Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure.

Science.gov (United States)

Schnittger, I; Appleton, C P; Hatle, L K; Popp, R L

1988-01-01

The purpose of this study was to prospectively determine the incidence of diastolic mitral and tricuspid regurgitation in atrioventricular (AV) block using Doppler echocardiography. The temporal relation between mitral and tricuspid diastolic insufficiency and the diastolic murmur recorded in patients with complete heart block was also investigated. Twenty-two consecutive patients with AV block (referred to the Echo-Doppler laboratory for routine clinical studies), aged 18 to 87 years, were enrolled in the study. Eleven patients had third degree AV block and a ventricular-inhibited (VVI) pacemaker, two patients had second degree AV block, seven patients had first degree AV block, one patient had blocked premature atrial complexes and one patient had atrial flutter with 4:1 AV block. Diastolic mitral regurgitation was detected in 20 patients, and diastolic tricuspid regurgitation in 21. A mid-diastolic murmur was detected in all patients except in the three youngest. The murmur occurred before diastolic regurgitation and coincided with peak forward flow through the AV valve after atrial contraction. M-mode mitral valve echocardiograms obtained in nine patients demonstrated near closure of some portions of the mitral valve after atrial contraction. Effective closure of the valve, however, did not occur unless ventricular systole supervened. In conclusion, diastolic mitral and tricuspid regurgitation are almost universally present in patients with AV block and are associated with a diastolic murmur. The murmur coincides with forward AV valve flow. Diastolic regurgitation is silent. Effective AV valve closure is not established until ventricular systole occurs, as demonstrated by M-mode echocardiographic recording of the mitral valve.

Atrioventricular and Interventricular Groove and Septal Extension of Right Sinus of Valsalva Aneurysm: A Rare Cause of Complete Heart Block

International Nuclear Information System (INIS)

Khan, J.A.; Hussain, M.; Rizvi, N.H.; Fehmi, N.; Hussain, A.; Sial, J.A.

2013-01-01

A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block. (author)

Occult etiologies of complete atrioventricular block: Report of two cases

Directory of Open Access Journals (Sweden)

Neeta Bachani

2016-09-01

Full Text Available In patients presenting with complete atrioventricular (AV block, the common causes are degeneration of the conduction system, acute myocardial infarction, congenital and metabolic disorders (such as azotemia. However, at times, no cause can be ascribed and the label congenital or degenerative is applied depending on the patient's age and the QRS complex width. We present two cases of patients with complete AV block, who were subsequently found to have rare etiologies – sarcoidosis (with isolated feature of AV block and non-Hodgkin's lymphoma.

Complete paroxysmal atrioventricular block in a 2-year-old girl

DEFF Research Database (Denmark)

Holst, Line Marie; Dixen, Ulrik; Jeppesen, Dorthe L

2015-01-01

We present a case of atypical syncope in a 2-year-old, otherwise healthy girl. The patient presented with three episodes of syncope without any precipitating factors and no family history of sudden unexpected death. Holter monitoring revealed 24 events of complete atrioventricular block lasting up...

Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy

DEFF Research Database (Denmark)

Gang, Uffe Jakob Ortved; Jøns, Christian; Jørgensen, Rikke Mørch

2011-01-01

High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this st...... of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function....

Masquerading bundle branch block as a presenting manifestation of complete atrioventricular block that caused syncope.

Science.gov (United States)

Jiao, Zhenyu; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

2017-10-01

A 59-year-old male patient was admitted with the main complaints of stuffiness and shortness of breath. An ECG from precordial leads on admission showed masquerading bundle branch block. Syncope frequently occurred after admission. During syncope episodes, ECG telemetry showed that the syncope was caused by intermittent complete atrioventricular block, with the longest RR interval lasting for 4.36 s. At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker. Follow-up of 9 months showed no reoccurrence of syncope.

Clinically oriented device programming in bradycardia patients: part 2 (atrioventricular blocks and neurally mediated syncope). Proposals from AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

Science.gov (United States)

Palmisano, Pietro; Ziacchi, Matteo; Biffi, Mauro; Ricci, Renato P; Landolina, Maurizio; Zoni-Berisso, Massimo; Occhetta, Eraldo; Maglia, Giampiero; Botto, Gianluca; Padeletti, Luigi; Boriani, Giuseppe

2018-04-01

: The purpose of this two-part consensus document is to provide specific suggestions (based on an extensive literature review) on appropriate pacemaker setting in relation to patients' clinical features. In part 2, criteria for pacemaker choice and programming in atrioventricular blocks and neurally mediate syncope are proposed. The atrioventricular blocks can be paroxysmal or persistent, isolated or associated with sinus node disease. Neurally mediated syncope can be related to carotid sinus syndrome or cardioinhibitory vasovagal syncope. In sinus rhythm, with persistent atrioventricular block, we considered appropriate the activation of mode-switch algorithms, and algorithms for auto-adaptive management of the ventricular pacing output. If the atrioventricular block is paroxysmal, in addition to algorithms mentioned above, algorithms to maximize intrinsic atrioventricular conduction should be activated. When sinus node disease is associated with atrioventricular block, the activation of rate-responsive function in patients with chronotropic incompetence is appropriate. In permanent atrial fibrillation with atrioventricular block, algorithms for auto-adaptive management of the ventricular pacing output should be activated. If the atrioventricular block is persistent, the activation of rate-responsive function is appropriate. In carotid sinus syndrome, adequate rate hysteresis should be programmed. In vasovagal syncope, specialized sensing and pacing algorithms designed for reflex syncope prevention should be activated.

Bloqueo aurículo-ventricular de primer grado en tirotoxicosis aguda First degree atrio-ventricular block in acute thyrotoxicosis

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Antonio R. Vilches

2004-02-01

Full Text Available El cuadro clínico de la tirotoxicosis incluye síntomas cardiovasculares variados. La taquicardia sinusal es el trastorno electrocardiográfico más frecuente y los trastornos de conducción son extremadamente raros como modo de presentación. Comunicamos un caso de bloqueo aurículo-ventricular de primer grado en una paciente con hipertiroidismo recién diagnosticado y que comenzó días antes de la consulta con un cuadro general inespecífico. Su evaluación ulterior demostró que se trataba de una tirotoxicosis aguda autoinmune, y su tratamiento con metimazol corrigió el trastorno totalmente. Se discuten los mecanismos fisiopatológicos involucrados y las implicancias clínicas desde el punto de vista del internista.Thyrotoxicosis may present with a variety of cardiovascular symptoms. Sinus tachycardia is the most frequently encountered electrocardiographic abnormality and conduction disturbances are extremely uncommon. We present a case of first degree atrio-ventricular block in a patient with newly diagnosed hyperthyroidism and discuss the underlying pathophysiological mechanisms and the clinical implications from the internist’s standpoint.

Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae

OpenAIRE

Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Atsushi

2016-01-01

Patient: Male, 74 Final Diagnosis: Infective endocarditis Symptoms: Apetite loss ? fever Medication: ? Clinical Procedure: Transesophageal echocardiography Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). Case Report: A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our ...

Increased sarcolemmal Na+/H+ exchange activity in hypertrophied myocytes from dogs with chronic atrioventricular block

NARCIS (Netherlands)

van Borren, Marcel M. G. J.; Vos, Marc A.; Houtman, Marien J. C.; Antoons, Gudrun; Ravesloot, Jan H.

2013-01-01

Dogs with compensated biventricular hypertrophy due to chronic atrioventricular block (cAVB), are more susceptible to develop drug-induced Torsade-de-Pointes arrhythmias and sudden cardiac death. It has been suggested that the increased Na+ influx in hypertrophied cAVB ventricular myocytes

Prevalence of cardiac dyssynchrony and correlation with atrio-ventricular block and QRS width in dilated cardiomyopathy

DEFF Research Database (Denmark)

Anzouan-Kacou, J B; Ncho-Mottoh, M P; Konin, C

2012-01-01

Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block...

Reversible complete atrioventricular block in patient with wegener's granulomatosis - a report on fortunate outcome with long term follow-up.

Science.gov (United States)

Steckiewicz, Roman; Rosiak, Marek; Stolarz, Przemysław; Świętoń, Elżbieta B; Grabowski, Marcin; Kosior, Dariusz A

Reversible complete atrioventricular block in patient with Wegener's granulomatosis - a report on a positive outcome with long term follow-up. Atrioventricular (AV) block is a rare complication of Wegener's granulomatosis (WG), thus there are no standards of management in such cases. We present a case of a patient with a dual-chamber pacemaker (DDD) implanted due to complete AV block in the course of Wegener's granulomatosis (WG). An immunosuppressive therapy resulted in the resolution of non-cardiac and AV conduction disorders. The diagnostic functions of the pacemaker enabled us to evaluate AV conduction over a five-year follow-up period. The resolution of AV conduction disorders, which accompanied WG remission, suggests that careful monitoring with temporary cardiac pacing may be considered in some patients before permanent pacemaker implantation.

Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

DEFF Research Database (Denmark)

Axelsson, Anna; Weibring, Kristina; Havndrup, Ole

2014-01-01

.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200...... ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA. CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting...... recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA....

Paroxysmal atrioventricular block: Electrophysiological mechanism of phase 4 conduction block in the His-Purkinje system: A comparison with phase 3 block.

Science.gov (United States)

Shenasa, Mohammad; Josephson, Mark E; Wit, Andrew L

2017-11-01

Paroxysmal atrioventricular (A-V) block is relatively rare, and due to its transient nature, it is often under recognized. It is often triggered by atrial, junctional, or ventricular premature beats, and occurs in the presence of a diseased His-Purkinje system (HPS). Here, we present a 45-year-old white male who was admitted for observation due to recurrent syncope and near-syncope, who had paroxysmal A-V block. The likely cellular electrophysiological mechanisms(s) of paroxysmal A-V block and its differential diagnosis and management are discussed. Continuous electrocardiographic monitoring was done while the patient was in the cardiac unit. Multiple episodes of paroxysmal A-V block were documented in this case. All episodes were initiated and terminated with atrial/junctional premature beats. The patient underwent permanent pacemaker implantation and has remained asymptomatic since then. Paroxysmal A-V block is rare and often causes syncope or near-syncope. Permanent pacemaker implantation is indicated according to the current guidelines. Paroxysmal A-V block occurs in the setting of diseased HPS and is bradycardia-dependent. The detailed electrophysiological mechanisms, which involve phase 4 diastolic depolarization, and differential diagnosis are discussed. © 2017 Wiley Periodicals, Inc.

Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node.

Science.gov (United States)

Cary, N. R.; Fox, B.; Wright, D. J.; Cutler, S. J.; Shapiro, L. M.; Grace, A. A.

1990-01-01

A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia ('mesothelioma') of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required. Images Figure 1 Figure 2 Figure 3 PMID:2349186

Electrophysiological markers predicting impeding AV-block during ablation of atrioventricular nodal reentry tachycardia.

Science.gov (United States)

Fragakis, Nikolaos; Krexi, Lydia; Kyriakou, Panagiota; Sotiriadou, Melani; Lazaridis, Charalambos; Karamanolis, Athanasios; Dalampyras, Panagiotis; Tsakiroglou, Stelios; Skeberis, Vassilios; Tsalikakis, Dimitrios; Vassilikos, Vassilios

2018-01-01

Radiofrequency (RF) ablation of the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT) is occasionally complicated with atrioventricular block (AVB) often predicted by junctional beats (JB) with loss of ventriculo-atrial (VA) conduction. We analyzed retrospectively 153 patients undergoing ablation of SP for typical AVNRT. Patients were divided into two age groups: 127 ≤ 70 years and 26 > 70 years. We analyzed the interval between the atrial electrogram in the His-bundle position and the distal ablation catheter [A(H)-A(RFd)] and between the distal ablation catheter and the proximal coronary sinus catheter [A(RFd)-A(CS)] before RF applications with and without JB. We evaluated if these intervals can be used as predictors of JB incidence and also of JB with loss of VA conduction. We also assessed if age influences the risk of loss of VA conduction. The A(H)-A(RFd) and A(RFd)-A(CS) intervals were significantly shorter in RF applications causing JB than those without JB (33 ± 11 ms vs 39 ± 9 ms, P JB with VA block than those with VA conduction (29 ± 11 ms vs 35 ± 11 ms, P  70 years had shorter intervals (36 ± 11 ms vs 29 ± 8 ms, P  =  0.012, 17 ± 8 ms vs 13 ± 7 ms, P  =  0.027, respectively), while VA block was more common in this age group. The A(H)-A(RFd) and A(RFd)-A(CS) intervals can be used as markers for predicting JB occurrence as well as impending AVB. JB with loss of VA conduction occur more often in older patients possibly due to a higher position of SP. © 2017 Wiley Periodicals, Inc.

Atrioventricular conduction abnormality and hyperchloremic metabolic acidosis in toluene sniffing

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Jian-Hsiung Tsao

2011-10-01

Full Text Available Toluene is an aromatic hydrocarbon with widespread industrial use as an organic solvent. As a result of the euphoric effect and availability of these substances, inhalation of toluene-based products is popular among young adults and children. Chronic or acute exposure is known to cause acid–base and electrolyte disorders, and to be toxic to the nervous and hematopoietic systems. We report a 38-year-old man who suffered from general muscular weakness of all extremities after toluene sniffing, which was complicated with hypokalemic paralysis, atrioventricular conduction abnormality, and normal anion gap hyperchloremic metabolic acidosis. Renal function, serum potassium and acid–base status normalized within 3 days after aggressive potassium chloride and intravenous fluid replacement. Electrocardiography showed regression of first-degree atrioventricular block. Exposure to toluene can lead to cardiac arrhythmias and sudden sniffing death syndrome. Tachyarrhythmia is the classical manifestation of toluene cardiotoxicity. Atrioventricular conduction abnormalities have been rarely mentioned in the literature. Knowledge of the toxicology and medical complications associated with toluene sniffing is essential for clinical management of these patients.

Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation.

Science.gov (United States)

Flyer, Jonathan N; Zuckerman, Warren A; Richmond, Marc E; Anderson, Brett R; Mendelsberg, Tamar G; McAllister, Jennie M; Liberman, Leonardo; Addonizio, Linda J; Silver, Eric S

2017-06-20

Supraventricular tachycardia is common after heart transplantation. Adenosine, the standard therapy for treating supraventricular tachycardia in children and adults without transplantation, is relatively contraindicated after transplantation because of a presumed risk of prolonged atrioventricular block in denervated hearts. This study tested whether adenosine caused prolonged asystole after transplantation and if it was effective in blocking atrioventricular nodal conduction in these patients. This was a single-center prospective clinical study including healthy heart transplant recipients 6 months to 25 years of age presenting for routine cardiac catheterization during 2015 to 2016. After catheterization, a transvenous pacing catheter was placed and adenosine was given following a dose-escalation protocol until atrioventricular block was achieved. The incidence of clinically significant asystole (≥12 seconds after adenosine) was quantified. The effects of patient characteristics on adenosine dose required to produce atrioventricular block and duration of effect were also measured. Eighty patients completed adenosine testing. No patient (0%; 95% confidence interval, 0-3) required rescue ventricular pacing. Atrioventricular block was observed in 77 patients (96%; 95% confidence interval, 89-99). The median longest atrioventricular block was 1.9 seconds (interquartile range, 1.4-3.2 seconds), with a mean duration of adenosine effect of 4.3±2.0 seconds. No patient characteristic significantly predicted the adenosine dose to produce atrioventricular block or duration of effect. Results were similar across patient weight categories. Adenosine induces atrioventricular block in healthy pediatric and young adult heart transplant recipients with minimal risk when low initial doses are used (25 μg/kg; 1.5 mg if ≥60 kg) and therapy is gradually escalated. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02462941. © 2017 American Heart Association, Inc.

Inverse Relationship Between Membranous Septal Length and the Risk of Atrioventricular Block in Patients Undergoing Transcatheter Aortic Valve Implantation.

Science.gov (United States)

Hamdan, Ashraf; Guetta, Victor; Klempfner, Robert; Konen, Eli; Raanani, Ehud; Glikson, Michael; Goitein, Orly; Segev, Amit; Barbash, Israel; Fefer, Paul; Spiegelstein, Dan; Goldenberg, Ilan; Schwammenthal, Ehud

2015-08-17

This study sought to examine whether imaging of the atrioventricular (AV) membranous septum (MS) by computed tomography (CT) can be used to identify patient-specific anatomic risk of high-degree AV block and permanent pacemaker (PPM) implantation before transcatheter aortic valve implantation (TAVI) with self-expandable valves. MS length represents an anatomic surrogate of the distance between the aortic annulus and the bundle of His and may therefore be inversely related to the risk of conduction system abnormalities after TAVI. Seventy-three consecutive patients with severe aortic stenosis underwent contrast-enhanced CT before TAVI. The aortic annulus, aortic valve, and AV junction were assessed, and MS length was measured in the coronal view. In 13 patients (18%), high-degree AV block developed, and 21 patients (29%) received a PPM. Multivariable logistic regression analysis revealed MS length as the most powerful pre-procedural independent predictor of high-degree AV block (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.1 to 1.7, p = 0.01) and PPM implantation (OR: 1.43, 95% CI: 1.1 to 1.8, p = 0.002). When taking into account pre- and post-procedural parameters, the difference between MS length and implantation depth emerged as the most powerful independent predictor of high-degree AV block (OR: 1.4, 95% CI: 1.2 to 1.7, p < 0.001), whereas the difference between MS length and implantation depth and calcification in the basal septum were the most powerful independent predictors of PPM implantation (OR: 1.39, 95% CI: 1.2 to 1.7, p < 0.001 and OR: 4.9, 95% CI: 1.2 to 20.5, p = 0.03; respectively). Short MS, insufficient difference between MS length and implantation depth, and the presence of calcification in the basal septum, factors that may all facilitate mechanical compression of the conduction tissue by the implanted valve, predict conduction abnormalities after TAVI with self-expandable valves. CT assessment of membranous septal anatomy provides

Analysis of Onset Mechanisms of a Sphingosine 1-Phosphate Receptor Modulator Fingolimod-Induced Atrioventricular Conduction Block and QT-Interval Prolongation

Energy Technology Data Exchange (ETDEWEB)

Yagi, Yukihiro [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama, Kanagawa 222–8567 (Japan); Nakamura, Yuji [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Kitahara, Ken [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143–8541 (Japan); Harada, Takuma [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Kato, Kazuhiko; Ninomiya, Tomohisa [Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama, Kanagawa 222–8567 (Japan); Cao, Xin [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Ohara, Hiroshi [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143–8541 (Japan); Izumi-Nakaseko, Hiroko [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); Suzuki, Kokichi [Pharmaceutical Research Center, Meiji Seika Pharma Co., Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama, Kanagawa 222–8567 (Japan); Ando, Kentaro [Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143–8540 (Japan); and others

2014-11-15

Fingolimod, a sphingosine 1-phosphate (S1P) receptor subtype 1, 3, 4 and 5 modulator, has been used for the treatment of patients with relapsing forms of multiple sclerosis, but atrioventricular conduction block and/or QT-interval prolongation have been reported in some patients after the first dose. In this study, we directly compared the electropharmacological profiles of fingolimod with those of siponimod, a modulator of sphingosine 1-phosphate receptor subtype 1 and 5, using in vivo guinea-pig model and in vitro human ether-a-go-go-related gene (hERG) assay to better understand the onset mechanisms of the clinically observed adverse events. Fingolimod (0.01 and 0.1 mg/kg) or siponimod (0.001 and 0.01 mg/kg) was intravenously infused over 10 min to the halothane-anaesthetized guinea pigs (n = 4), whereas the effects of fingolimod (1 μmol/L) and siponimod (1 μmol/L) on hERG current were examined (n = 3). The high doses of fingolimod and siponimod induced atrioventricular conduction block, whereas the low dose of siponimod prolonged PR interval, which was not observed by that of fingolimod. The high dose of fingolimod prolonged QT interval, which was not observed by either dose of siponimod. Meanwhile, fingolimod significantly inhibited hERG current, which was not observed by siponimod. These results suggest that S1P receptor subtype 1 in the heart could be one of the candidates for fingolimod- and siponimod-induced atrioventricular conduction block since S1P receptor subtype 5 is localized at the brain, and that direct I{sub Kr} inhibition may play a key role in fingolimod-induced QT-interval prolongation. - Highlights: • Fingolimod and siponimod are S1P{sub 1,3,4,5} and S1P{sub 1,5} receptor modulators, respectively. • Fingolimod and siponimod induced AV block in the halothane-anesthetized guinea pigs. • S1P{sub 1} in the hearts may be the target of fingolimod- and siponimod-induced AV block. • Fingolimod directly inhibited hERG current, which was not

Analysis of Onset Mechanisms of a Sphingosine 1-Phosphate Receptor Modulator Fingolimod-Induced Atrioventricular Conduction Block and QT-Interval Prolongation

International Nuclear Information System (INIS)

Yagi, Yukihiro; Nakamura, Yuji; Kitahara, Ken; Harada, Takuma; Kato, Kazuhiko; Ninomiya, Tomohisa; Cao, Xin; Ohara, Hiroshi; Izumi-Nakaseko, Hiroko; Suzuki, Kokichi; Ando, Kentaro

2014-01-01

Fingolimod, a sphingosine 1-phosphate (S1P) receptor subtype 1, 3, 4 and 5 modulator, has been used for the treatment of patients with relapsing forms of multiple sclerosis, but atrioventricular conduction block and/or QT-interval prolongation have been reported in some patients after the first dose. In this study, we directly compared the electropharmacological profiles of fingolimod with those of siponimod, a modulator of sphingosine 1-phosphate receptor subtype 1 and 5, using in vivo guinea-pig model and in vitro human ether-a-go-go-related gene (hERG) assay to better understand the onset mechanisms of the clinically observed adverse events. Fingolimod (0.01 and 0.1 mg/kg) or siponimod (0.001 and 0.01 mg/kg) was intravenously infused over 10 min to the halothane-anaesthetized guinea pigs (n = 4), whereas the effects of fingolimod (1 μmol/L) and siponimod (1 μmol/L) on hERG current were examined (n = 3). The high doses of fingolimod and siponimod induced atrioventricular conduction block, whereas the low dose of siponimod prolonged PR interval, which was not observed by that of fingolimod. The high dose of fingolimod prolonged QT interval, which was not observed by either dose of siponimod. Meanwhile, fingolimod significantly inhibited hERG current, which was not observed by siponimod. These results suggest that S1P receptor subtype 1 in the heart could be one of the candidates for fingolimod- and siponimod-induced atrioventricular conduction block since S1P receptor subtype 5 is localized at the brain, and that direct I Kr inhibition may play a key role in fingolimod-induced QT-interval prolongation. - Highlights: • Fingolimod and siponimod are S1P 1,3,4,5 and S1P 1,5 receptor modulators, respectively. • Fingolimod and siponimod induced AV block in the halothane-anesthetized guinea pigs. • S1P 1 in the hearts may be the target of fingolimod- and siponimod-induced AV block. • Fingolimod directly inhibited hERG current, which was not observed by

Clinical and electrocardiographic presentations of transient trifascicular block in three cats.

Science.gov (United States)

Oxford, Eva M; Giacomazzi, Flavia B; Moïse, N Sydney; Santilli, Roberto A

2018-06-01

This report describes transient trifascicular block in three cats presented with lethargy and inappetence, and elevated cardiac troponin I concentrations. The electrocardiogram (ECG) of cat 1 showed a sinus rhythm with pronounced first-degree atrioventricular (AV) block, right bundle branch block, and left anterior fascicular block. The ECG of cat 2 showed truncular left bundle branch block alternating with left anterior fascicular block coupled with prolonged PR intervals, second-degree heart block, and paroxysmal third-degree AV block. The ECG of cat 3 showed first-degree AV block with concomitant right bundle branch block. The diagnosis of trifascicular block was made when paroxysmal third-degree AV block was documented. All cats recovered with medical management within weeks. Each cat resumed a sinus rhythm. Elevated cardiac troponin I concentrations suggested myocarditis that improved. Copyright © 2018 Elsevier B.V. All rights reserved.

