin (FP) or fuel assembly (FA) bowing and possible contribution to the FP failure root causes. Presented information were obtained by means of experiments on research reactor LR-0 concerning the: 1) Power distribution estimation on pellet surface of the FPs neighbouring a FP containing gadolinium (Gd 2 O 3 ) burnable absorber integrated into fuel in WWER-440 and -1000 type cores; 2) Power distribution measurement in periphery FAs neighbouring the baffle in WWER-1000 type cores and 3) Power distribution in FAs neighbouring the control rod absorbing part in a WWER-440 type core. (author)

  14. Assessment of the causes of failures of roto-dynamic equipment in Cirus

    International Nuclear Information System (INIS)

    Rao, K.N.; Singh, S.; Ganeshan, P.

    1994-01-01

    As a part of Cirus reactor life extension program study, a service life evaluation of critical roto-dynamic equipment in Cirus such as primary coolant pumps, and their concrete foundation structures, pressurised water loop pumps, main air compressors and supply and exhaust fans, was performed. An assessment of the causes of failures of roto-dynamic equipment in Cirus was done. Based on assessment of the degradation mitigating features and comparison to similar roto-dynamic equipment and their concrete foundation structures, it was concluded that life extension of these roto-dynamic equipment and their structures is feasible. To support this conclusion a program involving: a) non-destructive testing, b) surveillance and monitoring and, c) preventive maintenance is recommended. (author). 4 refs

  15. Analysis of the main causes of failures in the Atucha I PWR moderator circuit branch piping

    International Nuclear Information System (INIS)

    Porto, J.; Sarmiento, G.S.

    1983-01-01

    From 1977 to 1979 four through cracks were detected in the auxiliary connection of the moderator piping with the coolant circuit in the PWR Atucha I Nuclear Plant. The failures were observed to occur systematically in the same place of the pipe, where mechanical stresses were detected experimentally and thermal stresses were calculated based on temperature values measured on the pipe. The temperature field in steady state conditions as well as during thermal shocks was modelled by finite element codes, and the corresponding thermal stresses were than numerically calculated. Considering those thermal and mechanical solicitations, a crack propagation analysis based on the elastoplastic fracture mechanics and the finite element method is now being developed. Among other causes such as fatigue corrosion and vibrations, the results of the analysis show that the most preponderant factors determining the cracking are mechanical stress, thermal stress and thermal fatigue

  16. Mutations in genes encoding condensin complex proteins cause microcephaly through decatenation failure at mitosis.

    Science.gov (United States)

    Martin, Carol-Anne; Murray, Jennie E; Carroll, Paula; Leitch, Andrea; Mackenzie, Karen J; Halachev, Mihail; Fetit, Ahmed E; Keith, Charlotte; Bicknell, Louise S; Fluteau, Adeline; Gautier, Philippe; Hall, Emma A; Joss, Shelagh; Soares, Gabriela; Silva, João; Bober, Michael B; Duker, Angela; Wise, Carol A; Quigley, Alan J; Phadke, Shubha R; Wood, Andrew J; Vagnarelli, Paola; Jackson, Andrew P

    2016-10-01

    Compaction of chromosomes is essential for accurate segregation of the genome during mitosis. In vertebrates, two condensin complexes ensure timely chromosome condensation, sister chromatid disentanglement, and maintenance of mitotic chromosome structure. Here, we report that biallelic mutations in NCAPD2, NCAPH, or NCAPD3, encoding subunits of these complexes, cause microcephaly. In addition, hypomorphic Ncaph2 mice have significantly reduced brain size, with frequent anaphase chromatin bridge formation observed in apical neural progenitors during neurogenesis. Such DNA bridges also arise in condensin-deficient patient cells, where they are the consequence of failed sister chromatid disentanglement during chromosome compaction. This results in chromosome segregation errors, leading to micronucleus formation and increased aneuploidy in daughter cells. These findings establish "condensinopathies" as microcephalic disorders, with decatenation failure as an additional disease mechanism for microcephaly, implicating mitotic chromosome condensation as a key process ensuring mammalian cerebral cortex size. © 2016 Martin et al.; Published by Cold Spring Harbor Laboratory Press.

  17. Procedures for conducting common cause failure analysis in probabilistic safety assessment

    International Nuclear Information System (INIS)

    1992-05-01

    The principal objective of this report is to supplement the procedure developed in Mosleh et al. (1988, 1989) by providing more explicit guidance for a practical approach to common cause