Transient complete atrioventricular block with Morgagni—Adams—Stokes attacks in a child after aortic valve replacement

Directory of Open Access Journals (Sweden)

D. R. Sabirova

2014-01-01

Full Text Available The diagnosis and treatment of life-threatening arrhythmias after surgical correction of congenital heart diseases is one the urgent problems in pediatrlc cardiology. The paper describes the clinical picture, diagnosis, and therapy in a patent with transient complete atrioventricular block after open heart surgery. A protracted Morgagni—Adams—Stokes attack is one of the causes of sudden cardiac death. The occurrence of even single syncopes in patients after surgery for congenital heart disease requires that the arrhythmogenic nature of the attack should be ruled out for the timely and adequate therapy including the implantation of antiarrhythmic devices.

Short-term variability of repolarization is superior to other repolarization parameters in the evaluation of diverse antiarrhythmic interventions in the chronic atrioventricular block dog

NARCIS (Netherlands)

Bossu, Alexandre; Varkevisser, Rosanne; Beekman, Henriette D.M.; Houtman, Marien J C; Van Der Heyden, Marcel A.G.; Vos, Marc A.

2017-01-01

Short-term variability (STV), to quantify beat-to-beat variability of repolarization, is a surrogate parameter that reliably identifies proarrhythmic risk in preclinical models. Examples include not only the use in the chronic atrioventricular block (CAVB) dog model whereby it was developed but also

Congenital complete atrioventricular block. Report of one case and literature review

International Nuclear Information System (INIS)

Diaz D, Alejandro; Serrano G, Ana; Guzman B, Monica; Ruz M, Miguel

2008-01-01

Complete congenital atrioventricular block is a rare entity that has a high morbidity and mortality. Its real incidence remains unknown and a high suspicion index is needed for its diagnosis and consequently for its early intervention. It is observed in children of mothers having connective tissue autoimmune diseases, in particular systemic lupus erythematosus, when the condition is congenital. If it is post-natal, congenital cardiopathies are responsible in most cases. It may al so appear in. structurally normal hearts. The characteristic clinical finding is persistent bradycardia manifested since intrauterine life and affecting the circulatory fetal stability, going as far as to produce hydrops fetalis, a serious and lethal condition. After birth, it appears with bradycardia as well, that may or not unbalance the patient hemodynamics. Diagnosis is made upon clinical suspicion with fetal echocardiography and when post-natal, through electrocardiogram and maternal antibody type antiRo and antiLa. Pacemaker implantation is the definitive treatment that contributes to improve patient survival and prognosis. We present the case of a premature female patient with 31 weeks of gestation due to non-immune hydrops in who complete atrioventricuiar block secondary to maternal lupus erythematosus confirmed by frankly positive anti-nuclear antibodies and positive antiRo and antiLa antibodies was diagnosed, and that received inotropic support after pace maker implantation. She improved completely from her heart failure and was sent to other institution for conventional management of premature

Comfrey herbal remedy causing second-degree heart block: do not be outfoxed by digitalis.

Science.gov (United States)

Vithayathil, Mathew Kurian; Edwards, Matthew

2016-12-01

A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18 hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves. After viewing the images of comfrey and foxglove, it highlighted the possibility of mistaken ingestion of Digitalis, containing the organic forms of cardiac glycosides, such as digoxin and digitoxin. Raised serum digoxin levels confirmed this. The patient was haemodynamically stable, and given digoxin-binding antibodies. After 5 days of cardiac monitoring, her ECG returned to normal rhythm, and she was discharged home. 2016 BMJ Publishing Group Ltd.

Bloqueio atrioventricular no pós-operatório de cirurgia cardíaca valvar: incidência, fatores de risco e evolução hospitalar Atrioventricular block in the postoperative period of heart valve surgery: incidence, risk factors and hospital evolution

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Andres Di Leoni Ferrari

2011-09-01

Full Text Available INTRODUÇÃO: Distúrbios do sistema de condução cardíaco são complicações potenciais e conhecidas dos procedimentos de cirurgia cardíaca valvar. OBJETIVOS: Investigar a associação entre fatores peri-operatórios com bloqueio atrioventricular (BAV e a necessidade de estimulação cardíaca artificial temporária (ECAT e, se necessário, implante de marcapasso definitivo no pós-operatório de cirurgia cardíaca (POCC valvar. MÉTODOS: Coorte histórica de pacientes submetidos a cirurgia cardíaca valvar, sendo realizada análise de banco de dados por regressão logística. RESULTADOS: No período de janeiro de 1996 a dezembro de 2008, foram realizadas 1102 cirurgias cardíacas valvares: 718 (65,2% na valva aórtica e 407 (36,9% na valva mitral; destas, 190 (17,2% cirurgias de revascularização miocárdica associadas à cirurgia valvar e 23 (2,1% cirurgias valvares combinadas (aórtica+mitral. Cento e oitenta e sete (17% pacientes apresentaram quadro clínico e eletrocardiográfico de BAV durante o POCC valvar, necessitando de ECAT. Quatorze (7,5% pacientes evoluíram para implante de marcapasso definitivo (1,27% do total da amostra. A análise multivariada evidenciou associação significativa de BAV com cirurgia de valva mitral (OR=1,76; IC 95% 1,08-2,37; P=0,002, implante de prótese biológica (OR=1,59; IC 95% 1,02-3,91; P= 0,039, idade maior que 60 anos (OR = 1,99; IC 95% 1,35-2,85; PINTRODUCTION: Disturbances of the cardiac conduction system are potential complications after cardiac valve surgery. OBJECTIVES: This study was designed to investigate the association between perioperative factors and atrio-ventricular block, the need for temporary cardiac artificial pacing and, if necessary, permanent pacemaker implantation after cardiac valve surgery. METHODS: Retrospective analysis of the Cardiac Surgery Database - Hospital São Lucas/PUCRS. The data are collected prospectively and analyzed retrospectively. RESULTS: Between January

O efeito da morfina na inibição vagal do coração: demonstração da dupla via do nodo atrioventricular - DOI: 10.4025/actascihealthsci.v28i2.1102 The effect of morphine on vagal inhibition of the heart: demonstration of dual atrioventricular nodal pathways - DOI: 10.4025/actascihealthsci.v28i2.1102

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José Geraldo Pereira da Cruz

2006-03-01

Full Text Available A estimulação elétrica do nervo vago diminui a freqüência cardíaca e aumenta o intervalo PQ no eletrocardiograma, podendo ativar a via anterógrada do nodo atrioventricular. Neste experimento é investigada a interação da morfina sobre o controle nervoso parassimpático cardíaco em relação à dupla condução do nodo atrioventricular. A estimulação do nervo vago induz uma significativa bradicardia e um bloqueio atrioventricular de terceiro grau, com a onda P aparecendo negativa na derivação II. Devido aos efeitos moduladores da anestesia sobre o coração, administração de injeções de morfina induz o aparecimento de onda P positiva através de uma ação inibitória sobre a reentrância do nodo atrioventricular. Tudo sugere a presença de duas vias atrioventriculares, anatômica e funcionalmente distintasThat electrical stimulation of the vagus decreased heart rate and increased the PQ interval in electrocardiogram, consistent with anterograde dual atriventricular conduction. The present experiments were investigating the interaction of the morphine with cardiac parasympathetic nervous control in dual atrioventricular node. Electrical stimulation of the vagus nerve induced significant bradycardia and of third degree atrioventricular block and the P wave appearance was negative in leads II. Because background anesthesia modulates the heart, administered morphine injection the P waves appearance was positive through one inhibitory action on atrioventricular nodal reentry. All suggest the presence of two functionally and anatomically distinct atrioventricular pathways

Complete atrioventricular canal.

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Calabrò, Raffaele; Limongelli, Giuseppe

2006-04-05

Complete atrioventricular canal (CAVC), also referred to as complete atrioventricular septal defect, is characterised by an ostium primum atrial septal defect, a common atrioventricular valve and a variable deficiency of the ventricular septum inflow. CAVC is an uncommon congenital heart disease, accounting for about 3% of cardiac malformations. Atrioventricular canal occurs in two out of every 10,000 live births. Both sexes are equally affected and a striking association with Down syndrome was found. Depending on the morphology of the superior leaflet of the common atrioventricular valve, 3 types of CAVC have been delineated (type A, B and C, according to Rastelli's classification). CAVC results in a significant interatrial and interventricular systemic-to-pulmonary shunt, thus inducing right ventricular pressure and volume overload and pulmonary hypertension. It becomes symptomatic in infancy due to congestive heart failure and failure to thrive. Diagnosis of CAVC might be suspected from electrocardiographic and chest X-ray findings. Echocardiography confirms it and gives anatomical details. Over time, pulmonary hypertension becomes irreversible, thus precluding the surgical therapy. This is the reason why cardiac catheterisation is not mandatory in infants (less than 6 months) but is indicated in older patients if irreversible pulmonary hypertension is suspected. Medical treatment (digitalis, diuretics, vasodilators) plays a role only as a bridge toward surgery, usually performed between the 3rd and 6th month of life.

Complete atrioventricular canal

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Limongelli Giuseppe

2006-04-01

Full Text Available Abstract Complete atrioventricular canal (CAVC, also referred to as complete atrioventricular septal defect, is characterised by an ostium primum atrial septal defect, a common atrioventricular valve and a variable deficiency of the ventricular septum inflow. CAVC is an uncommon congenital heart disease, accounting for about 3% of cardiac malformations. Atrioventricular canal occurs in two out of every 10,000 live births. Both sexes are equally affected and a striking association with Down syndrome was found. Depending on the morphology of the superior leaflet of the common atrioventricular valve, 3 types of CAVC have been delineated (type A, B and C, according to Rastelli's classification. CAVC results in a significant interatrial and interventricular systemic-to-pulmonary shunt, thus inducing right ventricular pressure and volume overload and pulmonary hypertension. It becomes symptomatic in infancy due to congestive heart failure and failure to thrive. Diagnosis of CAVC might be suspected from electrocardiographic and chest X-ray findings. Echocardiography confirms it and gives anatomical details. Over time, pulmonary hypertension becomes irreversible, thus precluding the surgical therapy. This is the reason why cardiac catheterisation is not mandatory in infants (less than 6 months but is indicated in older patients if irreversible pulmonary hypertension is suspected. Medical treatment (digitalis, diuretics, vasodilators plays a role only as a bridge toward surgery, usually performed between the 3rd and 6th month of life.

Structural and functional alterations in the atrioventricular node and atrioventricular ring tissue in ischaemia-induced heart failure.

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Yanni, Joseph; Maczewski, Michal; Mackiewicz, Urszula; Siew, Samuel; Fedorenko, Olga; Atkinson, Andrew; Price, Marcus; Beresewicz, Andrzej; Anderson, Robert H; Boyett, Mark R; Dobrzynski, Halina

2014-07-01

Heart failure (HF) causes dysfunction of the atrioventricular node (AVN) - first or second-degree heart block is a risk factor for sudden cardiac death in HF patients. The aim of the study was to determine if HF causes remodelling of the AVN and right atrioventricular ring (RAVR). HF was induced in rats (n=4) by ligation of the proximal left coronary artery, which resulted in a large infarct of the left ventricle. Sham-operated rats (n=4) were used as controls. Eight weeks after surgery, functional experiments were performed and the hearts were frozen. The body weight of HF rats was similar to control rats, but the mean heart weight of HF rats was significantly enlarged. In HF rats compared to controls, the left ventricle was dilated, left ventricular end-diastolic pressure elevated (21.0 ± 0.6 and 5.4 ± 0.2 mm Hg), left ventricular ejection fraction reduced (0.2 ± 0.02 and 0.5 ± 0.02) and left ventricular end-systolic pressure reduced (102 ± 4.2 and 127 ± 3.1 mm Hg). In HF rats, the in vivo and in vitro PR intervals were increased (41% and 20%), as was the Wenckebach cycle length, indicative of AVN dysfunction. The collagen content was significantly increased in the AVN and RAVR indicating fibrosis. Immunolabelling of caveolin3 (cell membrane marker) showed that there was hypertrophy in HF (cell diameter was increased by 63%, 39% in AVN, RAVR). The TUNEL assay showed that the myocytes of the AVN and RAVR in HF undergo apoptotic cell death. Immunolabelling showed that expression of HCN4 was significantly decreased in the AVN and RAVR (43% and 47%) in HF. We conclude that in HF there is remodelling of the AVN and RAVR and this remodelling may explain the AVN dysfunction.

An extremely rare clinical entity: congenitally corrected transposition with situs ınversus and single coronary artery presented with complete atrioventricular block in a young man.

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Cirakoglu, Omer Faruk; Bayraktar, Ali; Sayin, Muhammet Rasit

2018-05-01

Congenitally corrected transposition of the great arteries is a rare form of CHD. Situs inversus is a much less common variant of a congenitally corrected transposition of the great arteries. In rare cases, transposition events may be accompanied by various cardiac anomalies. However, situs inversus patients with congenitally corrected transposition, single coronary artery anomaly, and atrioventricular block together have not been reported previously. This combination of abnormalities is presented as a first in the literature.

Agenesia de cava superior associada a bloqueio atrioventricular de 3º grau Agenesis of the right superior vena cava associated with total heart block

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Gustavo J. Ventura Couto

2008-03-01

Full Text Available A persistência de veia cava superior esquerda com ausência da veia cava superior é uma anomalia rara, principalmente quando associada a bloqueio atrioventricular de 3º grau. Relatamos o caso de uma paciente, na qual durante implante de marca-passo definitivo, para a correção de bloqueio atrioventricular total, foi detectada presença de veia cava superior esquerda com suspeição de ausência de veia cava superior, o que levou ao emprego de técnica diferenciada para fixação do eletrodo ventricular. Para confirmação da provável agenesia, foram realizados diversos exames complementares de imagem, demonstrando-se a dificuldade no diagnóstico da síndrome aqui descrita.The superior left vena cava with the absent superior vena cava is a rare abnormality, especially when associated with total heart block. We report a case of a patient in which the presence of superior left vena cava and the absence of the superior vena cava was detected during the implantation of a pacemaker for the correction of a total heart block, which led us to use a different technique for the fixation of the ventricular electrode. To confirm the supposed absence, several image exams were made showing the difficulty on the diagnosis of the described syndrome.

Complex phenotype linked to a mutation in exon 11 of the lamin A/C gene: Hypertrophic cardiomyopathy, atrioventricular block, severe dyslipidemia and diabetes.

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Francisco, Ana Rita G; Santos Gonçalves, Inês; Veiga, Fátima; Mendes Pedro, Mónica; Pinto, Fausto J; Brito, Dulce

2017-09-01

The lamin A/C (LMNA) gene encodes lamins A and C, which have an important role in nuclear cohesion and chromatin organization. Mutations in this gene usually lead to the so-called laminopathies, the primary cardiac manifestations of which are dilated cardiomyopathy and intracardiac conduction defects. Some mutations, associated with lipodystrophy but not cardiomyopathy, have been linked to metabolic abnormalities such as diabetes and severe dyslipidemia. Herein we describe a new phenotype associated with a mutation in exon 11 of the LMNA gene: hypertrophic cardiomyopathy, atrioventricular block, severe dyslipidemia and diabetes. A 64-year-old woman with hypertrophic cardiomyopathy and a point mutation in exon 11 of the LMNA gene (c.1718C>T, Ser573Leu) presented with severe symptomatic ventricular hypertrophy and left ventricular outflow tract obstruction. She underwent septal alcohol ablation, followed by Morrow myectomy. The patient was also diagnosed with severe dyslipidemia, diabetes and obesity, and fulfilled diagnostic criteria for metabolic syndrome. No other characteristics of LMNA mutation-related phenotypes were identified. The development of type III atrioventricular block with no apparent cause, and mildly depressed systolic function, prompted referral for cardiac resynchronization therapy. In conclusion, the association between LMNA mutations and different phenotypes is complex and not fully understood, and can present with a broad spectrum of severity. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of incomplete atrioventricular septal defect

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Marcelo Felipe Kozak

2015-04-01

Full Text Available AbstractIntroduction:Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defect.Objective:To determine factors associated with moderate or greater left atrioventricular valve regurgitation within 30 days of surgical repair of incomplete atrioventricular septal defect.Methods:We assessed the results of 51 consecutive patients 14 years-old and younger presenting with incomplete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative left atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. The median age was 4.1 years; the median weight was 13.4 Kg; 37.2% had Down syndrome. At the time of preoperative evaluation, there were 23 cases with moderate or greater left atrioventricular valve regurgitation (45.1%. Abnormalities on the left atrioventricular valve were found in 17.6%; annuloplasty was performed in 21.6%.Results:At the time of postoperative evaluation, there were 12 cases with moderate or greater left atrioventricular valve regurgitation (23.5%. The variation between pre- and postoperative grades of left atrioventricular valve regurgitation of patients with atrioventricular valve malformation did not reach significance (P=0.26, unlike patients without such abnormalities (P=0.016. During univariate analysis, only absence of Down syndrome was statistically significant (P=0.02. However, after a multivariate analysis, none of the factors reached significance.Conclusion:None of the factors studied was determinant of a moderate or greater left atrioventricular valve regurgitation within the first 30 days of repair of incomplete atrioventricular septal defect in the sample. Patients without abnormalities on the left atrioventricular valve benefit more of the operation.

Association of temporary complete AV block and junctional ectopic tachycardia after surgery for congenital heart disease

International Nuclear Information System (INIS)

Paech, Christian; Dähnert, Ingo; Kostelka, Martin; Mende, Meinhardt; Gebauer, Roman

2015-01-01

Junctional ectopic tachycardia (JET) is a postoperative complication with a mortality rate of up to 14% after surgery for congenital heart disease. This study evaluated the risk factors of JET and explored the association of postoperative temporary third degree atrioventricular (AV) block and the occurrence of JET. Data were collected retrospectively from 1158 patients who underwent surgery for congenital heart disease. The overall incidence of JET was 2.8%. Temporary third degree AV block occurred in 1.6% of cases. Permanent third degree AV block requiring pacemaker implantation occurred in 1% of cases. In all, 56% of patients with JET had temporary AV block (P < 0.001), whereas no case of postoperative JET was reported in patients with permanent AV block (P = 0.56). temporary third degree AV block did not suffer from JET. A correlation between temporary third degree AV block and postoperative JET could be observed. The risk factors identified for JET include younger age groups at the time of surgery, longer aortic cross clamping time and surgical procedures in proximity to the AV node

Atrioventricular Dissociation following Blunt Chest Trauma

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Salim Surani

2014-01-01

Full Text Available Blunt chest trauma (BCT is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.

The angulation of the septal structures impacts ventricular imbalance in atrioventricular septal defects with a common atrioventricular junction.

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Ahmad, Zaheer; Lim, Zek; Roman, Kevin; Haw, Marcus; Anderson, Robert H; Vettukattil, Joseph

2016-02-01

Multiplanar re-formatting of full-volume three-dimensional echocardiography data sets offers new insights into the morphology of atrioventricular septal defects. We hypothesised that distortion of the alignment between the atrial and ventricular septums results in imbalanced venous return to the ventricles, with consequent proportional ventricular hypoplasia. A single observer evaluated 31 patients, with a mean age of 52.09 months, standard deviation of 55, and with a range from 2 to 264 months, with atrioventricular septal defects, of whom 17 were boys. Ventricular imbalance, observed in nine patients, was determined by two-dimensional assessment, and confirmed at surgical inspection in selected cases when a univentricular strategy was undertaken. Offline analysis using multiplanar re-formatting was performed. A line was drawn though the length of the ventricular septum and a second line along the plane of the atrial septum, taking the angle between these two lines as the atrioventricular septal angle. We compared the angle between 22 patients with adequately sized ventricles, and those with ventricular imbalance undergoing univentricular repair. In the 22 patients undergoing biventricular repair, the septal angle was 0 in 14 patients; the other eight patients having angles ranging from 1 to 36, with a mean angle of 7.4°, and standard deviation of 11.1°.The mean angle in the nine patients with ventricle imbalance was 28.6°, with a standard deviation of 3.04°, and with a range from 26 to 35°. Of those undergoing univentricular repair, two patients died, with angles of 26 and 30°, respectively. The atrioventricular septal angle derived via multiplanar formatting gives important information regarding the degree of ventricular hypoplasia and imbalance. When this angle is above 25°, patients are likely to have ventricular imbalance requiring univentricular repair.

Atrioventricular Pacemaker Lead Reversal

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Mehmet K Aktas, MD

2007-01-01

Full Text Available During cardiac surgery temporary epicardial atrial and ventricular leads are placed in case cardiac pacing is required postoperatively. We present the first reported series of patients with reversal of atrioventricular electrodes in the temporary pacemaker without any consequent deleterious hemodynamic effect. We review the electrocardiographic findings and discuss the findings that lead to the discovery of atrioventricular lead reversal.

Functional Capacity of Patients with Pacemaker Due to Isolated Congenital Atrioventricular Block

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de Oliveira Júnior, Roberto Márcio; da Silva, Kátia Regina; Kawauchi, Tatiana Satie; Alves, Lucas Bassolli de Oliveira; Crevelari, Elizabeth Sartori; Martinelli, Martino; Costa, Roberto

2015-01-01

Background Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation. Objectives To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling. Methods This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%. Results A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. Conclusions The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling. PMID:25387405

Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden.

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Frid, Christina; Björkhem, Gudrun; Jonzon, Anders; Sunnegårdh, Jan; Annerén, Göran; Lundell, Bo

2004-02-01

The survival for patients with atrioventricular septal defect has improved markedly over the last decades and, during the same period, the survival of children with Down's syndrome has also increased. The aim of our study was to investigate long-term survival in patients having atrioventricular septal defect with common valvar orifice, but without associated significant congenital heart defects, in the setting of Down's syndrome, comparing the findings to those in chromosomally normal children with the same malformation. In a population-based retrospective study, we scrutinised the medical records from 801 liveborn children with atrioventricular septal defect born in Sweden during the period 1973 through 1997. Data on gender, presence or absence of Down's syndrome, associated congenital heart defects, date of birth, operation and death were recorded and followed up until 2001. An isolated atrioventricular septal defect with common atrioventricular valvar orifice was present in 502 children, of whom 86% had Down's syndrome. We found a significant reduc tion over time in age at operation, and in postoperative mortality at 30 days, from 28 to 1%. Using a multiple logistic regression model, we found no significant differences in mortality between genders, nor between those with or without Down's syndrome. Early corrective surgery could not be identified as a significant independent factor for survival. The 5-year postoperative survival in patients with Down's syndrome increased from 65% over the period from 1973 through 1977, to about 90% in the period 1993 through 1997, and the same trend was observed in chromosomally normal patients. Survival in uncomplicated atrioventricular septal defect with common atrioventricular valvar orifice has greatly increased, and surgical correction is now equally successful in patients with Down's syndrome and chromosomally normal patients, and for both genders. Death in connection with surgery is no longer the major threat, and focus

Infinite-degree-corrected stochastic block model

DEFF Research Database (Denmark)

Herlau, Tue; Schmidt, Mikkel Nørgaard; Mørup, Morten

2014-01-01

In stochastic block models, which are among the most prominent statistical models for cluster analysis of complex networks, clusters are defined as groups of nodes with statistically similar link probabilities within and between groups. A recent extension by Karrer and Newman [Karrer and Newman...... corrected stochastic block model as a nonparametric Bayesian model, incorporating a parameter to control the amount of degree correction that can then be inferred from data. Additionally, our formulation yields principled ways of inferring the number of groups as well as predicting missing links...

Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach

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Hamid Bigdelian

2016-02-01

Full Text Available Background: Tetralogy of Fallot (TOF is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used. Methods: This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40, the transatrial approach (n=40, or a combined atrioventricular approach (n=40. Demographic data and the outcomes of the surgical procedures were compared among the groups. Results: In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034, right ventricular failure (p=0.027 and mediastinal bleeding (p=0.007. Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001. No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395. Conclusion: Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate.

[Parahisian atrial tachycardia or atrioventricular nodal reentrant tachycardia with tendon of Todaro breakthrough?].

Science.gov (United States)

Orczykowski, Michał; Jaworska-Wilczyńska, Maria; Urbanek, Piotr; Bodalski, Robert; Derejko, Paweł; Gajek, Jacek; Hryniewiecki, Tomasz; Szumowski, Lukasz; Walczak, Franciszek

2010-08-01

We present a case of a 61 year-old woman with tachycardia originating close to the His bundle where radiofrequency (RF) ablation may bear potential risk of atrioventricular (AV) block. In this case report we discuss the possibility of a AV nodal reciprocating tachycardia with tendon of Todaro breakthrough. Patient was safely and effectively treated with RF catheter ablation.

Prolonged Atrioventricular Block and Ventricular Standstill Following Adenosine Triphosphate Injection in a Patient Taking Dipyridamole and Antiarrhythmic Agents: A Case Report

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Kotaro Oe, MD

2009-01-01

Full Text Available An 83-year-old woman was admitted to our hospital because of palpitation. She had hypertension and paroxysmal atrial fibrillation, treated with digoxin and cibenzoline, and took dipyridamole for microalbuminuria. Before admission, she had taken pilsicainide pills in addition. On admission, electrocardiogram showed regular tachycardia with mildly prolonged QRS width. For the purpose of terminating tachycardia, 10 mg of adenosine triphosphate (ATP was rapidly injected. About 20 sec later, atrioventricular block and ventricular standstill occurred. She presented loss of consciousness and convulsion, and chest compression was performed. About 30 sec later, the QRS complex reappeared, and she became alert. Serum concentration of digoxin, cibenzoline and pilsicainide was within therapeutic level, respectively. We should be cautious in using ATP for a patient taking dipyridamole and antiarrhythmic agents.

Doxorubicin-induced second degree and complete atrioventricular block.

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Kilickap, Saadettin; Akgul, Ebru; Aksoy, Sercan; Aytemir, Kudret; Barista, Ibrahim

2005-05-01

Doxorubicin is one of the most effective chemotherapeutic agents used in the treatment of malignancies. Cardiotoxicity is the most important dose-limiting toxicity of doxorubicin. Although cardiomyopathy is the most well known side effect of doxorubicin, it usually occurs many years after the treatment and relates to cumulative doxorubicin dosage. Another form of doxorubicin cardiotoxicity is arrhythmia which may occur at any time and after any dosage. However, doxorubicin-induced arrhythmia is rarely a life-threatening side effect. In this report, we present a case in which there were doxorubicin-induced life-threatening arrhythmias.

Unbalanced atrioventricular septal defect: definition and decision making.

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Overman, David M; Baffa, Jeanne M; Cohen, Meryl S; Mertens, Luc; Gremmels, David B; Jegatheeswaram, Anusha; McCrindle, Brian W; Blackstone, Eugene H; Morell, Victor O; Caldarone, Christopher; Williams, William G; Pizarro, Christian

2010-04-01

Unbalanced atrioventricular septal defect is an uncommon lesion with widely varying anatomic manifestations. When unbalance is severe, diagnosis and treatment is straightforward, directed toward single-ventricle palliation. Milder forms, however, pose a challenge to current diagnostic and therapeutic approaches. The transition from anatomies that are capable of sustaining biventricular physiology to those that cannot is obscure, resulting in uneven application of surgical strategy and excess mortality. Imprecise assessments of ventricular competence have dominated clinical decision making in this regard. Malalignment of the atrioventricular junction and its attendant derangement of inflow physiology is a critical factor in determining the feasibility of biventricular repair in the setting of unbalanced atrioventricular septal defect. The atrioventricular valve index accurately identifies unbalanced atrioventricular septal defect and also brings into focus a zone of transition from anatomies that can support a biventricular end state and those that cannot.

Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus.

Science.gov (United States)

Mantovani, Alessandro; Rigolon, Riccardo; Pichiri, Isabella; Bonapace, Stefano; Morani, Giovanni; Zoppini, Giacomo; Bonora, Enzo; Targher, Giovanni

2017-01-01

Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiac tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus. The aim of this study was to examine whether an association also exists between NAFLD and heart block. We have retrospectively evaluated a hospital-based cohort of 751 patients with type 2 diabetes discharged from our Division of Diabetes and Endocrinology during years 2007-2014. Standard electrocardiograms were performed on all patients. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced hepatic fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis markers. Overall, 524 (69.8%) patients had NAFLD and 202 (26.9%) had heart block (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block) on electrocardiograms. Patients with NAFLD had a remarkably higher prevalence of any persistent heart block than those without NAFLD (31.3% vs. 16.7%, pdiabetes.

Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

Science.gov (United States)

Bogossian, Harilaos; Frommeyer, Gerrit; Göbbert, Kornelius; Hasan, Fuad; Nguyen, Quy Suu; Ninios, Ilias; Mijic, Dejan; Bandorski, Dirk; Hoeltgen, Reinhard; Seyfarth, Melchior; Lemke, Bernd; Eckardt, Lars; Zarse, Markus

2017-08-01

The present European guidelines suggest a diagnostic electrophysiological (EP) study to determine indication for cardiac pacing in patients with bundle branch block and unexplained syncope. We evaluated the prognostic relevance of an EP study for mortality and the development of permanent complete atrioventricular (AV) block in patients with symptomatic bifascicular block and first-degree AV block. The HV interval is a poor prognostic marker to predict the development of permanent AV block in patients with symptomatic bifascicular block (BFB) and AV block I°. Thirty consecutive patients (mean age, 74.8 ± 8.6 years; 25 males) with symptomatic BFB and first-degree AV block underwent an EP study before device implantation, according to current guidelines. For 53 ± 31 months, patients underwent yearly follow-up screening for syncope or higher-degree AV block. Thirty patients presented with prolonged HV interval during the EP study (mean, 82.2 ± 20.1 ms; range, 57-142 ms), classified into 3 groups: group 1, 70 to ≤100 ms (mean, 80 ± 8 ms; range, 70-97 ms; n = 18), and group 3, >100 ms (mean, 119 ± 14 ms; range, 107-142 ms; n = 5). According to the guidelines, patients in groups 2 and 3 received a pacemaker. The length of the HV interval was not associated with the later development of third-degree AV block or with increased mortality. Our present study suggests that an indication for pacemaker implantation based solely on a diagnostic EP study with prolongation of the HV interval is not justified. © 2017 Wiley Periodicals, Inc.

Radiofrequency Catheter Ablation of Coexistent Idiopathic Left Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

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Ken-Pen Weng

2005-10-01

Full Text Available A healthy 15-year-old male patient presented with a 6-month history of recurrent attacks of palpitations. On multiple emergency room visits, a sustained wide QRS complex tachycardia with a right bundle branch block and northwest axis deviation was documented. The tachycardia was not terminated by intravenous adenosine, but was suppressed with intravenous verapamil. There was no evidence of structural heart disease, myocarditis, long QT syndrome, or electrolyte imbalance after a series of standard examinations. Idiopathic left ventricular tachycardia (ILVT was suspected. Electrophysiologic studies revealed 2 inducible tachycardias, which were shown to represent atrioventricular nodal reentrant tachycardia (AVNRT and ILVT. Transformation from AVNRT to ILVT occurred spontaneously following atrial pacing. Successful ablation of ILVT and the slow atrioventricular nodal pathway resulted in cure of the double tachycardia.

Anatomy of the human atrioventricular junctions revisited

NARCIS (Netherlands)

Anderson, R. H.; Ho, S. Y.; Becker, A. E.

2000-01-01

There have been suggestions made recently that our understanding of the atrioventricular junctions of the heart is less than adequate, with claims for several new findings concerning the arrangement of the ordinary working myocardium and the specialised pathways for atrioventricular conduction. In

Esclerosis sistémica complicada con síncope y bloqueo AV completo Systemic sclerosis complicated with syncope and complete AV block

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Francisco Femenía

2010-10-01

Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.

Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit

Science.gov (United States)

Nikolaidou, Theodora; Cai, Xue J.; Stephenson, Robert S.; Yanni, Joseph; Lowe, Tristan; Atkinson, Andrew J.; Jones, Caroline B.; Sardar, Rida; Corno, Antonio F.; Dobrzynski, Halina; Withers, Philip J.; Jarvis, Jonathan C.; Hart, George; Boyett, Mark R.

2015-01-01

Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ). Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR) were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT). Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ. PMID:26509807

Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit.

Directory of Open Access Journals (Sweden)

Theodora Nikolaidou

Full Text Available Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ. Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT. Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ.

Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth

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V. Martucci

2012-01-01

Full Text Available Transient episodes of fetal bradycardia (heart rate less than 110 bpm are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100 bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias.

Istaroxime, a positive inotropic agent devoid of proarrhythmic properties in sensitive chronic atrioventricular block dogs.

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Bossu, Alexandre; Kostense, Amée; Beekman, Henriette D M; Houtman, Marien J C; van der Heyden, Marcel A G; Vos, Marc A

2018-05-10

Current inotropic agents in heart failure therapy associate with low benefit and significant adverse effects, including ventricular arrhythmias. Istaroxime, a novel Na + /K + -transporting ATPase inhibitor, also stimulates SERCA2a activity, which would confer improved inotropic and lusitropic properties with less proarrhythmic effects. We investigated hemodynamic, electrophysiological and potential proarrhythmic and antiarrhythmic effects of istaroxime in control and chronic atrioventricular block (CAVB) dogs sensitive to drug-induced Torsades de Pointes arrhythmias (TdP). In isolated normal canine ventricular cardiomyocytes, istaroxime (0.3-10 μM) evoked no afterdepolarizations and significantly shortened action potential duration (APD) at 3 and 10 μM. Istaroxime at 3 μg/kg/min significantly increased left ventricular (LV) contractility (dP/dt + ) and relaxation (dP/dt-) respectively by 81 and 94% in anesthetized control dogs (n = 6) and by 61 and 49% in anesthetized CAVB dogs (n = 7) sensitive to dofetilide-induced TdP. While istaroxime induced no ventricular arrhythmias in control conditions, only single ectopic beats occurred in 2/7 CAVB dogs, which were preceded by increase of short-term variability of repolarization (STV) and T wave alternans in LV unipolar electrograms. Istaroxime pre-treatment (3 μg/kg/min for 60 min) did not alleviate dofetilide-induced increase in repolarization and STV, and mildly reduced incidence of TdP from 6/6 to 4/6 CAVB dogs. In six CAVB dogs with dofetilide-induced TdP, administration of istaroxime (90 μg/kg/5 min) suppressed arrhythmic episodes in two animals. Taken together, inotropic and lusitropic properties of istaroxime in CAVB dogs were devoid of significant proarrhythmic effects in sensitive CAVB dogs, and istaroxime provides a moderate antiarrhythmic efficacy in prevention and suppression of dofetilide-induced TdP. Copyright © 2018. Published by Elsevier Ltd.

Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back

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Maxwell Eyram Afari

2016-01-01

Full Text Available Carditis is an uncommon presentation of the early disseminated phase of Lyme disease. We present the case of a young female who presented with erythema migrans and was found to have first-degree heart block which progressed to complete heart block within hours. After receiving ceftriaxone, there was complete resolution of the heart block in sequential fashion. Our case illustrates the importance of early recognition and anticipation of progressive cardiac conduction abnormalities in patients presenting with Lyme disease.

Does the atrioventricular node conduct?

NARCIS (Netherlands)

Meijler, F.L.; Fisch, C.

1989-01-01

It is difficult to be certain wh en the term "conduction" was first applied to the transfer of atrial activation to the ventricles .' In 1894, Engelmann used the word "Leitung", which can be translated as "connection" or as "conduction" .2 In 1906, Tawara described the atrioventricular node,

Hyperkalemia-induced complete heart block

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Alireza Baratloo

2015-05-01

Full Text Available Background: Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair pulse conduction in Purkinje fibers and ventricles more than that in the Atrioventricular (AV node. Therefore, although complete AV block can occur, it is a rare initial presentation. Case Report: We describe a 62-year-old man with a history of diabetes mellitus, ischemic heart disease and previous Coronary Artery Bypass Graft (CABG, who came to our emergency department due to generalized weakness starting 2 days before admission. The patient also had decreased force in lower limbs, exacerbating from the morning, and was finally diagnosed as a hyperkalemia-induced Complete Heart Block (CHB. It should also be noted that the patient responded dramatically to the administration of 10 mL of 10% calcium gluconate along with external pacing until potassium level correction became effective. Conclusion: In spite of the fact that Hyperkalemia can be associated with frequent Electrocardiogram (ECG abnormality, advanced heart blocks (second- and third-degree AV blocks are usually found only in patients with pre-existing heart failure, conduction abnormalities, or other cardiac diseases. Institution of effective treatment rapidly and forgiveness of traditional non-effective, time consumptive and sometimes risking full-adjustment modalities, such as sodium bicarbonate infusion or exchange resins that prevent their use in the emergent phase, can help minimize patient morbidity and mortality.

An improved in vivo method for atrioventricular node ablation via thoracotomy

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R.H. MacIver

2010-02-01

Full Text Available The atrioventricular (AV node is permanently damaged in approximately 3% of congenital heart surgery operations, requiring implantation of a permanent pacemaker. Improvements in pacemaker design and in alternative treatment modalities require an effective in vivo model of complete heart block (CHB before testing can be performed in humans. Such a model should enable accurate, reliable, and detectable induction of the surgical pathology. Through our laboratory’s efforts in developing a tissue engineering therapy for CHB, we describe here an improved in vivo model for inducing chronic AV block. The method employs a right thoracotomy in the adult rabbit, from which the right atrial appendage may be retracted to expose an access channel for the AV node. A novel injection device was designed, which both physically restricts needle depth and provides electrical information via electrocardiogram interface. This combination of features provides real-time guidance to the researcher for confirming contact with the AV node, and documents its ablation upon formalin injection. While all animals tested could be induced to acute AV block, those with ECG guidance were more likely to maintain chronic heart block >12 h. Our model enables the researcher to reproduce both CHB and the associated peripheral fibrosis that would be present in an open congenital heart surgery, and which would inevitably impact the design and utility of a tissue engineered AV node replacement.

In vivo analysis of torsadogenic potential of an antipsychotic drug paliperidone using the acute atrioventricular block rabbit as a proarrhythmia model

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Mihoko Hagiwara

2016-09-01

Full Text Available We assessed electrophysiological effects of an atypical antipsychotic drug paliperidone in acute atrioventricular block rabbits. Intravenous administration of paliperidone at a clinically relevant dose (0.06 mg/kg hardly affected the QT interval or monophasic action potential (MAP duration, and the higher doses (0.6 and 6 mg/kg prolonged the QT interval and MAP duration. Meanwhile, premature ventricular contractions with R on T phenomenon were observed in 3 out of 6 animals at the middle dose, and torsades de pointes (TdP episodes were detected in 2 out of 6 animals at the high dose. Intravenous administration of its chemically related compound risperidone at a clinically relevant dose (0.03 mg/kg hardly affected the electrophysiological parameters, and the higher doses (0.3 and 3 mg/kg prolonged the QT interval and MAP duration. Meanwhile, the premature ventricular contractions with R on T were observed in 2 out of 6 animals at the middle dose, and TdP episodes were detected in 4 out of 6 animals at the high dose. These results suggest that paliperidone showed torsadogenic potential at supra-therapeutic doses, whose potency can be estimated to be equal or slightly subordinate in comparison with that of risperidone.

Selection of permanent pacing position of cardiac ventricle in patients with complete right bundle branch block

International Nuclear Information System (INIS)

Yang Minquan; Zhou Jun; Zhu Yan; Wang Jin; Rong Xin; Zhang Xiaoyi

2005-01-01

Objective: To find out the optimal pacing localization by comparing different pacing positions of the right ventricle in brady-cardiacarrhythmia patients with complete right bundle branch block. Methods: DDD type of double lumen permanent pacemaker was implanted in each of the 8 cases of sick sinus syndrome (SSS) and/or III degree atrioventricular block (III degree AVB) with complete right bundle branch block in normal heart function or class I. For each patient, four pacing positions in right ventricle were compared and the QRS pacing durations were recorded. The position with the shortest the QRS duration was chosen as the permanent pacing position. Heart function, chest X-rays and left ventricle ejection fraction (LVEF) were followed up after the operation. Results: In all the 8 cases, the posterior septum of the right ventricle were chosen as the permanent pacing position, with the shorter pacing QRS duration than that of pre-operation (P<0.05) and other pacing positions of the right ventricle. All parameters of this permanent pacing position were within the normal range. During the follow-up of 6-36 months, no abnormity was found in cardiac functions. Conclusion: In brady-cardiacarrhythmia patients with complete right bundle branch block, the implantation of permanent pacemaker should be at the junction region of inlet and outlet tracts, of the posterior septum of the right ventricle with ideal physiological function. (authors)

Outcome of slow pathway modulation for atrioventricular nodal reentrant tachycardia with 50 versus 30 watts-more power, more effect?

Science.gov (United States)

Dechering, Dirk G; Schleberger, Ruben; Greiser, Eva; Dickow, Jannis; Koebe, Julia; Frommeyer, Gerrit; Willems, Stephan; Eckardt, Lars; Hoffmann, Boris A; Wasmer, Kristina

2018-03-19

Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches. We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months. Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.

Complete heart block in a 9 year old girl caused by borreliosis.

Science.gov (United States)

Gildein, H P; Günther, S; Mocellin, R

1993-01-01

A complete atrioventricular block was seen in a nine year old girl in whom an infection with Borrelia burgdorferi was confirmed by serological testing. There were no other symptoms or cutaneous manifestations of the disease. Though a rash on the right ear was later recalled by her parents. The patient was treated with high dose penicillin and orciprenaline was given intermittently. The complete heart block disappeared within four days. PMID:8038006

A rare form of atrioventricular septal defect with severe subaortic stenosis.

Science.gov (United States)

Venugopalan, P; Agarwal, A K; Reyes, Z

2001-06-01

An unusual form of atrioventricular septal defect associated with severe subaortic obstruction is reported in a neonate who presented with intractable cardiac failure. The baby had a large defect in the atrioventricular septum allowing communication from the left ventricle to the right atrium, without interatrial or interventricular communication, and a cleft anterior mitral leaflet. The baby expired despite palliative surgery performed to bypass the subaortic stenosis.

A case of advanced second-degree atrioventricular block in a ferret ...

African Journals Online (AJOL)

admin

2016-04-15

Apr 15, 2016 ... Introduction. Acquired heart disease is common in ferrets over four years of age. A recent retrospective study showed that the most common echocardiographic abnormality in this species is valvular regurgitation (52%), often affecting the aortic and mitral valves (Laniesse et al.,. 2014). Left ventricle ...

Acquired heart block: a possible complication of patent ductus arteriosus in a preterm infant.

Science.gov (United States)

Grasser, Monika; Döhlemann, Christoph; Mittal, Rashmi; Till, Holger; Dietz, Hans-Georg; Münch, Georg; Holzinger, Andreas

2008-01-01

A large patent ductus arteriosus (PDA) is a frequently encountered clinical problem in extremely low birth weight (ELBW) infants. It leads to an increased pulmonary blood flow and in a decreased or reversed diastolic flow in the systemic circulation, resulting in complications. Here we report a possible complication of PDA not previously published. On day 8 of life, a male ELBW infant (birth weight 650 g) born at a gestational age of 23 weeks and 3 days developed an atrioventricular block (AV block). The heart rate dropped from 168/min to 90/min, and the ECG showed a Wenckebach second-degree AV block and intraventricular conduction disturbances. Echocardiography demonstrated a PDA with a large left-to-right shunt and large left atrium and left ventricle with high contractility. Within several minutes after surgical closure of the PDA, the heart rate increased, and after 30 min the AV block had improved to a 1:1 conduction ratio. Echocardiography after 2 h revealed a significant decrease of the left ventricular and atrial dimensions. Within 12 h, the AV block completely reversed together with the intraventricular conduction disturbances. We suggest that PDA with a large left-to-right shunt and left ventricular volume overload may lead to an AV block in an ELBW infant. Surgical closure of the PDA may be indicated. (c) 2007 S. Karger AG, Basel.

Exercise capacity and N-terminal pro-brain natriuretic peptide levels with biventricular vs. right ventricular pacing for atrioventricular block: results from the PREVENT-HF German Substudy.

Science.gov (United States)

Stockburger, Martin; de Teresa, Eduardo; Lamas, Gervasio; Desaga, Martin; Koenig, Carsten; Habedank, Dirk; Cobo, Erik; Navarro, Xavier; Wiegand, Uwe

2014-01-01

Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP). Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2), oxygen uptake at the anaerobic threshold (VO2AT), ventilatory efficiency (VE/VCO2), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83-4.91, P = 0.007], VO2AT (ANCOVA effect 2.14 mL/min/k, CI 0.14-4.15, P = 0.03), and VE/VCO2 (ANCOVA effect -5.46, CI -10.79 to -0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI -0.40 to +0.41, P = 0.97; OT: ANCOVA effect -0.03, CI -0.44 to 0.30, P = 0.90). Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326.

Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study.

Science.gov (United States)

Kaye, Gerald C; Linker, Nicholas J; Marwick, Thomas H; Pollock, Lucy; Graham, Laura; Pouliot, Erika; Poloniecki, Jan; Gammage, Michael

2015-04-07

Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period. We randomized 240 patients (age 74 ± 11 years, 67% male) with a high-grade AV block requiring >90% ventricular pacing and preserved baseline LVEF >50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 ± 9 to 55 ± 9%, P = 0.047) and the RVHS groups (56 ± 10 to 54 ± 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 ± 25 vs. 56 ± 24 min, P function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years. ClinicalTrials.gov number NCT00461734. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Echocardiographic effects of changing atrioventricular delay in cardiac resynchronization therapy based on displacement

DEFF Research Database (Denmark)

Valeur, Nana; Fritz-Hansen, Thomas; Risum, Niels

2010-01-01

In studies showing benefits of cardiac resynchronization therapy (CRT), individual atrioventricular (AV) delays have been optimized using echocardiography. However, the method for AV delay optimization remains controversial.......In studies showing benefits of cardiac resynchronization therapy (CRT), individual atrioventricular (AV) delays have been optimized using echocardiography. However, the method for AV delay optimization remains controversial....

Supra-Hisian Conduction Block as an Unusual Presenting Feature of Takotsubo Cardiomyopathy.

Science.gov (United States)

Prabhu, Mukund Aravind; Pai, Praveen Gopalakrishna; Vupputuri, Anjith; Shekhar, Saritha; Harikrishnan, Madhavankutty Santhakumari; Kumaraswamy, Natarajan Umayammal

2017-05-01

Atrioventricular (AV) block is rare in Takotsubo cardiomyopathy (TC). A 66-year-old female presented with fatigue. Her electrocardiogram revealed 3:2 Mobitz Type II AV block, confirmed to be supra-Hisian by electrophysiological study. Echocardiogram and left ventricular angiogram showed moderate left ventricular dysfunction and apical ballooning, whereas coronary angiogram revealed mildly ectatic coronaries. At 2 weeks AV block persisted, needing permanent pacemaker implantation. At 1-month follow-up, she had normal ventricular function and no AV block. Delayed recovery of AV conduction is possible in TC, thus implying to wait for a longer period before implanting a pacemaker. © 2016 Wiley Periodicals, Inc.

Atrioventricular Dissociation after Electroconvulsive Therapy

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Siegfried William Yu

2011-01-01

Full Text Available Electroconvulsive therapy (ECT is increasingly used as a treatment for psychiatric disorders. Cardiac effects are the principal cause of medical complications in these patients. We report a case of atrioventricular (AV dissociation that occurred after ECT that was treated with pacemaker implantation. The mechanisms contributing to the onset of AV dissociation in this patient, and the management and rationale for device therapy, in light of the most recent guidelines, are reviewed.

Effect of atrioventricular conduction on heart rate variability

KAUST Repository

Ahmad, Talha Jamal; Ali, Hussnain; Majeed, S. M Imran; Khan, Shoab A.

2011-01-01

This paper discusses the effect of atrioventricular conduction time (AVCT) on the short-term Heart Rate Variability (HRV) by computing HRV parameters using intervals between the onsets of successive P waves (PP time series) for three groups: normal

Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation.

LENUS (Irish Health Repository)

Radeljic, Vjekoslav

2012-01-31

AIM: To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS: Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average +\\/-standard deviation 23 +\\/- 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION: In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and

Extraction of SelectSecure leads compared to conventional pacing leads in patients with congenital heart disease and congenital atrioventricular block.

Science.gov (United States)

Shepherd, Emma; Stuart, Graham; Martin, Rob; Walsh, Mark A

2015-06-01

SelectSecure™ pacing leads (Medtronic Inc) are increasingly being used in pediatric patients and adults with structural congenital heart disease. The 4Fr lead is ideal for patients who may require lifelong pacing and can be advantageous for patients with complex anatomy. The purpose of this study was to compare the extraction of SelectSecure leads with conventional (stylette-driven) pacing leads in patients with structural congenital heart disease and congenital atrioventricular block. The data on lead extractions from pediatric and adult congenital heart disease (ACHD) patients from August 2004 to July 2014 at Bristol Royal Hospital for Children and the Bristol Heart Institute were reviewed. Multivariable regression analysis was used to determine whether conventional pacing leads were associated with a more difficult extraction process. A total of 57 patients underwent pacemaker lead extractions (22 SelectSecure, 35 conventional). No deaths occurred. Mean age at the time of extraction was 17.6 ± 10.5 years, mean weight was 47 ± 18 kg, and mean lead age was 5.6 ± 2.6 years (range 1-11 years). Complex extraction (partial extraction/femoral extraction) was more common in patients with conventional pacing leads at univariate (P < .01) and multivariate (P = .04) levels. Lead age was also a significant predictor of complex extraction (P < .01). SelectSecure leads can be successfully extracted using techniques that are used for conventional pacing leads. They are less likely to be partially extracted and are less likely to require extraction using a femoral approach compared with conventional pacing leads. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Acidosis slows electrical conduction through the atrio-ventricular node.

Science.gov (United States)

Nisbet, Ashley M; Burton, Francis L; Walker, Nicola L; Craig, Margaret A; Cheng, Hongwei; Hancox, Jules C; Orchard, Clive H; Smith, Godfrey L

2014-01-01

Acidosis affects the mechanical and electrical activity of mammalian hearts but comparatively little is known about its effects on the function of the atrio-ventricular node (AVN). In this study, the electrical activity of the epicardial surface of the left ventricle of isolated Langendorff-perfused rabbit hearts was examined using optical methods. Perfusion with hypercapnic Tyrode's solution (20% CO2, pH 6.7) increased the time of earliest activation (Tact) from 100.5 ± 7.9 to 166.1 ± 7.2 ms (n = 8) at a pacing cycle length (PCL) of 300 ms (37°C). Tact increased at shorter PCL, and the hypercapnic solution prolonged Tact further: at 150 ms PCL, Tact was prolonged from 131.0 ± 5.2 to 174.9 ± 16.3 ms. 2:1 AVN block was common at shorter cycle lengths. Atrial and ventricular conduction times were not significantly affected by the hypercapnic solution suggesting that the increased delay originated in the AVN. Isolated right atrial preparations were superfused with Tyrode's solutions at pH 7.4 (control), 6.8 and 6.3. Low pH prolonged the atrial-Hisian (AH) interval, the AVN effective and functional refractory periods and Wenckebach cycle length significantly. Complete AVN block occurred in 6 out of 9 preparations. Optical imaging of conduction at the AV junction revealed increased conduction delay in the region of the AVN, with less marked effects in atrial and ventricular tissue. Thus acidosis can dramatically prolong the AVN delay, and in combination with short cycle lengths, this can cause partial or complete AVN block and is therefore implicated in the development of brady-arrhythmias in conditions of local or systemic acidosis.

Acidosis slows electrical conduction through the atrio-ventricular node

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Ashley Muir Nisbet

2014-06-01

Full Text Available Acidosis affects the mechanical and electrical activity of mammalian hearts but comparatively little is known about its effects on the function of the atrio-ventricular node (AVN. In this study, the electrical activity of the epicardial surface of the left ventricle of isolated Langendorff-perfused rabbit hearts was examined using optical methods. Perfusion with hypercapnic Tyrode’s solution (20% CO2, pH 6.7 increased the time of earliest activation (Tact from 100.5+7.9 to 166.1+7.2ms (n=8 at a pacing cycle length (PCL of 300ms (37oC. Tact increased at shorter PCL, and the hypercapnic solution prolonged Tact further: at 150ms PCL, Tact was prolonged from 131.0+5.2 to 174.9+16.3ms. 2:1 AVN block was common at shorter cycle lengths. Atrial and ventricular conduction times were not significantly affected by the hypercapnic solution suggesting that the increased delay originated in the AVN. Isolated right atrial preparations were superfused with Tyrode’s solutions at pH 7.4 (control, 6.8 and 6.3. Low pH prolonged the atrial-Hisian (AH interval, the effective and functional refractory periods and Wenckebach cycle length significantly. Complete AVN block occurred in 6 out of 9 preparations. Optical imaging of conduction at the AV junction revealed increased conduction delay in the region of the AVN, with less marked effects in atrial and ventricular tissue. Thus acidosis can dramatically prolong the AVN delay, and in combination with short cycle lengths, this can cause partial or complete AVN block and is therefore implicated in the development of brady-arrhythmias in conditions of local or systemic acidosis.

Lyme carditis. Electrophysiologic and histopathologic study

International Nuclear Information System (INIS)

Reznick, J.W.; Braunstein, D.B.; Walsh, R.L.; Smith, C.R.; Wolfson, P.M.; Gierke, L.W.; Gorelkin, L.; Chandler, F.W.

1986-01-01

To further define the nature of Lyme carditis, electrophysiologic study and endomyocardial biopsy were performed in a patient with Lyme disease, whose principal cardiac manifestation was high-degree atrioventricular block. Intracardiac recording demonstrated supra-Hisian block and complete absence of an escape mechanism. Gallium 67 scanning demonstrated myocardial uptake, and right ventricular endomyocardial biopsy revealed active lymphocytic myocarditis. A structure compatible with a spirochetal organism was demonstrated in one biopsy specimen. It is concluded that Lyme disease can produce active myocarditis, as suggested by gallium 67 imaging and confirmed by endomyocardial biopsy. Furthermore, the presence of high-grade atrioventricular block in this disease requires aggressive management with temporary pacemaker and corticosteroid therapy

Repair of tetralogy of Fallot associated with atrioventricular septal defect.

Science.gov (United States)

Tláskal, T; Hucín, B; Kostelka, M; Chaloupecký, V; Marek, J; Tax, P; Janouàek, J; Kuèera, V; Hruda, J; Reich, O; Skovránek, J

1998-01-01

Tetralogy of Fallot, when associated with atrioventricular septal defect permitting shunting at ventricular level, represents a complex cyanotic congenital malformation. Experience with surgical repair is limited, and results vary considerably. Between 1984 and 1996, we repaired 14 consecutive patients with this combination seen in our center. Their ages ranged from 8 months to 21 years (median 7.4 years). Six (42.9%) had Down's syndrome. In eight patients the correct diagnosis was made using echocardiography alone. In the remaining six patients, who had previously-constructed arterial shunts and/or suspected pulmonary arterial stenosis, catheterization and angiocardiography were also performed. The repair consisted of double patch closure of the septal defect, reconstruction of two atrioventricular orifices, and relief of pulmonary stenosis at all levels. In five patients with a hypoplastic pulmonary trunk, a monocusp transannular patch (four patients) or an allograft (one patient) was used for restoration of continuity from the right ventricle to the pulmonary arteries. Patch enlargement of one or both pulmonary arteries was necessary in five patients. One patient (7.1%) died early, and another late. The twelve surviving (85.8%) patients have been followed for 1.2-12.5 years after surgery (median 4.9 years, mean 5.9+/-3.9 years). During the follow-up, reoperation was necessary for repair of residual ventricular septal defect and pulmonary regurgitation in two patients, and closure of an atrial septal defect and alteration to left atrioventricular valvar regurgitation in one patient. Seven patients are in class I of the New York Heart Association, four in class II, and one in class III. Tetralogy of Fallot associated with atrioventricular septal defect can be corrected with low mortality and good long-term results. Residual lesions, however, have a tendency to progress, especially when seen in combination. After surgery, all patients need long-term close follow-up.

Programming Cardiac Resynchronization Therapy for Electrical Synchrony: Reaching Beyond Left Bundle Branch Block and Left Ventricular Activation Delay.

Science.gov (United States)

Varma, Niraj; O'Donnell, David; Bassiouny, Mohammed; Ritter, Philippe; Pappone, Carlo; Mangual, Jan; Cantillon, Daniel; Badie, Nima; Thibault, Bernard; Wisnoskey, Brian

2018-02-06

QRS narrowing following cardiac resynchronization therapy with biventricular (BiV) or left ventricular (LV) pacing is likely affected by patient-specific conduction characteristics (PR, qLV, LV-paced propagation interval), making a universal programming strategy likely ineffective. We tested these factors using a novel, device-based algorithm (SyncAV) that automatically adjusts paced atrioventricular delay (default or programmable offset) according to intrinsic atrioventricular conduction. Seventy-five patients undergoing cardiac resynchronization therapy (age 66±11 years; 65% male; 32% with ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 162±16 ms) with intact atrioventricular conduction (PR interval 194±34, range 128-300 ms), left bundle branch block, and optimized LV lead position were studied at implant. QRS duration (QRSd) reduction was compared for the following pacing configurations: nominal simultaneous BiV (Mode I: paced/sensed atrioventricular delay=140/110 ms), BiV+SyncAV with 50 ms offset (Mode II), BiV+SyncAV with offset that minimized QRSd (Mode III), or LV-only pacing+SyncAV with 50 ms offset (Mode IV). The intrinsic QRSd (162±16 ms) was reduced to 142±17 ms (-11.8%) by Mode I, 136±14 ms (-15.6%) by Mode IV, and 132±13 ms (-17.8%) by Mode II. Mode III yielded the shortest overall QRSd (123±12 ms, -23.9% [ P <0.001 versus all modes]) and was the only configuration without QRSd prolongation in any patient. QRS narrowing occurred regardless of QRSd, PR, or LV-paced intervals, or underlying ischemic disease. Post-implant electrical optimization in already well-selected patients with left bundle branch block and optimized LV lead position is facilitated by patient-tailored BiV pacing adjusted to intrinsic atrioventricular timing using an automatic device-based algorithm. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Exclusive double outlet right ventricle with atrioventricular concordance and pulmonary stenosis. Results of reconstructive surgery.

Science.gov (United States)

Busquet, J; Fontan, F; Choussat, A; Caianiello, G; Fernandez, G

1988-01-01

Double outlet right ventricle associated with atrioventricular concordance, pulmonary stenosis and situs solitus of the atria is a subset of double outlet right ventricle related through the surgical treatment. From 1974 to 1985, 14 patients, 5 males, 9 females (mean age 8.9 years, range 13 months-22 years) were operated upon. All patients had infundibular stenosis and normal or large pulmonary arteries. The apex of the heart was to the right in 2 patients, the right and left ventricles were superior and inferior in 2 patients and 1 patient had both anomalies. The ventricular septal defect was subaortic in 11 patients (aorto-mitral discontinuity in 5) and non-committed in 3 patients. Three patients had 2 ventricular septal defects. The aorta was anterior in 3 patients and to the right of the pulmonary artery in 11 patients. All patients, through a transventricular and transatrial approach, had a reconstructive surgery. In 3 patients, an aortic homograft valved conduit was used. One patient had the ventricular septal defect enlarged. There was one early death (7.1%) from high residual right ventricle pressure and no late death. One patient had a transient atrioventricular block. One patient was reoperated upon for a residual ventricular septal defect. All survivors had a good clinical result. Re-evaluation in 8 patients confirmed excellent haemodynamics: the right ventricle to pulmonary artery pressure gradient decreased from 80 mm Hg (range 60-95) preoperatively to 24 mm Hg (range 3-32) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery

Science.gov (United States)

Garg, Rakesh; Sinha, Renu; Nishad, PK

2011-01-01

Wolff-Parkinson-White (WPW) syndrome is one of the pre-excitation syndromes in which activation of an accessory atrioventricular (AV) conduction pathway leads to bypass the AV node and cause earlier ventricular activation than the normal pathway. We report a patient with intermittent WPW syndrome who repeatedly manifested pre-excitation after subarachnoid block. PMID:21712875

Tredjegradsatrioventrikulært blok hos en ung kvinde med kongenit centralt hypoventilationssyndrom

DEFF Research Database (Denmark)

Hagelberg, Rikke; Dixen, Ulrik

2015-01-01

Congenital central hypoventilation syndrome (CCHS) is a rare multisystem disorder characterized by autonomic nervous system dysfunction, which often manifests as failure to maintain ventilatory homeostasis during sleep. We present a case with a third degree atrioventricular block in a young woman...

A Heart too Drunk to Drive; AV Block following Acute Alcohol Intoxication.

Science.gov (United States)

van Stigt, Arthur H; Overduin, Ruben J; Staats, Liza C; Loen, Vera; van der Heyden, Marcel A G

2016-02-29

Acute excessive alcohol consumption is associated with heart rhythm disorders like atrial fibrillation but also premature ventricular contractions, collectively known as the "holiday heart syndrome". More rarely but clinically significant are reports of atrioventricular (AV) conduction disturbances in binge drinkers with no underlying heart disease or chronic alcohol consumption. To obtain better insights into common denominators and the potential underlying mechanisms we collected and compared individual case reports of AV block following acute alcohol intoxication in otherwise healthy people. By screening PubMed, Google Scholar, Scopus and JSTOR, fifteen cases were found of which eight were sufficiently documented for full analysis. Blood alcohol levels ranged from 90 to 958 mg/dl (19 to 205 mM). Second and third degree AV block was observed most (6/8) albeit that in two of these patients a vagal stimulus led to deterioration from first into higher order AV block. In all cases, patients reverted to normal sinus rhythm upon becoming sober again. Mildly lowered body temperature (35.9 ± 0.5°C) was observed but can be excluded as a major cause of conduction blockade. We hypothesize that ethanol induced partial inhibition of calcium and potentially also sodium currents in conductive tissue structures may be one of the mechanisms of conduction slowing and block that may become exaggerated upon increased vagal tone. An impairment of gap junction function cannot be excluded as a contributing factor. In conclusion, cases of documented alcohol induced AV block are very rare but events can occur at relatively low serum alcohol levels which should prompt to awareness of this phenomenon in alcohol intoxicated patients.

Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery

Directory of Open Access Journals (Sweden)

Rakesh Garg

2011-01-01

Full Text Available Wolff-Parkinson-White (WPW syndrome is one of the pre-excitation syndromes in which activation of an accessory atrioventricular (AV conduction pathway leads to bypass the AV node and cause earlier ventricular activation than the normal pathway. We report a patient with intermittent WPW syndrome who repeatedly manifested pre-excitation after subarachnoid block.

First Degree Pacemaker Exit Block

Directory of Open Access Journals (Sweden)

Johnson Francis

2016-10-01

Full Text Available Usually atrial and ventricular depolarizations follow soon after the pacemaker stimulus (spike on the ECG. But there can be an exit block due to fibrosis at the electrode - tissue interface at the lead tip. This can increase the delay between the spike and atrial or ventricular depolarization.

Surgical treatment of atrial and ventricular septal defects after unsuccessful interventional therapy: a retrospective analysis

International Nuclear Information System (INIS)

Han Hongguang; Zhang Nanbin; Wang Zengwei; Wang Huishan; Zhu Hongyu; Li Xinmin

2010-01-01

Objective: To investigate the causes of failure in treating atrial septal defect (ASD) and ventricular septal defect (VSD) with interventional procedures and to evaluate the clinical efficacy of surgical treatment in order to increase the successful rate. Methods: A total of 13 patients, who underwent surgical therapy because of unsuccessful interventional treatment for ASD or VSD during the period of January 2001-December 2007, were selected,and the clinical data were retrospectively analyzed. The surgical indications included the occluder abscission (n=7), III degree atrioventricular conduction block (n=3), valvular regurgitation (n=2), residual shunt (n=1) and interventional failure (n=1). The cardiac surgeries, including removal of the displaced occluder and / or the repair of atrioventricular septal defects, were performed with the help of cardiopulmonary bypass in all 13 cases. After surgical treatment, all patients were transferred into ICU for further supervision and treatment. Results: The average diameter of ASD on surgical exploration was 31 mm, which was greater than the preoperative average diameter (26 mm), with a significant difference (P 0.05). The III degree atrioventricular conduction block in 3 cases restored sinus rhythm after operation. All the procedures were successfully completed in all patients. No death occurred during the hospitalization period. Conclusion: Proper and timely cardiac surgery is an effective and safe measure for the treatment of the complications due to unsuccessful interventional therapy as well as the atrioventricular septal defect itself. (authors)

Canonical wnt signaling regulates atrioventricular junction programming and electrophysiological properties

NARCIS (Netherlands)

Gillers, Benjamin S.; Chiplunkar, Aditi; Aly, Haytham; Valenta, Tomas; Basler, Konrad; Christoffels, Vincent M.; Efimov, Igor R.; Boukens, Bastiaan J.; Rentschler, Stacey

2015-01-01

Proper patterning of the atrioventricular canal (AVC) is essential for delay of electrical impulses between atria and ventricles, and defects in AVC maturation can result in congenital heart disease. To determine the role of canonical Wnt signaling in the myocardium during AVC development. We used a

The influence of chain rigidity and the degree of sulfonation on the morphology of block copolymers as nano reactor

Science.gov (United States)

Hong, K.; Zhang, X.

2005-03-01

Polyelectrolyte block copolymer was used to form an ordered domain of ionic block as a ``nanoreactor'' due to its ability to bind oppositely charged metal ion, Zn^2+, Fe^2+ etc. The purpose of our research is to investigate the controllability of the size and morphology of domains (inorganic nano particles) by changing backbone stiffness, the charge density and the volume fraction of ionic block. Poly(styrene sulfonate) (PSS), which backbone is flexible, and poly(cyclohexadiene sulfonate) (PCHDS), which backbone is ``semiflexible'', were used as ionic blocks. We synthesized PtBS-PSS and PS-PCHDS with various degree of sulfonation and the volume fraction. Zinc oxide (ZnO) nano particles successfully formed in the ionic domain of microphase separated block copolymers. We used SANS to characterize the morphology of block copolymers and TEM for block copolymer containing ZnO nano particles. Our experimental results show that the chemistry of ``sulfonation'' of block copolymers can be successfully used to synthesize nano composite materials.

Echocardiographic effects of changing atrioventricular delay in cardiac resynchronization therapy based on displacement

DEFF Research Database (Denmark)

Valeur, Nana; Fritz-Hansen, Thomas; Risum, Niels

2010-01-01

In studies showing benefits of cardiac resynchronization therapy (CRT), individual atrioventricular (AV) delays have been optimized using echocardiography. However, the method for AV delay optimization remains controversial....

Atrioventricular node reentrant tachycardia (AVNRT) after mitral valvuloplasty during cardiac rehabilitation.

Science.gov (United States)

Fallavollita, Luca; Santillo, Elpidio; Marini, Luciano; Balestrini, Fabrizio

2012-12-01

We descrive a patient who presents palpitations during cardiac rehabilitation after mitral valvuloplasty. ECG showed regular narrow QRS tachycardia compatible with Atrioventricular Node Reentrant Tachycardia. After slow pathway radiofrequency catheter ablation, the patient completed the rehabilitation program remained tachycardia and palpitations-free.

Atrial flutter with spontaneous 1:1 atrioventricular conduction in adults: an uncommon but frequently missed cause for syncope/presyncope.

Science.gov (United States)

Turitto, Gioia; Akhrass, Philippe; Leonardi, Marino; Saponieri, Cesare; Sette, Antonella; El-Sherif, Nabil

2009-01-01

To compare patients with atrial flutter (AFl) and 1:1 atrioventricular conduction (AVC) with patients with AFl and higher AVC. The characteristics of 19 patients with AFl and 1:1 AVC (group A) were compared with those of 116 consecutive patients with AFl and 2:1 AVC or higher degree AV block (group B). Age, gender, and left ventricular function were similar in the two groups. In group A versus group B, more patients had no structural heart disease (42% vs 17%, P AVC or vice versa was associated with small but definite changes in AFl CL, which showed larger variations in response to sympathetic stimulation. In group A patients who were studied off drugs, the atrial-His interval was not different from group B, but maximal atrial pacing rate with 1:1 AVC was faster. In group A, five patients were misdiagnosed as ventricular tachyarrhythmias, and three with a defibrillator received inappropriate shocks. Four patients had ablation of AVC and six had ablation of AFl circuit. The main difference between groups A and B may be an inherent capacity of the AV node for faster conduction, especially in response to increased sympathetic tone. The latter affects not only AVC but also the AFl CL. One should be aware of the different presentations of AFl with 1:1 AVC to avoid misdiagnosis/mismanagement and to consider the diagnosis in patients with narrow or wide QRS tachycardia and rates above 220/min.

Wolff-Parkinson-White syndrome type B and left bundle-branch block: electrophysiologic and radionuclide study

Energy Technology Data Exchange (ETDEWEB)

Rakovec, P.; Kranjec, I.; Fettich, J.J.; Jakopin, J.; Fidler, V.; Turk, J.

1985-01-01

Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates.

Wolff-Parkinson-White syndrome type B and left bundle-branch block: electrophysiologic and radionuclide study

International Nuclear Information System (INIS)

Rakovec, P.; Kranjec, I.; Fettich, J.J.; Jakopin, J.; Fidler, V.; Turk, J.

1985-01-01

Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates

["Habitual" left branch block alternating with 2 "disguised" bracnch block].

Science.gov (United States)

Lévy, S; Jullien, G; Mathieu, P; Mostefa, S; Gérard, R

1976-10-01

Two cases of alternating left bundle branch block and "masquerading block" (with left bundle branch morphology in the stnadard leads and right bundle branch block morphology in the precordial leads) were studied by serial tracings and his bundle electrocardiography. In case 1 "the masquerading" block was associated with a first degree AV block related to a prolongation of HV interval. This case is to our knowledge the first cas of alternating bundle branch block in which his bundle activity was recorded in man. In case 2, the patient had atrial fibrilation and His bundle recordings were performed while differents degrees of left bundle branch block were present: The mechanism of the alternation and the concept of "masquerading" block are discussed. It is suggested that this type of block represents a right bundle branch block associated with severe lesions of the "left system".

Morfologia da junção atrioventricular em Iguana iguana (Reptilia-Iguanidae

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Sonia Regina Jurado

2006-06-01

Full Text Available The atrioventricular junctional area (AVJA, including atrioventricular (AV node and bundle was investigated in seven hearts of common or green iguana (Iguana iguana using the light microscopy. Adult animals, both sexes, were captured in the Pantanal, Brazil. All hearts were fixed in buffered formaldehyde 10% (pH 7.2 for 24 hours, embedded in paraplast according to routine methods, and serially cut at 5 µm thickness. In the Iguana iguana, the AVJA consists of a mass of the fibers intermingled with variable amount of connective tissue and blood vessels surrounded by adjacent myocardium and the attachment of the right atrioventricular valve in the fibrous skeleton. By light microscopy, conducting cells of the AV node and bundle can be distinguished from working cells by their much smaller size, paler staining reaction and the presence of a sheath of connective tissue. The AV node and bundle and its branches were found to constitute a continuous tract. Histochemically, we found elastic fibers between cells of the conduction, mainly in the AV node. The PAS method reveals absence of glycogen in specialized cells. The fibrous skeleton, mainly the right trigone, showed a well-developed chondroid tissue, made by hyaline like cartilage (binucleated condrocytes included in the big lacunas and extracellular matrix with fibrillar collagen. In conclusion, the nodal and Purkinje cells in heart iguana presented poorly morphological differentiation comparing mammals and birds, however the skeleton fibrous has a different cartilage kind.

Letter by Gourdie and Sedmera regarding article, "Abnormal conduction and morphology in the atrioventricular node of mice with atrioventricular canal-targeted deletion of Alk3/Bmpr1a receptor"

Czech Academy of Sciences Publication Activity Database

Gourdie, R. G.; Sedmera, David

2008-01-01

Roč. 118, - (2008), e106-e106 ISSN 0009-7322 Institutional research plan: CEZ:AV0Z50450515 Keywords : conduction system * heart development * atrioventricular canal Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 14.595, year: 2008

Congenital intermittent atrio-ventricular dissociation in tetralogy of Fallot (a case report.

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Karande S

1991-01-01

Full Text Available A case of tetralogy of fallot with congenital intermittent atrioventricular dissociation is reported. A review of standard postgraduate books of cardiology fails to describe this condition, thus showing its extreme rarity. The therapeutic dilemma in treating such a case is also discussed.

Defeito do septo atrioventricular forma total associado a tricuspidização da valva atrioventricular esquerda na infância

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Aleksander DOBRIANSKYJ

1997-10-01

Full Text Available Entre maio de 1987 e dezembro de 1996, o reparo do defeito do septo atrioventricular, forma total (DSAVT, com duplo retalho de pericárdio bovino e tricuspidização da valva atrioventricular (VAV esquerda, foi realizado em 34 pacientes consecutivos com mortalidade global de 5 (14,7% pacientes (pac.. Grupo I: abaixo de 6 meses (m com 12 pac. (1 óbito; 8,3%; Grupo II: entre 7m e 12m, com 15 pac. (4 óbitos; 26,6% e Grupo III: entre 1 e 5 anos (a com 7 pac. sem óbitos. Ocorreram 2 óbitos tardios (1 por Insuficiência mitral residual + insuficiência cardíaca congestiva e outro por pneumonia + insuficiência respiratória. Duas crianças receberam implante de marcapasso definitivo (após 45 dias e 4 anos. Nenhum paciente foi reoperado, apesar de mais 2 apresentarem insuficiência da VAV esquerda e 1 VAV direita, controlada clinicamente, e as restantes encontram-se nos graus I e II da New York Heart Association (NYHA. Apesar de 29 pacientes apresentarem peso abaixo de 10 kg, utilizou-se circulação extracorpórea (CEC e hipotermia a 25°C sem parada circulatória total. Iniciou-se o reparo pela zona de "aposição" da VAV única com um ou dois pontos em "x", mantendo tricúspide. Sutura-se o primeiro retalho de pericárdio bovino (PB em forma de "gota", insinuando-o entre as cordas do lado direito do septo; a seguir, sutura-se o segundo retalho, fazendo uma aposição concomitante com a VAV única, septando-se, desta forma, as quatro cavidades. As vantagens desta técnica são: preservação da integridade valvar, maior durabilidade funcional da VAV esquerda, menor possibilidade de reoperação mesmo em pacientes mais jovens e que devem ser preferencialmente operados em torno de 6º mês de vida.Between May 1987 and December 1996, repair of the "Ostium Atrioventricularis Communis" (OAVC, with total shaping by means of a double bovine pericardial patch and tricuspidation of the left atrioventricular valve (AVV was performed on 34 consecutive

Indicators of a poor outcome after temporary pacing in patients with complete atrioventricular block

International Nuclear Information System (INIS)

Kazmi, U.; Hyder, S.N.; Sheikh, A.M.

2013-01-01

Background: Temporary pace maker (tpm) implantation is an emergency procedure, performed in symptomatic patients with AV block We report our experience of temporary pacing at a tertiary care center. It is the first study of its type from a local center. Objectives: To study the clinical course of patients after tpm implantation and to determine indicators of a poor outcome after tpm implantation. Methods: This was descriptive retrospective study. Data of all tpm procedures performed at Children Hospital from 2006 to 2012 was retrieved. We excluded patients with surgically placed tpm leads. All patients receiving transvenous tpm were included in our study. Results: Total of 12 patients received tpm, 8 were male (66.6%) and 4 were female (33.3%). Median age was 6 years ( range 1.4 -13 year ). Mean weight was 30kg, (range 8.7 - 50kg). All of them presented with complete heart block.One patient each had post diphtheria cardiomyopathy, unknown poisoning. The rest had congenital heart block. The mean period between tpm to ppm implantation was 5 days, (range 1 - 30 days). One patient spontaneously reverted to sinus rhythm(8.3%), 6 had ppm implantation (58.3%), 5 patients expired (33.3%). A low Ejection Fraction was found to be associated with a poor outcome (p<0.01). Variables that were associated with a poor outcome(mortality), were SOB (p<0.015), weak pulses (p<0.015), and hepatomegaly (p<0.01). Conclusion: Low Ejection Fraction and Heart failure is associated with a poor outcome and increased mortality in patients with complete AV block. We suggest that pacing should be considered in patients earlier, before they develop signs or symptoms of cardiac dysfunction. (author)

Complete A-V block: incidental or a part of cor triatriatum dexter.

Science.gov (United States)

Guler, Y; Akgun, T; Toprak, C; Guler, A; Esen, A M

2014-05-01

Cor triatriatum dexter (CTD) is an extremely rare cardiac anomaly in which the right atrium is divided into two distinct chambers by a membrane. The persistence of the right valve of sinus venosus results in a complete septation of the right atrium. This anomaly is frequently associated with other right-sided cardiac abnormalities. Its clinical manifestation and the need for intervention are determined by the number and the size of the fenestrations on the membrane, associated cardiac anomalies and arrhythmias. We describe a case of CTD in a patient with complete atrioventricular (A-V) block.

Evolution and scaling of atrioventricular conduction time in mammals. [Pt. 1

NARCIS (Netherlands)

Meijler, F.L.; Strackee, J.

2006-01-01

Scaling can be defined as the adjustment of a structure, a function, or an organ to the size of the mammalian body. An example is the size of the heart in relation to the size of the body. The duration of the PR interval on the electrocardiogram (atrioventricular delay) in relation to the size of

Defeito completo do septo atrioventricular com cianose Complete repair in total atrioventricular canal defect with cyanosis

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Carla Tanamati

2006-09-01

Full Text Available Os defeitos do septo atrioventricular total (DSAVT representam 4% das mal formações cardíacas e acima de 50% dos defeitos observados na síndrome de Down (SD¹. A apresentação clínica é de insuficiência cardíaca precoce na infância e hipertensão pulmonar por hiperfluxo. Raramente a cianose é observada e sugere hipertensão pulmonar ou associação à tetralogia de Fallot³, dupla via de saída de ventrículo direito², anomalia de Ebstein4, drenagem anômala de cava esquerda persistente em átrio esquerdo (Barbero Marcial, comunicação pessoal. Crianças com SD são particularmente difíceis de avaliação por apresentarem obstrução de vias aéreas superiores, que podem contribuir com o aumento da resistência pulmonar observada no cateterismo cardíaco. A presença de cianose pré-operatória constitui-se um desafio ao tratamento cirúrgico devido ao risco de hipertensão pulmonar irreversível com falência ventricular direita com, a correção dos defeitos intracardíacos.Atrioventricular septal defects account for 4% of congenital cardiac malformations and over 50% of cardiac defects seen in Down syndrome¹. Clinical presentation is marked by congestive heart failure early in infancy. Cyanosis is rarely found in infants and suggests irreversible pulmonary hypertension or associated cardiac defects as tetralogy of Fallot, double outlet right ventricle², Ebstein anomaly³, persistent left superior vena cava draining in the left atrium (Barbero Marcial, personal communication. Children with Down's syndrome is particularly difficult to assess because they often suffer from upper airways obstruction4, which may contribute to the increased pulmonary vascular resistance determined at cardiac catheterization. This association of factors becomes a challenge for operability and, we will report one such case.

Wnt signaling regulates atrioventricular canal formation upstream of BMP and Tbx2

NARCIS (Netherlands)

Verhoeven, Manon C.; Haase, Christa; Christoffels, Vincent M.; Weidinger, Gilbert; Bakkers, Jeroen

2011-01-01

In the developing heart, the atrioventricular canal (AVC) is essential for separation and alignment of the cardiac chambers, for valve formation, and serves to delay the electrical impulse from the atria to the ventricles. Defects in various aspects of its formation are the most common form of

Mirror Image Gerbode or Partial Atrioventricular Canal Defect?

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Cem Ariturk

2015-12-01

Full Text Available Gebode defect, that can accurately be treated surgical repair, is defined as a true communication between left ventricle and right atrium. A 74-year-old woman with a worsening history of ortophnea and peripheral edema was hospitalised. A communication between right atrium and left ventricle was diagnosed using transeusophageal echocardiography. The defect was repaired and mitral valve was replaced with a biologic valve. It would be beter to tailor surgical strategy for each case with atrioventricular canal defect after preoperative transeusophageal echocardiography and peroperative direct sight.

Anatomy of Atrioventricular Node Artery and Pattern of Dominancy in Normal Coronary Subject: A Comparison between Individuals with and without Isolated Right Bundle Branch Block.

Science.gov (United States)

Kazemisaeid, Ali; Pakbaz, Marziyeh; Yaminisharif, Ahmad; Davoodi, Gholamreza; Lotfi Tokaldany, Masoumeh; Hakki Kazazi, Elham

2012-11-01

Isolated right bundle branch block (RBBB) is a common finding in the general population. The atrioventricular node (AVN) artery contributes to the blood supply of the right bundle branch. Our hypothesis was that the anatomy of the AVN artery and the pattern of dominancy differ between subjects with and without RBBB. We retrospectively studied the coronary angiography of 92 patients with RBBB and 184 age- and gender-matched controls without RBBB. All the subjects had angiographically proven normal coronary arteries. The dominant circulation and precise origin of the AVN artery were determined in each subject. Obtained data were compared between the two study groups. There was no significant difference between the two groups in terms of dominancy (p value = 0.200). Origination of the AVN artery from the right circulatory system was more common in both groups, but this pattern was more prevalent in the cases than in the controls (p value = 0.021). There was a great variation of the AVN artery origin. In the total study population, the AVN artery was more commonly separated from a non crux origin than from the crux area. The prevalence of the non-crux origination of the AVN artery was significantly higher in the cases than in the controls (p value AVN artery from the right circulatory system was more common in both groups, the prevalence of the right origin of the AVN artery was significantly higher in the cases than in the controls. We observed that the AVN artery most commonly originated from the dominant artery but not necessarily from the crux. The anatomy of the AVN artery but not the pattern of dominancy is somewhat different in subjects with RBBB compared with normal individuals.

Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexes.

Science.gov (United States)

Ragupathi, Loheetha; Johnson, Drew; Greenspon, Arnold; Frisch, Daniel; Ho, Reginald T; Pavri, Behzad B

2018-04-18

Atrioventricular (AV) block is usually due to infranodal disease and associated with a wide QRS complex; such patients often progress to complete AV block and pacemaker dependency. Uncommonly, infranodal AV block can occur within the His bundle with a narrow QRS complex. The aims of this study were to define clinical/echocardiographic characteristics of patients with AV block within the His bundle and report progression to pacemaker dependency. We retrospectively identified patients with narrow QRS complexes and documented intra-His delay or block at electrophysiology study (group A) or with electrocardiogram-documented Mobitz II AV block/paroxysmal AV block (group B). Clinical, electrophysiological, and echocardiographic variables at presentation and pacemaker parameters at the last follow-up visit were evaluated. Twenty-seven patients (19 women) were identified (mean age 64 ± 13 years; range, 38-85 years). Four patients who had block with narrow QRS complexes rarely progress to pacemaker dependency and require infrequent pacing. This entity is more common in women, with a higher prevalence of aortic and/or mitral annular calcification. If confirmed by additional studies, single-chamber pacemaker may be sufficient. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Atrial activation during atrioventricular nodal reentrant tachycardia: studies on retrograde fast pathway conduction

NARCIS (Netherlands)

Katritsis, Demosthenes G.; Ellenbogen, Kenneth A.; Becker, Anton E.

2006-01-01

Detailed right and left septal mapping of retrograde atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) has not been undertaken and may provide insight into the complex physiology of AVNRT, especially the anatomic localization of the fast and slow pathways. The

Clinical and laboratory findings in mad honey poisoning: A single ...

African Journals Online (AJOL)

In the evaluation of the patients' heart rhythms on admission to the emergency room, nine (56.3%) patients had sinus bradycardia, three (18.8%) patients had nodal rhythm, two (12.5%) patients had first degree atrioventricular block, and two (12.5%) patients had atrial fibrillation. Atropine 1.1 ± 0.4 mg and saline 1125 ± 465 ...

Complete heart block in a patient with POEMS syndrome: A case report

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Farzaneh Ashrafi

2014-09-01

Full Text Available BACKGROUND: Polyneuropathy, organomegaly, endocrinopathy, monoclonal syndrome (POEMS is a rare paraneoplastic syndrome associated with plasma cell dyscrasia. CASE REPORT: A 48-year-old man presented with a 1-year history of paresthesia and progressive weakness of extremities. Diagnosis of POEMS syndrome was made for him on the basis of clinical presentation, additional physical findings, typical sclerotic bone lesion, and bone marrow findings. In last admission, he explained episodes of dyspnea and chest pain that associated with frequent premature ventricular contraction in his electrocardiograph. Patient heart monitoring showed some episodes of complete heart block. Infra-His atrioventricular block in electro-physiologic study was detected. He had no history of ischemic heart disease. His cardiopulmonary findings on examination were normal. All results of cardiac biomarkers and serum electrolytes and repeated echocardiography were within normal range. Cong red staining of rectal fat pad biopsy was negative. After pacemaker insertion radiation of sclerotic bone, lesion started for him, but radiotherapy was ineffective, and he expired with respiratory failure. Complete heart block in POEMS syndrome has not been reported previously, and it is the first POEMS case with complete heart block. CONCLUSION: Complete heart block is a cardiac manifestation of POEMS syndrome.   Keywords: Complete Heart Block, POEM Syndrome, Multiple Meloma 

Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal supraventricular tachycardias

NARCIS (Netherlands)

Hahurij, Nathan D.; Gittenberger-de Groot, Adriana C.; Kolditz, Denise P.; Bökenkamp, Regina; Schalij, Martin J.; Poelmann, Robert E.; Blom, Nico A.

2008-01-01

BACKGROUND: Fetal and neonatal atrioventricular (AV) reentrant tachycardias can be life-threatening but resolve in most cases during the first year of life. The transient presence of accessory AV myocardial connections during annulus fibrosus development may explain this phenomenon. METHODS AND

Tbx20 interacts with smads to confine tbx2 expression to the atrioventricular canal

NARCIS (Netherlands)

Singh, Reena; Horsthuis, Thomas; Farin, Henner F.; Grieskamp, Thomas; Norden, Julia; Petry, Marianne; Wakker, Vincent; Moorman, Antoon F. M.; Christoffels, Vincent M.; Kispert, Andreas

2009-01-01

RATIONALE: T-box transcription factors play critical roles in the coordinated formation of the working chambers and the atrioventricular canal (AVC). Tbx2 patterns embryonic myocardial cells to form the AVC and suppresses their differentiation into chamber myocardium. Tbx20-deficient embryos, which

Atrioventricular depolarization differences identify coronary artery anomalies in Kawasaki disease.

Science.gov (United States)

Cortez, Daniel; Sharma, Nandita; Jone, Pei-Ni

2017-03-01

Kawasaki disease (KD) is the leading cause of acquired heart disease in children. Signal average electrocardiogram changes in patients during the acute phase of KD with coronary artery anomalies (CAA) include depolarization changes. We set out to determine if 12-lead-derived atrioventricular depolarization differences can identify CAA in patients with KD. A blinded, retrospective case-control study of patients with KD was performed. Deep Q waves, corrected QT-intervals (QTc), spatial QRS-T angles, T-wave vector magnitudes (RMS-T), and a novel parameter for assessment of atrioventricular depolarization difference (the spatial PR angle) and a two dimensional PR angle were assessed. Comparisons between groups were performed to test for significant differences. One hundred one patients with KD were evaluated, with 68 having CAA (67.3%, mean age 3.6 ± 3.0 years, 82.6% male), and 32 without CAA (31.7%, mean age 2.7 ± 3.2 years, 70.4% male). The spatial PR angle significantly discriminated KD patients with CAA from those without, 59.7° ± 31.1° versus 41.6° ± 11.5° (p differences, measured by the spatial or two dimensional PR angle differentiate KD patients with CAA versus those without. © 2016 Wiley Periodicals, Inc.

Echocardiographic definition and surgical decision-making in unbalanced atrioventricular septal defect: a Congenital Heart Surgeons' Society multiinstitutional study.

Science.gov (United States)

Jegatheeswaran, Anusha; Pizarro, Christian; Caldarone, Christopher A; Cohen, Meryl S; Baffa, Jeanne M; Gremmels, David B; Mertens, Luc; Morell, Victor O; Williams, William G; Blackstone, Eugene H; McCrindle, Brian W; Overman, David M

2010-09-14

Although identification of unbalanced atrioventricular septal defect (AVSD) is obvious when extreme, exact criteria to define the limits of unbalanced are not available. We sought to validate an atrioventricular valve index (AVVI) (left atrioventricular valve area/total atrioventricular valve area, centimeters squared) as a discriminator of balanced and unbalanced forms of complete AVSD and to characterize the association of AVVI with surgical strategies and outcomes. Diagnostic echocardiograms and hospital records of 356 infants with complete AVSD at 4 Congenital Heart Surgeons' Society (CHSS) institutions (2000-2006) were reviewed and AVVI measured (n=315). Patients were classified as unbalanced if AVVI≤0.4 (right dominant) or ≥0.6 (left dominant). Surgical strategy and outcomes were examined across the range of AVVI. Competing risks analysis until the time of commitment to a surgical strategy examined 4 end states: biventricular repair (BVR), univentricular repair (UVR), pulmonary artery banding (PAB), and death before surgery. A prediction nomogram for surgical strategy based on AVVI was developed. The majority of patients had balanced AVSD (0.4

Early safety and efficacy of fingolimod treatment in Denmark

DEFF Research Database (Denmark)

Voldsgaard, A; Koch-Henriksen, N; Magyari, M

2017-01-01

BACKGROUND: Initiation of fingolimod treatment is associated with a transient decrease of heart rate, and atrioventricular (AV) conduction block may occur. OBJECTIVE: To evaluate the therapeutic effect and safety of fingolimod treatment in MS patients in Denmark with focus on cardiac and pulmonary...... to bradycardia and/or second-degree AV block type I. All patients recovered spontaneously. Two patients discontinued fingolimod. Eleven (5.4%) patients reported respiratory complaints and two of these patients discontinued treatment. CONCLUSIONS: Fingolimod appears to be safe and effective in MS patients...

Echocardiography-guided Radiofrequency Catheter Ablation of Atrioventricular Node and VVI Pacemaker Implantation

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T Guo

2014-05-01

Full Text Available Objective: This study is to evaluate the feasibility and safety of intracardiac radiofrequency catheter ablation (RFCA of the atrioventricular node (AVN and pacemaker implantation using transthoracic echocardiography. Methods: Eleven patients – six males and five females (mean age 66 years – with persistent or permanent atrial fibrillation/atrial flutter received RFCA of AVN and VVI pacemaker implantation (paces and senses the ventricle and is inhibited if it senses ventricular activity. Under transthoracic echocardiography, the electrode catheters were positioned intracardiac, and target ablation was performed, with the permanent pacemaking catheter in the left subclavian vein and the ablation catheter in the right femoral vein. The multi-view imaging and dynamic observation applied during the stable AV dissociation were successful. Results: Atrioventricular node ablation and permanent pacemaker implantation in 11 patients were completed successfully without X-ray exposure. The operation success rate was 100%. All patients recovered well within the follow-up period. Conclusions: Radiofrequency catheter ablation of AVN and VVI pacemaker implantation under transthoracic echocardiography guidance is a safe, easy and feasible approach. This procedure could be an important supplemental measure to catheter ablation of arrhythmia under routine X-ray fluoroscopy.

Successful catheter ablation of ventricular premature complexes from the right atrial side of the atrioventricular septum with good contact force.

Science.gov (United States)

Arai, Marina; Fukamizu, Seiji; Kawamura, Iwanari; Miyazawa, Satoshi; Hojo, Rintaro; Sakurada, Harumizu; Hiraoka, Masayasu

2018-04-01

The acquisition of good contact force for radiofrequency catheter ablation of ventricular premature complexes (VPCs) originating from the basal septum of the left ventricle (LV) is often difficult. We describe a case of VPCs originating from the basal septum of the LV, which were successfully eliminated by applying radiofrequency at the right atrium (RA) side of the atrioventricular septum (AVS) without causing any significant impairment of atrioventricular conduction because the ablation catheter could obtain better contact force through the RA approach. Moreover, intracardiac echocardiography (ICE) and RA angiography effectively demonstrated the AVS.

Mechanism of polyuria and natriuresis in atrioventricular nodal tachycardia.

Science.gov (United States)

Canepa-Anson, R; Williams, M; Marshall, J; Mitsuoka, T; Lightman, S; Sutton, R

1984-01-01

A woman with tachycardia associated with polyuria was investigated. Electrophysiological analysis showed that the tachycardia was an atrioventricular nodal re-entrant tachycardia. Programmed stimulation was then used to provoke and sustain the tachycardia for 40 minutes. Polyuria, with an appreciable increase in free water clearance, was observed. This was associated with reduction in plasma and urinary arginine vasopressin concentrations. Appreciable natriuresis also developed. These results support the hypothesis that the polyuria with increased free water clearance and the natriuresis occurring during sustained tachycardia in man are due to inhibition of secretion of vasopressin and the release of natriuretic factor. PMID:6434116

Bloqueo aurículo-ventricular congénito completo: Reporte de un caso y revisión de la literatura Congenital complete atrioventricular block: eport of one case and literature review

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Alejandro Díaz D

2008-02-01

Full Text Available El bloqueo aurículo-ventricular completo congénito, es una entidad poco común, que presenta alta morbilidad y mortalidad con incidencia real que permanece desconocida y requiere alto índice de sospecha para su diagnóstico y, por ende, su temprana intervención. Se observa en hijos de madres con enfermedades autoinmunes del tejido conectivo, en especial, lupus eritematoso sistémico cuando su aparición es congénita. A nivel postnatal, es más frecuente que ocurra por cardiopatías congénitas. También puede manifestarse en corazones normales desde el punto de vista estructural. El hallazgo clínico característico es bradicardia persistente que se manifiesta desde la vida intrauterina y repercute en la estabilidad circulatoria del feto llegando a producir hidrops, complicación seria y letal. Después del nacimiento aparece igualmente con bradicardia que puede o no descompensar la parte hemodinámica del paciente. El diagnóstico se hace por sospecha clínica, con ecocardiografía fetal y postnatal, electrocardiograma y detección de anticuerpos maternos tipo antiRo y antiLa. La implantación de un marcapasos es el tratamiento definitivo que contribuye a mejorar la sobrevida y el pronóstico de estos pacientes. Se presenta el caso de una paciente prematura, de 31 semanas, debido a hidrops no inmune, en quien se diagnosticó bloqueo aurículo-ventricular completo congénito secundario a lupus materno confirmado por anticuerpos anti-nucleares francamente positivos y anticuerpos antiRo y antiLa positivos, quien recibió manejo con soporte inotrópico y posterior implantación de marcapasos. Presentó mejoría completa de la falla cardiaca y se remitió hacia otra institución para manejo convencional del prematuro.Complete congenital atrioventricular block is a rare entity that has a high morbidity and mortality. Its real incidence remains unknown and a high suspicion index is needed for its diagnosis and consequently for its early

[Estimation of the atrioventricular time interval by pulse Doppler in the normal fetal heart].

Science.gov (United States)

Hamela-Olkowska, Anita; Dangel, Joanna

2009-08-01

To assess normative values of the fetal atrioventricular (AV) time interval by pulse-wave Doppler methods on 5-chamber view. Fetal echocardiography exams were performed using Acuson Sequoia 512 in 140 singleton fetuses at 18 to 40 weeks of gestation with sinus rhythm and normal cardiac and extracardiac anatomy. Pulsed Doppler derived AV intervals were measured from left ventricular inflow/outflow view using transabdominal convex 3.5-6 MHz probe. The values of AV time interval ranged from 100 to 150 ms (mean 123 +/- 11.2). The AV interval was negatively correlated with the heart rhythm (page of gestation (p=0.007). However, in the same subgroup of the fetal heart rate there was no relation between AV intervals and gestational age. Therefore, the AV intervals showed only the heart rate dependence. The 95th percentiles of AV intervals according to FHR ranged from 135 to 148 ms. 1. The AV interval duration was negatively correlated with the heart rhythm. 2. Measurement of AV time interval is easy to perform and has a good reproducibility. It may be used for the fetal heart block screening in anti-Ro and anti-La positive pregnancies. 3. Normative values established in the study may help obstetricians in assessing fetal abnormalities of the AV conduction.

Worsening atrioventricular conduction after hospital discharge in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the HORIZONS-AMI trial.

Science.gov (United States)

Kosmidou, Ioanna; Redfors, Björn; McAndrew, Thomas; Embacher, Monica; Mehran, Roxana; Dizon, José M; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

2017-11-01

The chronic effects of ST-segment elevation myocardial infarction (STEMI) on the atrioventricular conduction (AVC) system have not been elucidated. This study aimed to evaluate the incidence, predictors, and outcomes of worsened AVC post-STEMI in patients treated with a primary percutaneous coronary intervention (PCI). The current analysis included patients from the HORIZONS-AMI trial who underwent primary PCI and had available ECGs. Patients with high-grade atrioventricular block or pacemaker implant at baseline were excluded. Analysis of ECGs excluding the acute hospitalization period indicated worsened AVC in 131 patients (worsened AVC group) and stable AVC in 2833 patients (stable AVC group). Patients with worsened AVC were older, had a higher frequency of hypertension, diabetes, renal insufficiency, previous coronary artery bypass grafting, and predominant left anterior descending culprit lesions. Predictors of worsened AVC included age, hypertension, and previous history of coronary artery disease. Worsened AVC was associated with an increased rate of all-cause death and major adverse cardiac events (death, myocardial infarction, ischemic target vessel revascularization, and stroke) as well as death or reinfarction at 3 years. On multivariable analysis, worsened AVC remained an independent predictor of all-cause death (hazard ratio: 2.005, confidence interval: 1.051-3.827, P=0.0348) and major adverse cardiac events (hazard ratio 1.542, confidence interval: 1.059-2.244, P=0.0238). Progression of AVC system disease in patients with STEMI treated with primary PCI is uncommon, occurs primarily in the setting of anterior myocardial infarction, and portends a high risk for death and major adverse cardiac events.

Atrioventricular valve repair in patients with functional single-ventricle physiology: impact of ventricular and valve function and morphology on survival and reintervention.

Science.gov (United States)

Honjo, Osami; Atlin, Cori R; Mertens, Luc; Al-Radi, Osman O; Redington, Andrew N; Caldarone, Christopher A; Van Arsdell, Glen S

2011-08-01

This study was to determine whether atrioventricular valve repair modifies natural history of single-ventricle patients with atrioventricular valve insufficiency and to identify factors predicting survival and reintervention. Fifty-seven (13.5%) of 422 single-ventricle patients underwent atrioventricular valve repair. Valve morphology, regurgitation mechanism, and ventricular morphology and function were analyzed for effect on survival, transplant, and reintervention with multivariate logistic and Cox regression models. Comparative analysis used case-matched controls. Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24, 46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%), mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years, P = .015). Patients with successful repair and normal ventricular function had equivalent survival to matched controls (P = .36). Independent predictors for death or transplant included increased indexed annular size (P = .05), increased cardiopulmonary bypass time (P = .04), and decreased postrepair ventricular function (P = .01). Ventricular dilation was a time-related factor for all events, including failed repair. Survival was lower in single-ventricle patients operated on for atrioventricular valve insufficiency than in case-matched controls. Patients with little postoperative residual regurgitation and preserved ventricular function had equivalent survival to controls. Lower grade ventricular function and ventricular dilation correlated with death and repair failure, suggesting that timing of intervention may affect outcome. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All

[Limits of cardiac functional adaptation in "top level" resistance athletes].

Science.gov (United States)

Carù, B; Righetti, G; Bossi, M; Gerosa, C; Gazzotti, G; Maranetto, D

2001-02-01

Sports activity, particularly when performed at high level, provokes cardiovascular adjustments depending on the type of sport and on the level of the load. We evaluated 15 athletes from the Italian national team during a non-agonistic period of cross country skiing, with non-invasive tests including exercise test, color Doppler echocardiography, Holter monitoring, physical examination and standard rest electrocardiogram. Physical examination, rest electrocardiogram, exercise testing and echocardiography were all within the range of the expected values for this type of subjects. Holter monitoring recorded during the periods of agonistic activity revealed significant hypokinetic arrhythmias such as severe bradycardia, pauses, I and II degree atrioventricular blocks, and complete atrioventricular block in 2 cases; these features were not observed on Holter monitoring recorded during the non-agonistic period. The perfect health status of subjects and their racing results may bring about physiological functional adjustments, but these observations suggest the need for a follow-up to evaluate possible pathologic outcomes.

Deficiency of the vestibular spine in atrioventricular septal defects in human fetuses with down syndrome

NARCIS (Netherlands)

Blom, Nico A.; Ottenkamp, Jaap; Wenink, Arnold G. C.; Gittenberger-de Groot, Adriana C.

2003-01-01

Data on the morphogenesis of atrioventricular septal defect (AVSD) in Down syndrome are lacking to support molecular studies on Down syndrome heart critical region. Therefore, we studied the development of complete AVSD in human embryos and fetuses with trisomy 21 using 3-dimensional graphic

Modelling the heart with the atrioventricular plane as a piston unit.

Science.gov (United States)

Maksuti, Elira; Bjällmark, Anna; Broomé, Michael

2015-01-01

Medical imaging and clinical studies have proven that the heart pumps by means of minor outer volume changes and back-and-forth longitudinal movements in the atrioventricular (AV) region. The magnitude of AV-plane displacement has also shown to be a reliable index for diagnosis of heart failure. Despite this, AV-plane displacement is usually omitted from cardiovascular modelling. We present a lumped-parameter cardiac model in which the heart is described as a displacement pump with the AV plane functioning as a piston unit (AV piston). This unit is constructed of different upper and lower areas analogous with the difference in the atrial and ventricular cross-sections. The model output reproduces normal physiology, with a left ventricular pressure in the range of 8-130 mmHg, an atrial pressure of approximatly 9 mmHg, and an arterial pressure change between 75 mmHg and 130 mmHg. In addition, the model reproduces the direction of the main systolic and diastolic movements of the AV piston with realistic velocity magnitude (∼10 cm/s). Moreover, changes in the simulated systolic ventricular-contraction force influence diastolic filling, emphasizing the coupling between cardiac systolic and diastolic functions. The agreement between the simulation and normal physiology highlights the importance of myocardial longitudinal movements and of atrioventricular interactions in cardiac pumping. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A case of typical atrioventricular nodal (AVN) reentrant tachycardia confined to the compact AV node, showing a variety of rare electrophysiological findings, including eccentric AVN echoes

OpenAIRE

Tanaka, Kazushi; Shiotani, Shinji; Fukuda, Keisuke; Fujihara, Masahiko; Higashimori, Akihiro; Morioka, Nobuyuki; Yokoi, Yoshiaki; Fujimura, Osamu

2014-01-01

Herein, we report the case of a 49-year-old woman with typical atrioventricular nodal (AVN) reentrant tachycardia, confined to the compact atrioventricular node, showing numerous rare electrophysiological findings such as unique AVN reentrant echoes, double ventricular responses, latent retrograde dual AVN pathways, antegrade triple AVN pathways, and longitudinal dissociation within the lower final common pathway.

A case of typical atrioventricular nodal (AVN reentrant tachycardia confined to the compact AV node, showing a variety of rare electrophysiological findings, including eccentric AVN echoes

Directory of Open Access Journals (Sweden)

Kazushi Tanaka, M.D., Ph.D.

2014-12-01

Full Text Available Herein, we report the case of a 49-year-old woman with typical atrioventricular nodal (AVN reentrant tachycardia, confined to the compact atrioventricular node, showing numerous rare electrophysiological findings such as unique AVN reentrant echoes, double ventricular responses, latent retrograde dual AVN pathways, antegrade triple AVN pathways, and longitudinal dissociation within the lower final common pathway.

Effect of atrioventricular conduction on heart rate variability

KAUST Repository

Ahmad, Talha Jamal

2011-08-01

This paper discusses the effect of atrioventricular conduction time (AVCT) on the short-term Heart Rate Variability (HRV) by computing HRV parameters using intervals between the onsets of successive P waves (PP time series) for three groups: normal, arrhythmia and sudden cardiac death (SCD) patients. A very precise wavelet transform based ECG delineator was developed to detect PP, PR and RR time series. Mean PR variation in arrhythmia and SCD group was found to be significantly high as compared to the normal group. It was observed that when PR variations in arrhythmia and SCD cases crossed a certain threshold, RR variability no longer provided a very accurate estimate of HRV. In such cases, PP variability was able to provide a better assessment of HRV. © 2011 IEEE.

Light irradiance through novel CAD-CAM block materials and degree of conversion of composite cements.

Science.gov (United States)

Lise, Diogo Pedrollo; Van Ende, Annelies; De Munck, Jan; Yoshihara, Kumiko; Nagaoka, Noriyuki; Cardoso Vieira, Luiz Clovis; Van Meerbeek, Bart

2018-02-01

To assess light irradiance (LI) delivered by two light-curing units (LCU's) and to measure the degree of conversion (DC) of three composite cements, when cured through different thicknesses of two novel CAD-CAM block materials. 100-μm-thick films of a dual-curable composite cement (G-CEM LinkAce, GC), a light-curable flowable resin-based composite (RBC) (G-ænial Universal Flo, GC) and a micro-hybrid RBC (G-ænial Posterior, GC) were investigated as luting agents. Two 'polymer-ceramic' CAD-CAM blocks (Cerasmart, GC; Enamic, Vita Zahnfabrik) were sectioned in slabs with different thicknesses (1, 3 and 5mm). LI at the bottom of the specimens was measured using a calibrated spectrometer, while being light-cured through the CAD-CAM block slabs for 40s with a low- (±500mW/cm 2 ) or high- (±1,600mW/cm 2 ) irradiance LCU (n=5). After light-curing, micro-Raman spectra of the composite films were acquired to determine DC at 5min, 10min, 1h and 24h. LI data were statistically analyzed by Kruskal-Wallis followed by post-hoc comparisons, while a linear mixed-effect model was applied for the DC analysis. In addition, the CAD-CAM blocks ultrastructure was characterized upon argon-ion slicing using scanning transmission electron microscopy (STEM). Finally, light transmission (LT) through each CAD-CAM block material was assessed using a spectrophotometer. Curing-light attenuation and DC were significantly influenced by thickness and type of the overlying material. LCU only had a significant effect on DC of the micro-hybrid RBC. DC significantly increased over time for all composite cements. CAD-CAM block structural analysis revealed a relatively small and homogenous filler configuration (mean filler size of 0.2-0.5μm) for Cerasmart, while Enamic contained ceramic grains varying in shape and size (1-10μm), which were interconnected by the polymer-based network. LT was much higher at a wavelength range of 300-800nm for Cerasmart than for Enamic. Light-curable composite cements

Intermittent bradyarrhythmia in a Hispaniolan Amazon parrot (Amazona ventralis).

Science.gov (United States)

Rembert, Melanie S; Smith, Julie A; Strickland, Keith N; Tully, Thomas N

2008-03-01

A clinically normal 2-year-old Hispaniolan Amazon parrot (Amazona ventralis) was found to have periodic second-degree atrioventricular (AV) block with variable nodal conductions while anesthetized with isoflurane during a thermal-support research project. Arrhythmias were observed on 5 successive weekly electrocardiograms. A complete cardiac evaluation, including a diagnostic electrocardiogram, revealed intermittent bradyarrhythmias ranging from a 2:1 to a 7:1 second-degree AV block, with concurrent hypotensive episodes during the nodal blocks. Results of a complete blood cell count, plasma biochemical profile, blood gas analysis, and atropine-response test, as well as radiography and auscultation, revealed no obvious cause for the arrhythmias. Echocardiography demonstrated cardiac wall thickness, chamber size, and systolic function similar to other psittacine birds. On return to the colony, the parrot continued to be outwardly asymptomatic despite the dramatic conduction disturbances. Although cardiac arrhythmias, including second-degree AV block, have been widely reported in birds, the wide variation of nodal conductions, the intermittent nature, and an arrhythmia with a 7:1 second-degree AV block that spontaneously reverts to normal as seen in this case have not been well documented in parrots.

Coronary sinus and atrioventricular groove avulsion after motor vehicle crash

Directory of Open Access Journals (Sweden)

Bradley M Dennis

2014-01-01

Full Text Available Simultaneous cardiac and pericardial rupture from blunt chest trauma is a highly lethal combination with rarely reported survival. We report of a case of young patient with a right atrioventricular groove injury, pericardial rupture and a unique description of a coronary sinus avulsion following blunt chest trauma. Rapid recognition of this injury is crucial to patient survival, but traditional diagnostic adjuncts such as ultrasound, echocardiography and computed tomography are often unhelpful. Successful repair of these injuries requires high suspicion of injury, early cardiac surgery involvement of and possible even placement of the patient on cardiopulmonary bypass.

Myocardial Tbx20 regulates early atrioventricular canal formation and endocardial epithelial-mesenchymal transition via Bmp2

NARCIS (Netherlands)

Cai, Xiaoqiang; Nomura-Kitabayashi, Aya; Cai, Weibin; Yan, Jianyun; Christoffels, Vincent M.; Cai, Chen-Leng

2011-01-01

During early embryogenesis, the formation of the cardiac atrioventricular canal (AVC) facilitates the transition of the heart from a linear tube into a chambered organ. However, the genetic pathways underlying this developmental process are poorly understood. The T-box transcription factor Tbx20 is

The double switch for atrioventricular discordance.

Science.gov (United States)

Brawn, William J

2005-01-01

Conventional surgery for atrioventricular discordance usually associated with ventricular arterial discordance leaves the morphologic right ventricle in the systemic circulation. Long-term follow-up results with this approach reveal a high incidence of right ventricular failure. The double switch procedure was introduced to restore the morphologic left ventricle to the systemic circulation. This operation is performed in two main ways: the atrial-arterial switch and the atrial switch plus Rastelli procedure. This double switch approach has been successful at least in the medium term in abolishing morphologic right ventricular failure and its associated tricuspid valve regurgitation. In the atrial-arterial switch group, there is an incidence of morphologic left ventricular dysfunction, sometimes associated with neoaortic valve regurgitation, and the minority of cases need aortic valve replacement. The long-term function of the morphologic left ventricle and the aortic valve need careful surveillance in the future. The atrial-Rastelli group of patients has not in the medium term shown evidence of ventricular dysfunction but will require change on a regular basis of their ventricular to pulmonary artery valved conduits.

Posterior extensions of the human compact atrioventricular node: a neglected anatomic feature of potential clinical significance

NARCIS (Netherlands)

Inoue, S.; Becker, A. E.

1998-01-01

Catheter ablation procedures have revived interest in the detailed anatomy of the specialized atrioventricular (AV) septal junctional area. The compact AV node usually is considered to have a blunt posterior end. The objective of this study was to reconstruct the human compact AV node in relation to

Post-operative ventricular flow dynamics following atrioventricular valve surgical and device therapies: A review.

Science.gov (United States)

Nguyen, Yen Ngoc; Ismail, Munirah; Kabinejadian, Foad; Tay, Edgar Lik Wui; Leo, Hwa Liang

2018-04-01

Intra-ventricular flow dynamics has recently emerged as an important evaluation and diagnosis tool in different cardiovascular conditions. The formation of vortex pattern during the cardiac cycle has been suggested to play important epigenetic and energy-modulation roles in cardiac remodelling, adaptations and mal-adaptations. In this new perspective, flow alterations due to different cardiovascular procedures can affect the long-term outcome of those procedures. Especially, repairs and replacements performed on atrioventricular valves are likely to exert direct impact on intra-ventricular flow pattern. In this review, current consensus around the roles of vortex dynamics in cardiac function is discussed. An overview of physiological vortex patterns found in healthy left and right ventricles as well as post-operative ventricular flow phenomenon owing to different atrioventricular valvular procedures are reviewed, followed by the summary of different vortex identification schemes used to characterise intraventricular flow. This paper also emphasises on future research directions towards a comprehensive understanding of intra-cardiac flow and its clinical relevance. The knowledge could encourage more effective pre-operative planning and better outcomes for current clinical practices. Copyright © 2018. Published by Elsevier Ltd.

Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

Directory of Open Access Journals (Sweden)

Aksu T

2015-02-01

Full Text Available Tolga Aksu, Tumer Erdem Guler, Ebru Golcuk, Ismail Erden, Kazim Serhan Ozcan Department of Cardiology, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey Abstract: Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated. Keywords: dextrocardia, AVNRT, ablation, pulmonary agenesis

Fallot's tetralogy in combination with an open common atrioventricular canal

International Nuclear Information System (INIS)

Alekyan, B.G.; Dvinyaninova, N.B.; Chiaureli, M.R.; Arzhanukhina, S.Yu.

1987-01-01

The methods and clinics of diagnostics of Fallot tetrad (FT) combined with the opened general atrioventricular canal (AVC) of the heart are described on the basis of observation of a 6.5-year old patient and analysis of literary data. On the basis of studying clinical data, electro-, phono-, echocardiography and roentgenography, as well as heart catheterization and angiocardiography the conclusion is made that nowadays the most informative method of diagnostics of FT and AVC combination before angiocardiography is a dimer echocardiography which permits to diagnoze AVC. Angiocardiographic study proves this diagnosis and gives a precise anotomical picture of various components of this combination of heart failure

Transmembrane protein 2 (Tmem2) is required to regionally restrict atrioventricular canal boundary and endocardial cushion development

NARCIS (Netherlands)

Smith, K.; Lagendijk, A.K.; Courtney, A.D.; Chen, H.; Paterson, S.; Hogan, B.M.; Wicking, C.; Bakkers, J.

2011-01-01

The atrioventricular canal (AVC) physically separates the atrial and ventricular chambers of the heart and plays a crucial role in the development of the valves and septa. Defects in AVC development result in aberrant heart morphogenesis and are a significant cause of congenital heart malformations.

Cardiac complications relating to pregnancy and recurrence of disease in the offspring of women with atrioventricular septal defects

NARCIS (Netherlands)

Drenthen, W; Pieper, PG; van der Tuuk, K; Roos-Hesselink, JW; Voors, AA; Mostert, B; Mulder, BJM; Moons, P; Ebels, T; van Veldhuisen, DJ

2005-01-01

Aims In most pregnancy reports, atrioventricular septal defects (AVSD) are not differentiated from more simple septal defects, thus underestimating the risks of pregnancy. To investigate the magnitude and determinants of risk during pregnancy in female patients with balanced AVSD. Methods and

Blending of styrene-block-butadiene-block-styrene copolymer with sulfonated vinyl aromatic polymers

NARCIS (Netherlands)

Ruggeri, Giacomo; Passaglia, Elisa; Giorgi, Ivan; Picchioni, Francesco; Aglietto, Mauro

2001-01-01

Different polymers containing sulfonic groups attached to the phenyl rings were prepared by sulfonation of polystyrene (PS) and styrene-block-(ethylene-co-1-butene)-block-styrene (SEBS). The sulfonation degree (SD) was varied between 1 and 20 mol% of the styrene units. Polyphase materials containing

Heart block and cardiac embolization of fractured inferior vena cava filter.

Science.gov (United States)

Abudayyeh, Islam; Takruri, Yessar; Weiner, Justin B

2016-01-01

A 66-year-old man underwent a placement of an inferior vena cava filter before a gastric surgery 9 years prior, presented to the emergency room with a complete atrioventricular block. Chest x-ray and transthoracic echocardiogram showed struts migrating to right ventricle with tricuspid regurgitation. Cardiothoracic surgery was consulted and declined an open surgical intervention due to the location of the embolized fragments and the patient's overall condition. It was also felt that the fragments had migrated chronically and were adhered to the cardiac structures. The patient underwent a dual-chamber permanent pacemaker implantation. Post-implant fluoroscopy showed no displacement of the inferior vena cava filter struts due to the pacemaker leads indicating that the filter fracture had likely been a chronic process. This case highlights a rare combination of complications related to inferior vena cava filter fractures and the importance of assessing for such fractures in chronic placements. Inferior vena cava filter placement for a duration greater than 1 month can be associated with filter fractures and strut migration which may lead to, although rare, serious or fatal complications such as complete atrioventricular conduction system disruption and valvular damage including significant tricuspid regurgitation. Assessing for inferior vena cava filter fractures in chronic filter placement is important to avoid such complications. When possible, retrieval of the filter should be considered in all patients outside the acute setting in order to avoid filter-related complications. Filter retrieval rates remain low even when a retrievable filter is in place and the patient no longer has a contraindication to anticoagulation.

Right ventricular hypoplasia syndrome. Atresia of the right atrioventricular ostium (X-ray examination)

International Nuclear Information System (INIS)

Golonzko, R.R.; Chernova, M.P.; Berishvili, I.I.; Bulchinskij, S.A.

1982-01-01

Data on routine radiologic examination of 51 patients aged 3 days to 3 years with the right atrio-ventricular ostium atresia were presented. The evidence obtained was compared with angiographic and, in part of cases, with morphometric findings. All patients were divided in two groups, depending on pulmonary circulation functions. Characteristic radiologic features of the valvular defect were revealed: ''quadrangle'' heart configuration; increase of right auricle; ''sheared off'' profile of the right ventricle, absence of increase of leftauricle in children up to 1 year

Heavy subgraph pairs for traceability of block-chains

Directory of Open Access Journals (Sweden)

Li Binlong

2014-05-01

Full Text Available A graph is called traceable if it contains a Hamilton path, i.e., a path containing all its vertices. Let G be a graph on n vertices. We say that an induced subgraph of G is o−1-heavy if it contains two nonadjacent vertices which satisfy an Ore-type degree condition for traceability, i.e., with degree sum at least n−1 in G. A block-chain is a graph whose block graph is a path, i.e., it is either a P1, P2, or a 2-connected graph, or a graph with at least one cut vertex and exactly two end-blocks. Obviously, every traceable graph is a block-chain, but the reverse does not hold. In this paper we characterize all the pairs of connected o−1-heavy graphs that guarantee traceability of block-chains. Our main result is a common extension of earlier work on degree sum conditions, forbidden subgraph conditions and heavy subgraph conditions for traceability

Asymmetric PS-block-(PS-co-PB)-block-PS block copolymers: morphology formation and deformation behaviour

International Nuclear Information System (INIS)

Adhikari, Rameshwar; Huy, Trinh An; Buschnakowski, Matthias; Michler, Goerg H; Knoll, Konrad

2004-01-01

Morphology formation and deformation behaviour of asymmetric styrene/butadiene triblock copolymers (total polystyrene (PS) content ∼70%) consisting of PS outer blocks held apart by a styrene-co-butadiene random copolymer block (PS-co-PB) each were investigated. The techniques used were differential scanning calorimetry, transmission electron microscopy, uniaxial tensile testing and Fourier-transform infrared spectroscopy. A significant shift of the phase behaviour relative to that of a neat symmetric triblock copolymer was observed, which can be attributed to the asymmetric architecture and the presence of PS-co-PB as a soft block. The mechanical properties and the microdeformation phenomena were mainly controlled by the nature of their solid-state morphology. Independent of morphology type, the soft phase was found to deform to a significantly higher degree of orientation when compared with the hard phase

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total Risk factors analysis in the surgical repair of complete atrioventricular septal defect

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Eduardo Keller Saadi

1993-06-01

Full Text Available Pacientes com defeito septal atrioventricular de forma total (DSAVT freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce. Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade, peso, sexo, ano da operação, presença de síndrome de Down, grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli, emprego de parada circulatória e técnica de correção (1 x 2 retalhos. Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que, independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.Patients with complete atrioventricular septal defects (CAVSD frequently present with severe heart failure which cannot be controllable medically and pulmonary hypertension in infancy. Just a small number survives without early surgical treatment. For this reason

Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects [version 1; referees: 3 approved

Directory of Open Access Journals (Sweden)

P Syamasundar Rao

2018-04-01

Full Text Available This review discusses the management of ventricular septal defects (VSDs and atrioventricular septal defects (AVSDs. There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe

Missed aortic valve endocarditis resulting in complete atrioventricular block and redo mechanical valve replacement.

Science.gov (United States)

Harky, Amer; Garner, Megan; Popa, Miruna; Shipolini, Alex

2017-08-03

Infective endocarditis is a rare disease associated with high morbidity and mortality. As a result, early diagnosis and prompt antibiotic treatment with or without surgical intervention is crucial in the management of such condition.We report a case of missed infective endocarditis of the aortic valve. The patient underwent mechanical aortic valve replacement, with the native valve being sent for histopathological examination. On re-admission 16 months later, he presented with syncope, shortness of breathing and complete heart block. On review of the histopathology of native aortic valve, endocarditis was identified which had not been acted on. The patient underwent redo aortic valve replacement for severe aortic regurgitation.We highlight the importance of following up histopathological results as well as the need for multidisciplinary treatment of endocarditis with a combination of surgical and antibiotic therapy. © 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.

Inhibitory effects of Urtica dioica L. root on electrophysiological properties of isolated rabbit atrioventricular node

OpenAIRE

A. Enayati; V. Khori*; M. Azadbakhat; M. Zahedi

2017-01-01

Background and objectives: The ideal drug for treatment of a wide range of supraventricular arrhythmia hasn't yet been developed. Previous studies have shown antihypertensive and negative inotropic effects of the Urtica dioica L. (nettle). Therefore, the aim of present study is to determine the rate dependent inhibitory effects of ethanol extract of nettle root and investigate the role of adrenoceptors in the anti-arrhythmic mechanism of nettle on the isolated rabbit atrio-ventricular node. M...

The anatomy and histology of the atrioventricular conducting system in the hedgehog (Hemiechinus auritus) heart

OpenAIRE

NABIPOUR, Abolghasem

2014-01-01

This study examined the atrioventricular conducting system in 4 adult male hedgehogs (Hemiechinus auritus). The histological structure of these components was studied using routine histological methods. The AVN was located at the lower and anterior part of the interatrial septum, near the root of the aorta. It was almost oval and consisted of twisted cells. Internodal pathways in the hedgehog heart were not observed, but there were numerous purkinje-like fibers within the myocardium of the at...

Right and left inferior extensions of the atrioventricular node may represent the anatomic substrate of the slow pathway in humans

NARCIS (Netherlands)

Katritsis, Demosthenes G.; Becker, Anton E.; Ellenbogen, Kenneth A.; Karabinos, Ilias; Giazitzoglou, Eleftherios; Korovesis, Socrates; Camm, A. John

2004-01-01

The purpose of this study was to investigate the electrophysiologic characteristics of the inferior extensions of the human atrioventricular (AV) node and their possible relationship to slow pathway conduction. The human heart contains right and left inferior extensions of the AV node that relate to

Surgical anatomy of the atrioventricular conduction bundle in anomalous muscle bundle of the right ventricle with subarterial ventricular septal defect

NARCIS (Netherlands)

Kurosawa, H.; Becker, A. E.

1985-01-01

A stillborn baby girl was found to have an anomalous muscle bundle of the right ventricle, associated with a doubly committed subarterial ventricular septal defect. The latter was separated from the area of the atrioventricular conduction bundle by muscle. Serial histologic sectioning of the

Disturbed Intracardiac Flow Organization After Atrioventricular Septal Defect Correction as Assessed With 4D Flow Magnetic Resonance Imaging and Quantitative Particle Tracing

NARCIS (Netherlands)

Calkoen, Emmeline E.; de Koning, Patrick J. H.; Blom, Nico A.; Kroft, Lucia J. M.; de Roos, Albert; Wolterbeek, Ron; Roest, Arno A. W.; Westenberg, Jos J. M.

2015-01-01

Objectives Four-dimensional (3 spatial directions and time) velocity-encoded flow magnetic resonance imaging with quantitative particle tracing analysis allows assessment of left ventricular (LV) blood flow organization. Corrected atrioventricular septal defect (AVSD) patients have an abnormal left

Acute heart failure associated with congenital complete atrioventricular block due to neonatal lupus: case series report

International Nuclear Information System (INIS)

Velasquez F, Carlos J; Correa, Cindy; Molina, Monica; Fernanda, Luisa; Velasquez, Nataly; Diaz, Luis H

2010-01-01

Neonatal lupus (NL) defines a set of clinical syndromes characterized by maternal autoantibodies against the RNA protein complex (Ro/SSA or La/SSB) that cross the placenta and potentially lead to fetal tissue damage. Little is known about other cardiac manifestations of NL different from congenital heart block (CHB), as heart failure (HF). Four cases of LN with BCC and acute HF at the first three days of life on average were reported. No complications or deaths were reported at 4,9 months of follow-up. All infants had anti-Ro high titles at the time of diagnosis.

Role of regional radiofrequency hyperthermia after hepatic artery block in the normal pit liver

International Nuclear Information System (INIS)

Luo Jingwei; Xu Guozhen; Xiong Jinghong; Liu Xiaoyun; Wang Weihu; Li Yexiong

2003-01-01

Objective: To study the temperature difference, tolerated high temperature, pathological changes between normal and blocked hepatic artery in radiofrequency hyperthermia for pig liver. Methods: Mature pig was used with iodine blocked right hepatic artery. Heat of the whole liver was given for 1 hour by SR-1000 radiofrequency hyperthermia with four thermocouple probes to measure the temperature of the right hepatic artery, right and left normal liver and rectum. Results: Temperature of blocked right liver increased by 10.2 degree C from 39.1 degree C to 49.3 degree C as compared with the left liver of which the temperature rose by 6.8 degree C from 39.7 degree C to 46.5 degree C but the temperature of right hepatic artery and rectum rose only by 3.3 degree C, 3.2 degree C respectively. After sacrificing the pig one week later, on lobe exploration, severe necrosis was observed in the right lobe but the left lobe was normal with a clear demarcation between the two lobes. Conclusions: Hepatic arterial iodine embolization potentiates radiofrequency hyperthermia in the liver. Liver with blocked artery showed conspicuous necrosis but liver with normal un-blocked artery was able to tolerate 46.5 degree C. This provides some evidence for the combination of regional hyperthermia and hepatic artery block in the treatment of advanced liver cancer

Familial atrioventricular nodal re-entrant tachycardia: A case seriers and a systematic review

Directory of Open Access Journals (Sweden)

Muthiah Subramanian

2017-11-01

Full Text Available Multiple reports of familial clustering suggest that genetic factors may contribute in the pathogenesis of atrioventricular nodal re-entrant tachycardia (AVNRT. We report three cases of AVNRT in a father and his two sons along with a review of literature of other similar cases. Electrophysiological studies induced typical AVNRT, which was successfully eliminated by radiofrequency ablation in all of them. Of the 22 reported cases, 96% had typical (slow-fast variant of AVNRT. The predominant pattern of inheritance appears to be autosomal dominant, though other patterns may exist. Further research is needed to understand the genetic influence of AVNRT and its pathophysiology. Keywords: Familial, AVNRT, Tachycardia

Digoxinforgiftning hos et spædbarn grundet forveksling af flasker med magistrelt fremstillet medicin

DEFF Research Database (Denmark)

Hansen, Louise Lindholdt; Herskind, Anne Maria

2014-01-01

-fragment and atropine. After three days of hospitalization she was discharged well-being. We suspect that the explanation for this intoxication is due to confusion of bottles of magistral preparations of medicine, as they were very identical. Therefore we call for increased attention in children receiving this type......We hereby describe a case report of a 9-month-old girl, who was accidentally intoxicated with digoxin since her parents by mistake gave her digoxin instead of propranolol. At admission sinusbradycardia and a first-degree atrioventricular block was found and she was treated with antidigitalis Fab...

Atrioventricular junction (AVJ) motion tracking: a software tool with ITK/VTK/Qt.

Science.gov (United States)

Pengdong Xiao; Shuang Leng; Xiaodan Zhao; Hua Zou; Ru San Tan; Wong, Philip; Liang Zhong

2016-08-01

The quantitative measurement of the Atrioventricular Junction (AVJ) motion is an important index for ventricular functions of one cardiac cycle including systole and diastole. In this paper, a software tool that can conduct AVJ motion tracking from cardiovascular magnetic resonance (CMR) images is presented by using Insight Segmentation and Registration Toolkit (ITK), The Visualization Toolkit (VTK) and Qt. The software tool is written in C++ by using Visual Studio Community 2013 integrated development environment (IDE) containing both an editor and a Microsoft complier. The software package has been successfully implemented. From the software engineering practice, it is concluded that ITK, VTK, and Qt are very handy software systems to implement automatic image analysis functions for CMR images such as quantitative measure of motion by visual tracking.

Persistence of functional atrioventricular accessory pathways in postseptated embryonic avian hearts: implications for morphogenesis and functional maturation of the cardiac conduction system

NARCIS (Netherlands)

Kolditz, Denise P.; Wijffels, Maurits C. E. F.; Blom, Nico A.; van der Laarse, Arnoud; Markwald, Roger R.; Schalij, Martin J.; Gittenberger-de Groot, Adriana C.

2007-01-01

BACKGROUND: During heart development, the ventricular activation sequence changes from a base-to-apex to an apex-to-base pattern. We investigated the possibility of impulse propagation through remnants of atrioventricular (AV) connections in quail hearts. METHODS AND RESULTS: In 86 hearts (group A,

Effects of calcium, calcium entry blockers and calmodulin inhibitors on atrioventricular conduction disturbances induced by hypoxia.

OpenAIRE

Anno, T.; Kodama, I.; Shibata, S.; Toyama, J.; Yamada, K.

1986-01-01

Effects of hypoxia on atrioventricular conduction were investigated in the Langendorff-perfused isolated heart of the rabbit with various extracellular calcium concentrations ([Ca2+]) as well as in the presence of verapamil, nifedipine, N-(6-aminohexyl)-5-chloro-1-naphthalenesulphonamide (W-7) and chlorpromazine. The prolongation of the atrio-His (AH) interval by hypoxia for 7 min was greater with increasing [Ca2+]o ranging from 1.2 to 5.2 mM. At [Ca2+]o of over 3.2 mM under hypoxic condition...

Acute pericarditis with cardiac tamponade induced by pacemaker implantation.

Science.gov (United States)

Shingaki, Masami; Kobayashi, Yutaka; Suzuki, Haruo

2015-11-01

An 87-year-old woman was diagnosed with third-degree atrioventricular block and underwent pacemaker implantation. On postoperative day 12, she experienced cardiac tamponade that was suspected on computed tomography to be caused by lead perforation; therefore, we performed open-heart surgery. However, we could not identify a perforation site on the heart, and drained a 400-mL exudative pericardial effusion. Subsequently, we diagnosed the pericardial effusion as due to pericarditis induced by pacemaker implantation. It is sometimes difficult to distinguish pericarditis from pacemaker lead perforation, so both should be included in the differential diagnosis. © The Author(s) 2014.

Lyme carditis mimicking giant cell arteritis

Directory of Open Access Journals (Sweden)

Krati Chauhan

2015-10-01

Full Text Available Presenting an interesting case of a patient who complained of myalgias, fatigue, headache, jaw claudication and scalp tenderness. Patient’s physical examination was unremarkable. Laboratory findings showed elevated erythrocyte sedimentation rate and C-reactive protein, bilateral temporal artery biopsy results were negative and first degree atrioventricular block was seen on electrocardiogram. Serology for Borrelia burgdorferi was positive; patient was diagnosed with Lyme carditis and treated with doxycycline. Lyme is a tick-borne, multi-system disease and occasionally its presentation may mimic giant cell arteritis. On follow-up there was complete resolution of symptoms and electrocardiogram findings.

Expression of the BMP receptor Alk3 in the second heart field is essential for development of the dorsal mesenchymal protrusion and atrioventricular septation

NARCIS (Netherlands)

Briggs, Laura E.; Phelps, Aimee L.; Brown, Elizabeth; Kakarla, Jayant; Anderson, Robert H.; van den Hoff, Maurice J. B.; Wessels, Andy

2013-01-01

The dorsal mesenchymal protrusion (DMP) is a prong of mesenchyme derived from the second heart field (SHF) located at the venous pole of the developing heart. Recent studies have shown that perturbation of its development is associated with the pathogenesis of atrioventricular (AV) septal defect.

Climatological features of blocking anticyclones

International Nuclear Information System (INIS)

Lupo, A.R.; Smith, P.J.; Oglesby, R.J.

1994-01-01

Several climatological studies have been previously performed using large observational data sets (i.e., 10 years or longer) in order to determine the predominant characteristics of blocking anticyclones, including favored development regions, duration, preferred seasonal occurrence, and frequency of occurrence. These studies have shown that blocking anticyclones occur most frequently from October to April over the eastern Atlantic and Pacific oceans downstream from both the North American and Asian continental regions and the storm track regions to the east of these continents. Some studies have also revealed the presence of a third region block formation in western Russia near 40 degrees E which is associated with another storm track region over the Mediterranean and western Asia

Atrioventricular node functional remodeling induced by atrial fibrillation.

Science.gov (United States)

Zhang, Youhua; Mazgalev, Todor N

2012-09-01

The atrioventricular node (AVN) plays a vital role in determining the ventricular rate during atrial fibrillation (AF). AF results in profound electrophysiological and structural remodeling in the atria as well as the sinus node. However, it is unknown whether AVN undergoes remodeling during AF. To determine whether AVN undergoes functional remodeling during AF. AVN conduction properties were studied in vitro in 9 rabbits with AF and 10 normal controls. A previously validated index of AVN dual-pathway electrophysiology, His-electrogram alternans, was used to monitor fast-pathway or slow-pathway (SP) AVN conduction in these experiments. AVN conduction properties were further studied in vivo in 7 dogs with chronic AF and 8 controls. Compared with the control rabbits, the rabbits with AF had a longer AVN conduction time (83 ± 16 ms vs 68 ± 7 ms; P AVN effective refractory period (141 ± 27 ms vs 100 ± 9 ms; P AVN effective refractory period and a slower ventricular rate during AF compared with the controls. Pronounced AVN functional electrophysiological remodeling occurs after long-term AF, which could lead to a spontaneous slowing of the ventricular rate. Furthermore, the SP dominance during AF underscores the effectiveness of its modification by ablation for ventricular rate control during AF. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Dual Atrioventricular Nodal Pathways Physiology: A Review of Relevant Anatomy, Electrophysiology, and Electrocardiographic Manifestations

Directory of Open Access Journals (Sweden)

Bhalaghuru Chokkalingam Mani, MD

2014-01-01

Full Text Available More than half a century has passed since the concept of dual atrioventricular (AV nodal pathways physiology was conceived. Dual AV nodal pathways have been shown to be responsible for many clinical arrhythmia syndromes, most notably AV nodal reentrant tachycardia. Although there has been a considerable amount of research on this topic, the subject of dual AV nodal pathways physiology remains heavily debated and discussed. Despite advances in understanding arrhythmia mechanisms and the widespread use of invasive electrophysiologic studies, there is still disagreement on the anatomy and physiology of the AV node that is the basis of discontinuous antegrade AV conduction. The purpose of this paper is to review the concept of dual AV nodal pathways physiology and its varied electrocardiographic manifestations.

Echo determinants of dyssynchrony (atrioventricular and inter- and intraventricular) and predictors of response to cardiac resynchronization therapy.

Science.gov (United States)

Kapetanakis, Stamatis; Bhan, Amit; Monaghan, Mark J

2008-10-01

Cardiac resynchronization therapy (CRT) has revolutionized not only the treatment of chronic heart failure but also how we assess left ventricular (LV) dysfunction on echo. Increasingly, it has become clear that identifying and quantifying delays in events during the cardiac cycle is an important assessment in LV dysfunction as it has prognostic implications for patients undergoing CRT. The delays in atrioventricular, right-to-left ventricular, and LV segmental contraction have been shown to be important components in cardiac performance, and this review provides an overview of the commonest methods used for these assessments and their implications for selecting patients for biventricular pacing.

Tachyarrhythmias, bradyarrhythmias and acute coronary syndromes

Directory of Open Access Journals (Sweden)

Trappe Hans-Joachim

2010-01-01

Full Text Available The incidence of bradyarrhythmias in patients with acute coronary syndrome (ACS is 0.3% to 18%. It is caused by sinus node dysfunction (SND, high-degree atrioventricular (AV block, or bundle branch blocks. SND presents as sinus bradycardia or sinus arrest. First-degree AV block occurs in 4% to 13% of patients with ACS and is caused by rhythm disturbances in the atrium, AV node, bundle of His, or the Tawara system. First- or second-degree AV block is seen very frequently within 24 h of the beginning of ACS; these arrhythmias are frequently transient and usually disappear after 72 h. Third-degree AV blocks are also frequently transient in patients with infero-posterior myocardial infarction (MI and permanent in anterior MI patients. Left anterior fascicular block occurs in 5% of ACS; left posterior fascicular block is observed less frequently (incidence < 0.5%. Complete bundle branch block is present in 10% to 15% of ACS patients; right bundle branch block is more common (2/3 than left bundle branch block (1/3. In patients with bradyarrhythmia, intravenous (IV atropine (1-3 mg is helpful in 70% to 80% of ACS patients and will lead to an increased heart rate. The need for pacemaker stimulation (PS is different in patients with inferior MI (IMI and anterior MI (AMI. Whereas bradyarrhythmias are frequently transient in patients with IMI and therefore do not need permanent PS, there is usually a need for permanent PS in patients with AMI. In these patients bradyarrhythmias are mainly caused by septal necrosis. In patients with ACS and ventricular arrhythmias (VTA amiodarone is the drug of choice; this drug is highly effective even in patients with defibrillation-resistant out-of-hospital cardiac arrest. There is general agreement that defibrillation and advanced life support is essential and is the treatment of choice for patients with ventricular flutter/fibrillation. If defibrillation is not available in patients with cardiac arrest due to VTA

Protograph LDPC Codes with Node Degrees at Least 3

Science.gov (United States)

Divsalar, Dariush; Jones, Christopher

2006-01-01

In this paper we present protograph codes with a small number of degree-3 nodes and one high degree node. The iterative decoding threshold for proposed rate 1/2 codes are lower, by about 0.2 dB, than the best known irregular LDPC codes with degree at least 3. The main motivation is to gain linear minimum distance to achieve low error floor. Also to construct rate-compatible protograph-based LDPC codes for fixed block length that simultaneously achieves low iterative decoding threshold and linear minimum distance. We start with a rate 1/2 protograph LDPC code with degree-3 nodes and one high degree node. Higher rate codes are obtained by connecting check nodes with degree-2 non-transmitted nodes. This is equivalent to constraint combining in the protograph. The condition where all constraints are combined corresponds to the highest rate code. This constraint must be connected to nodes of degree at least three for the graph to have linear minimum distance. Thus having node degree at least 3 for rate 1/2 guarantees linear minimum distance property to be preserved for higher rates. Through examples we show that the iterative decoding threshold as low as 0.544 dB can be achieved for small protographs with node degrees at least three. A family of low- to high-rate codes with minimum distance linearly increasing in block size and with capacity-approaching performance thresholds is presented. FPGA simulation results for a few example codes show that the proposed codes perform as predicted.

Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves.

Science.gov (United States)

Scanlan, Adam B; Nguyen, Alex V; Ilina, Anna; Lasso, Andras; Cripe, Linnea; Jegatheeswaran, Anusha; Silvestro, Elizabeth; McGowan, Francis X; Mascio, Christopher E; Fuller, Stephanie; Spray, Thomas L; Cohen, Meryl S; Fichtinger, Gabor; Jolley, Matthew A

2018-03-01

Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed "negative" molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.

[Fiessinger-Leroy-Reiter syndrome with non-obstructive cardiomyopathy treated with methotrexate].

Science.gov (United States)

Blétry, O; De Prost, Y; Scheuble, C; Frank, R; Godeau, P

1979-07-01

The case of a 50 year old male with the Fiessinger-Leroy-Reiter syndrome, ankylosing spondylitis and generalised pustular psoriasis is reported. This condition wax complicated by non-obstructive cardiomyopathy, congestive cardiac failure and first-degree atrioventricular block, the site of which was localised by electrophysiological studies (nodal block with an infrahisian conduction defect). After failure of several therapeutic regimes, a spectacular improvement was obtained with Methotrexate associated with a diuretic; the signs of heart failure regressed and the cardiomyopathy stablised. A parallel improvement was seen in the skin, cardiac and articular lesions and has been maintained with an 18 months follow-up. Left ventricular performance was studied by echocardiography. The mechanism of the beneficial effect of Methotrexate is unclear; this therapeutic trial is to be extended to include other cases of primary cardiomyopathy without obstruction.

CT and fluoroscopy guided celiac ganglion block

International Nuclear Information System (INIS)

Lim, Sun Kyung; Kwon, Dae Ik; Ahn, Hyup; Kim, Jong Il; Kim, Byung Young; Lee, Jong Gil

1994-01-01

To evaluate the effects and usefulness of fluoroscopy guided celiac ganglion block after marking of needle path with CT scan. Celiac ganglion block with 100% ethyl alcohol was performed in 50 cancer patients who were inoperable and had intractable abdominal pain. Duration and degree of pain relief after the procedure and its complication were analyzed. Early pain relief was observed in 98% and long term relief in 68% without serious complication. Fluoroscopy guided celiac ganglion block after marking of needle path with CT scan was a safe and valuable procedure in relieving intractable pain in terminal cancer patients and reduced the time in the CT room

Female preponderance in atrioventricular node reentrant tachycardia, but no sex related electrophysiological differences

Directory of Open Access Journals (Sweden)

Claes Williamsson

2014-01-01

Full Text Available The mechanism behind the female preponderance for atrio-ventricular node reentrant tachycardia (AVNRT is not clear. We compared baseline electrophysiological measurements and clinical data in 141 consecutive patients (96 women who underwent successful AVNRT ablation at their fi rst therapeutic procedure. Women had on average 9% higher resting heart rate than men (p<0.05, but were similar in all measures of AV node function. Isoproterenol infusion was required for AVNRT induction in 69 cases (49%, and the need for isoproterenol was associated with lower resting heart rate and longer anterograde and retrograde AV node refractory periods (p<0.05 for comparisons, but not with sex. We conclude that the spectrum of baseline AV node physiology in AVNRT patients is wide, and is similar in men and women. The female preponderance for AVNRT cannot be explained from comparisons of baseline AV node electrophysiological properties.

Origem das artérias dos nós sinoatrial e atrioventricular em população do sul da Índia: um estudo angiográfico Origen de las arterias de los nódulos sinusal y atrioventricular en población del Sur de la India: un estudio angiográfico Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study

Directory of Open Access Journals (Sweden)

Lakshmi Ramanathan

2009-05-01

Full Text Available FUNDAMENTO: Estudar o suprimento arterial do sistema condutor e sua correlação com a dominância das artérias coronárias em população do sul da Índia. OBJETIVO: Determinar angiograficamente as origens da artéria do nó sinoatrial (AnSA e artéria do nó atrioventricular (AnAV em indianos. MÉTODOS: O ESTudo incluiu 300 pacientes consecutivos (114 do sexo feminino e 186 do sexo masculino; idade média, 55 anos, habitantes da região costeira ao sul da Índia, submetidos a cineangiocoronariografia devido a sintomas como dor no peito, angina pectoris ou teste ergométrico positivo. As angiografias incluíram ambas as artérias coronárias (direita e esquerda em posição oblíqua anterior direita e esquerda. A origem da AnSA e AnAV a partir das artérias coronárias foi observada e correlacionada à dominância arterial. RESULTADOS: O nó SA (sinoatrial recebeu suprimento pela artéria coronária direita (ACD em 53% dos casos, pelo ramo circunflexo (Cx da artéria coronária esquerda (ACE em 42,66% dos casos, e em 4,33% dos casos esse nó foi irrigado por ambas as artérias coronárias. O nó AV (atrioventricular também recebeu suprimento sanguíneo com mais frequência da ACD (72,33% dos casos do que do ramo Cx da ACE (27,66%. Surpreendentemente, em nenhum caso este nó recebeu suprimento de ambas as artérias coronárias. CONCLUSÃO: Os Resultados do presente estudo podem auxiliar os cirurgiões cardíacos, sobretudo em cirurgias relacionadas a valvopatias, devido à franca proximidade entre os ramos nodais e o complexo valvar.FUNDAMENTO: Estudiar el suministro arterial del sistema conductor y su correlación con la dominancia de las arterias coronarias en población del Sur de la India. OBJETIVO: Determinar angiográficamente los orígenes de la arteria del nódulo sinusal (AnSA y la arteria del nódulo atrioventricular (AnAV en indios. MÉTODOS: El estudio incluyó 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo

Learning electrocardiogram on YouTube: how useful is it?

Science.gov (United States)

Akgun, Taylan; Karabay, Can Yucel; Kocabay, Gonenc; Kalayci, Arzu; Oduncu, Vecih; Guler, Ahmet; Pala, Selcuk; Kirma, Cevat

2014-01-01

YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube. YouTube was searched on May 28, 2013 for the search terms "AF ecg" for atrial fibrillation, "AVNRT" for atrioventricular nodal reentrant tachycardia, "AVRT" for atrioventricular reentrant tachycardia, "AV block or heart block" for atrioventricular block, "LBBB, RBBB" for bundle branch block, "left anterior fascicular block or left posterior fascicular block" for fascicular blocks, "VT ecg" for ventricular tachycardia, "long QT" and "Brugada ecg". Non-English language, unrelated and non-educational videos were excluded. Remaining videos were assessed for usefulness, source and characteristics. Usefulness was assessed with using a checklist developed by the authors. One hundred nineteen videos were included in the analysis. Sources of the videos were as follows: individuals n=70, 58.8%, universities/hospitals n=10, 8.4% and medical organizations n=3, 2.5%, health ads n=10 8.4%, health websites n=26, 21.8%. Fifty-six (47.1%) videos were classified as very useful and 16 (13.4%) videos were misleading. 90% of the videos uploaded by universities/hospitals were grouped as very useful videos, the same ratio was 45% for the individual uploads. There were statistically significant differences in ECG diagnosis among the groups (for very useful, useful and misleading, pYouTube has a substantial amount of videos on ECG with a wide diversity from useful to misleading content. The lack of quality content relating to ECG on YouTube necessitates that videos should be selected with utmost care. © 2013 Elsevier Inc. All rights reserved.

Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block.

Science.gov (United States)

Aksu, Recep; Bicer, Cihangir

2017-06-26

Research is ongoing to determine the lowest dose of local anesthetics in brachial plexus block that provides adequate anesthesia and postoperative analgesia and reduces complications related to local anesthetics. Patients 18-65 years of age who underwent upper limb surgery and who received ultrasound-guided supraclavicular brachial plexus block at the Erciyes University Faculty of Medicine Hospital between February 2014 and January 2015 were included in the study (n=50). Supraclavicular brachial plexus blocks were performed on Group B cases by adding 30 ml 0.33% bupivacaine and on Group BD cases by adding 15 ml 0.33% bupivacaine and 1 µg / kg dexmedetomidine. Block success was evaluated by the onset and block duration of motor and sensory block and the duration of analgesia. The block success of Group B and Group BD was 92.6% and 89.3%, respectively (P = 1.000). Onset time of sensory block, degree of sensory block, duration of sensory block, onset time of motor block, degree of motor block and duration of motor block were similar in both groups in the intergroup comparison (P > 0.05). Duration of analgesia and the operative conditions of groups were similar (P > 0.05). In the implementation of ultrasound-guided supraclavicular brachial plexus block, block success, sensory and motor block and analgesia duration were similar for patients anaesthetized with 30 ml of bupivacaine in comparison with dexmedetomidine+bupivacaine (when the bupivacaine dose was reduced by 50% by the addition of the adjuvant).

Evaluation of atrial, ventricular and atrioventricular septal defects by cine magnetic resonance imaging

International Nuclear Information System (INIS)

Akagi, Teiji; Kato, Hirohisa; Kiyomatsu, Yumi; Saiki, Kuninobu; Suzuki, Kazushige; Eto, Takaharu

1992-01-01

Cine magnetic resonance imaging (MRI) was performed on 20 patients (mean age: 5.3±4.4 years) with atrial, ventricular, or atrioventricular septal defects for evaluation of cardiac structure and blood flow. Prior to cine MRI, electrocardiographycally gated MRI using multislice scquisition was performed on all patients to localize optimal slice location. Cine-MRI was obtained with a 30 deg flip angle, 15 msec echo time, and 30 msec pulse repetition time, on a 256 x 256 or 128 x 128 acquisition matrix. Abnormalities of cardiac structure were well defined in all patients by gated cardiac imaging. In 18 of the 20 patients, cine-MRI was able to detect shunt flow, visualized as a low intensity signal in comparison with the surrounding blood flow. Cine-MRI can provide not only accurate anatomy of cardiac structures but functional assessment of the cardiac chamber, wall topology and flow relations. Cine-MRI will become an important noninvasive technique for assessment of anatomy and physiology in congenital heart disease. (author)

Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery.

Science.gov (United States)

van der Merwe, Johan; Van Praet, Frank; Stockman, Bernard; Degrieck, Ivan; Vermeulen, Yvette; Casselman, Filip

2018-02-14

This study reports the factors that contribute to sternotomy conversions (SCs) and adverse intraoperative events in minimally invasive aortic valve surgery (MI-AVS) and minimally invasive Endoscopic Port Access™ atrioventricular valve surgery (MI-PAS). In total, 3780 consecutive patients with either aortic valve disease or atrioventricular valve disease underwent minimally invasive valve surgery (MIVS) at our institution between 1 February 1997 and 31 March 2016. MI-AVS was performed in 908 patients (mean age 69.2 ± 11.3 years, 45.2% women, 6.2% redo cardiac surgery) and MI-PAS in 2872 patients (mean age 64.1 ± 13.3 years, 46.7% women, 12.2% redo cardiac surgery). A cumulative total of 4415 MIVS procedures (MI-AVS = 908, MI-PAS = 3507) included 1537 valve replacements (MI-AVS = 896, MI-PAS = 641) and 2878 isolated or combined valve repairs (MI-AVS = 12, MI-PAS = 2866). SC was required in 3.0% (n = 114 of 3780) of MIVS patients, which occurred in 3.1% (n = 28 of 908) of MI-AVS patients and 3.0% (n = 86 of 2872) of MI-PAS patients, respectively. Reasons for SC in MI-AVS included inadequate visualization (n = 4, 0.4%) and arterial cannulation difficulty (n = 7, 0.8%). For MI-PAS, SC was required in 54 (2.5%) isolated mitral valve procedures (n = 2183). Factors that contributed to SC in MI-PAS included lung adhesions (n = 35, 1.2%), inadequate visualization (n = 2, 0.1%), ventricular bleeding (n = 3, 0.1%) and atrioventricular dehiscence (n = 5, 0.2%). Neurological deficit occurred in 1 (0.1%) and 3 (3.5%) MI-AVS and MI-PAS conversions, respectively. No operative or 30-day mortalities were observed in MI-AVS conversions (n = 28). The 30-day mortality associated with SC in MI-PAS (n = 86) was 10.5% (n = 9). MIVS is increasingly being recognized as the 'gold-standard' for surgical valve interventions in the context of rapidly expanding catheter-based technology and increasing

Lyme carditis with isolated left bundle branch block and myocarditis successfully treated with oral doxycycline.

Science.gov (United States)

Cunha, Burke A; Elyasi, Maekal; Singh, Prince; Jimada, Ismail

2018-01-01

Lyme disease may present with a variety of cardiac manifestations ranging from first degree to third degree heart block. Cardiac involvement with Lyme disease may be asymptomatic, or symptomatic. Atrioventrical conduction abnormalities are the most common manifestation of Lyme carditis. Less common, are alternating right bundle branch block (RBBB) and left bundle branch block (LBBB). We present an interesting case of a young male whose main manifestation of Lyme carditis was isolated LBBB. He also had mild Lyme myocarditis. The patient was successfully treated with oral doxycycline, and his isolated LBBB and myocarditis rapidly resolved.

Early Disseminated Lyme Disease Masquerading as Mononucleosis: A Case Report.

Science.gov (United States)

Tumminello, Richard; Glaspey, Lindsey; Bhamidipati, Anita; Sheehan, Patrick; Patel, Sundip

2017-12-01

Disseminated Lyme disease can be difficult to diagnose, as it begins with nonspecific signs and symptoms, which, if not treated correctly, can lead to atrioventricular conduction blocks and meningitis. In addition, the diagnosis can be further complicated by potentially false-positive test results. We report a case of early-disseminated Lyme disease presenting with Borrelia meningitis and concomitant Lyme carditis, which was misdiagnosed as mononucleosis. A young, previously healthy patient had been hiking in the woods of upstate New York and 4 weeks later developed fever, night sweats, and myalgias. He was diagnosed with mononucleosis via a positive rapid heterophile agglutination antibody test to the Epstein-Barr virus at a walk-in clinic and was started on medications, but then subsequently developed left hip pain, a facial droop, and a very long first-degree atrioventricular conduction block. He went to the Emergency Department, where he had testing that confirmed disseminated Lyme disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the difficulty in early diagnosis of disseminated Lyme disease and how a potentially false-positive laboratory test can lead to the complications of Borrelia meningitis and Lyme carditis in untreated young healthy patients. Emergency physicians need to consider Lyme disease in patients with nonspecific signs and symptoms, especially if they have been outdoors for prolonged periods of time in Lyme-endemic areas. Copyright © 2017 Elsevier Inc. All rights reserved.

[Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block].

Science.gov (United States)

del Fresno Cañiaveras, J; Campos, A; Galiana, M; Navarro-Martínez, J A; Company, R

2008-11-01

To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

Clinical predictors of challenging atrioventricular node ablation procedure for rate control in patients with atrial fibrillation.

Science.gov (United States)

Polin, Baptiste; Behar, Nathalie; Galand, Vincent; Auffret, Vincent; Behaghel, Albin; Pavin, Dominique; Daubert, Jean-Claude; Mabo, Philippe; Leclercq, Christophe; Martins, Raphael P

2017-10-15

Atrioventricular node (AVN) ablation is usually a simple procedure but may sometimes be challenging. We aimed at identifying pre-procedural clinical predictors of challenging AVN ablation. Patients referred for AVN ablation from 2009 to 2015 were retrospectively included. Baseline clinical data, procedural variables and outcomes of AVN ablation were collected. A "challenging procedure" was defined 1) total radiofrequency delivery to get persistent AVN block≥400s, 2) need for left-sided arterial approach or 3) failure to obtain AVN ablation. 200 patients were included (71±10years). A total of 37 (18.5%) patients had "challenging" procedures (including 9 failures, 4.5%), while 163 (81.5%) had "non-challenging" ablations. In multivariable analysis, male sex (Odds ratio (OR)=4.66, 95% confidence interval (CI): 1.74-12.46), body mass index (BMI, OR=1.08 per 1kg/m 2 , 95%CI 1.01-1.16), operator experience (OR=0.40, 95%CI 0.17-0.94), and moderate-to-severe tricuspid regurgitation (TR, OR=3.65, 95%CI 1.63-8.15) were significant predictors of "challenging" ablations. The proportion as a function of number of predictors was analyzed (from 0 to 4, including male sex, operator inexperience, a BMI>23.5kg/m 2 and moderate-to-severe TR). There was a gradual increase in the risk of "challenging" procedure with the number of predictors by patient (No predictor: 0%; 1 predictor: 6.3%; 2 predictors: 16.5%; 3 predictors: 32.5%; 4 predictors: 77.8%). Operator experience, male sex, higher BMI and the degree of TR were independent predictors of "challenging" AVN ablation procedure. The risk increases with the number of predictors by patient. Copyright © 2017. Published by Elsevier B.V.

An efficient, block-by-block algorithm for inverting a block tridiagonal, nearly block Toeplitz matrix

International Nuclear Information System (INIS)

Reuter, Matthew G; Hill, Judith C

2012-01-01

We present an algorithm for computing any block of the inverse of a block tridiagonal, nearly block Toeplitz matrix (defined as a block tridiagonal matrix with a small number of deviations from the purely block Toeplitz structure). By exploiting both the block tridiagonal and the nearly block Toeplitz structures, this method scales independently of the total number of blocks in the matrix and linearly with the number of deviations. Numerical studies demonstrate this scaling and the advantages of our method over alternatives.

Work improvement by computerizing the process of shielding block production

International Nuclear Information System (INIS)

Kang, Dong Hyuk; Jeong, Do Hyeong; Kang, Dong Yoon; Jeon, Young Gung; Hwang, Jae Woong

2013-01-01

Introducing CR (Computed Radiography) system created a process of printing therapy irradiation images and converting the degree of enlargement. This is to increase job efficiency and contribute to work improvement using a computerized method with home grown software to simplify this process, work efficiency. Microsoft EXCEL (ver. 2007) and VISUAL BASIC (ver. 6.0) have been used to make the software. A window for each shield block was designed to enter patients' treatment information. Distances on the digital images were measured, the measured data were entered to the Excel program to calculate the degree of enlargement, and printouts were produced to manufacture shield blocks. By computerizing the existing method with this program, the degree of enlargement can easily be calculated and patients' treatment information can be entered into the printouts by using macro function. As a result, errors in calculation which may occur during the process of production or errors that the treatment information may be delivered wrongly can be reduced. In addition, with the simplification of the conversion process of the degree of enlargement, no copy machine was needed, which resulted in the reduction of use of paper. Works have been improved by computerizing the process of block production and applying it to practice which would simplify the existing method. This software can apply to and improve the actual conditions of each hospital in various ways using various features of EXCEL and VISUAL BASIC which has already been proven and used widely

Work improvement by computerizing the process of shielding block production

Energy Technology Data Exchange (ETDEWEB)

Kang, Dong Hyuk; Jeong, Do Hyeong; Kang, Dong Yoon; Jeon, Young Gung; Hwang, Jae Woong [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of)

2013-09-15

Introducing CR (Computed Radiography) system created a process of printing therapy irradiation images and converting the degree of enlargement. This is to increase job efficiency and contribute to work improvement using a computerized method with home grown software to simplify this process, work efficiency. Microsoft EXCEL (ver. 2007) and VISUAL BASIC (ver. 6.0) have been used to make the software. A window for each shield block was designed to enter patients' treatment information. Distances on the digital images were measured, the measured data were entered to the Excel program to calculate the degree of enlargement, and printouts were produced to manufacture shield blocks. By computerizing the existing method with this program, the degree of enlargement can easily be calculated and patients' treatment information can be entered into the printouts by using macro function. As a result, errors in calculation which may occur during the process of production or errors that the treatment information may be delivered wrongly can be reduced. In addition, with the simplification of the conversion process of the degree of enlargement, no copy machine was needed, which resulted in the reduction of use of paper. Works have been improved by computerizing the process of block production and applying it to practice which would simplify the existing method. This software can apply to and improve the actual conditions of each hospital in various ways using various features of EXCEL and VISUAL BASIC which has already been proven and used widely.

Innovative Antiarrhythmic Strategies in the Chronic Atrioventricular Block Dog

NARCIS (Netherlands)

Bossu, Alexandre

2017-01-01

Sudden cardiac death represents a major cause of mortality in Western countries and is often caused by ventricular fibrillation. This life-threatening arrhythmia can occur upon maladaptive cardiac remodelling like in heart failure, or can be favoured by drug-induced adverse effects such as Torsade

Irregular conformal block, spectral curve and flow equations

International Nuclear Information System (INIS)

Choi, Sang Kwan; Rim, Chaiho; Zhang, Hong

2016-01-01

Irregular conformal block is motivated by the Argyres-Douglas type of N=2 super conformal gauge theory. We investigate the classical/NS limit of irregular conformal block using the spectral curve on a Riemann surface with irregular punctures, which is equivalent to the loop equation of irregular matrix model. The spectral curve is reduced to the second order (Virasoro symmetry, SU(2) for the gauge theory) and third order (W_3 symmetry, SU(3)) differential equations of a polynomial with finite degree. The conformal and W symmetry generate the flow equations in the spectral curve and determine the irregular conformal block, hence the partition function of the Argyres-Douglas theory ala AGT conjecture.

A result-driven minimum blocking method for PageRank parallel computing

Science.gov (United States)

Tao, Wan; Liu, Tao; Yu, Wei; Huang, Gan

2017-01-01

Matrix blocking is a common method for improving computational efficiency of PageRank, but the blocking rules are hard to be determined, and the following calculation is complicated. In tackling these problems, we propose a minimum blocking method driven by result needs to accomplish a parallel implementation of PageRank algorithm. The minimum blocking just stores the element which is necessary for the result matrix. In return, the following calculation becomes simple and the consumption of the I/O transmission is cut down. We do experiments on several matrixes of different data size and different sparsity degree. The results show that the proposed method has better computational efficiency than traditional blocking methods.

Life-threatening Arrhythmias in a Becker Muscular Dystrophy Family due to the Duplication of Exons 3-4 of the Dystrophin Gene.

Science.gov (United States)

Ishizaki, Masatoshi; Fujimoto, Akiko; Ueyama, Hidetsugu; Nishida, Yasuto; Imamura, Shigehiro; Uchino, Makoto; Ando, Yukio

2015-01-01

We herein present a report of three patients with Becker muscular dystrophy in the same family who developed complete atrioventricular block or ventricular tachycardia with severe cardiomyopathy. Our cases became unable to walk in their teens, and were introduced to mechanical ventilation due to respiratory muscle weakness in their twenties and thirties. In all three cases, a medical device such as a permanent cardiac pacemaker or an implantable cardiac defibrillator was considered to be necessary. The duplication of exons 3-4 in the dystrophin gene was detected in two of the patients. In patients with Becker muscular dystrophy, complete atrioventricular block or ventricular tachycardia within a family has rarely been reported. Thus attention should be paid to the possibility of severe arrhythmias in the severe phenotype of Becker muscular dystrophy.

Echocardiographic estimation of acute haemodynamic response during optimization of multisite pace-maker using different pacing modalities and atrioventricular delays

Directory of Open Access Journals (Sweden)

Šalinger-Martinović Sonja

2009-01-01

Full Text Available Background/Aim. Cardiac resynchronization therapy (CRT improves ventricular dyssynchrony and is associated with an improvement in symptoms, quality of life and prognosis in patients with severe heart failure and intraventricular conduction delay. Different pacing modalities produce variable activation patterns and may be a cause of different haemodynamic changes. The aim of our study was to investigate acute haemodynamic changes with different CRT configurations during optimization procedure. Methods. This study included 30 patients with severe left ventricular systolic dysfunction and left bundle branch block with wide QRS (EF 24.33 ± 3.7%, QRS 159 ± 17.3 ms, New York Heart Association III/IV 25/5 with implanted CRT device. The whole group of patients had severe mitral regurgitation in order to measure dP/dt. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left and right ventricular pre-ejection intervals (LVPEI and RVPEI, interventricular mechanical delay (IVD and the maximal rate of ventricular pressure rise during early systole (max dP/dt were measured during left and biventricular pacing with three different atrioventricular (AV delays. Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 170.5 ± 24.6 to 145.9 ± 9.5 (p < 0.001, RVPEI from 102.4 ± 15.9 to 119.8 ± 10.9 (p < 0.001, IVD from 68.1 ± 18.3 to 26.5 ± 8.2 (p < 0.001 and dP/dt from 524.2 ± 67 to 678.2 ± 88.5 (p < 0.01. Conclusion. In patients receiving CRT echocardiographic assessment of the acute haemodynamic response to CRT is a useful tool in optimization procedure. The variability of Doppler parameters with different CRT modalities emphasizes the necessity of individualized approach in optimization procedure.

Long-Term Effects of Atrial Ganglionated Plexi Ablation on Function and Structure of Sinoatrial and Atrioventricular Node in Canine.

Science.gov (United States)

Zhang, Ming; Wang, Ximin; Xie, Xinxing; Wang, Zhongsu; Liu, Xiaoyan; Guan, Juan; Wang, Weizong; Li, Zhan; Wang, Jiangrong; Gao, Mei; Hou, Yinglong

2015-10-01

Long-term effects of ganglionated plexi (GP) ablation on sinoatrial node (SAN) and atrioventricular node (AVN) remain unclear. This study is to investigate the long-term effects of ablation of cardiac anterior right GP (ARGP) and inferior right GP (IRGP) on function and structure of SAN and AVN in canine. Thirty-two dogs were randomly divided into an operated group (n = 24) and sham-operated group (n = 8). ARGP and IRGP were ablated in operated group which was randomly divided into three subgroups according to the period of evaluation after operation (1 month, 6 months, 12 months). The functional and histological characteristics of SAN and AVN, as well as the expression of connexin (Cx) 43 and Cx 45 in SAN and AVN, were evaluated before and after ablation. Resting heart rate was increased and AVN effective refractory period was prolonged and sinus node recovery time (SNRT) and corrected SNRT were shortened immediately after ablation. These changes were reverted to preablation level after 1 month. At 1 month, ventricular rate during atrial fibrillation was slowed, atria-His intervals were prolonged, and Cx43 and Cx45 expression in SAN and AVN were downregulated. At 6 months, all changes were reverted to preablation level. The histological characteristics of SAN and AVN did not change. Ablation of ARGP and IRGP has short-term effects on function and structure of SAN and AVN rather than long-term effects, which suggests that ablation of ARGP and IRGP is safe. Atrioventricular conduction dysfunction after ablation may be related to downregulated Cx43 and Cx45 expression in AVN. © 2015 Wiley Periodicals, Inc.

HAND2 Target Gene Regulatory Networks Control Atrioventricular Canal and Cardiac Valve Development.

Science.gov (United States)

Laurent, Frédéric; Girdziusaite, Ausra; Gamart, Julie; Barozzi, Iros; Osterwalder, Marco; Akiyama, Jennifer A; Lincoln, Joy; Lopez-Rios, Javier; Visel, Axel; Zuniga, Aimée; Zeller, Rolf

2017-05-23

The HAND2 transcriptional regulator controls cardiac development, and we uncover additional essential functions in the endothelial to mesenchymal transition (EMT) underlying cardiac cushion development in the atrioventricular canal (AVC). In Hand2-deficient mouse embryos, the EMT underlying AVC cardiac cushion formation is disrupted, and we combined ChIP-seq of embryonic hearts with transcriptome analysis of wild-type and mutants AVCs to identify the functionally relevant HAND2 target genes. The HAND2 target gene regulatory network (GRN) includes most genes with known functions in EMT processes and AVC cardiac cushion formation. One of these is Snai1, an EMT master regulator whose expression is lost from Hand2-deficient AVCs. Re-expression of Snai1 in mutant AVC explants partially restores this EMT and mesenchymal cell migration. Furthermore, the HAND2-interacting enhancers in the Snai1 genomic landscape are active in embryonic hearts and other Snai1-expressing tissues. These results show that HAND2 directly regulates the molecular cascades initiating AVC cardiac valve development. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Effect of sympathetic nerve block on acute inflammatory pain and hyperalgesia

DEFF Research Database (Denmark)

Pedersen, J L; Rung, G W; Kehlet, H

1997-01-01

BACKGROUND: Sympathetic nerve blocks relieve pain in certain chronic pain states, but the role of the sympathetic pathways in acute pain is unclear. Thus the authors wanted to determine whether a sympathetic block could reduce acute pain and hyperalgesia after a heat injury in healthy volunteers....... The duration and quality of blocks were evaluated by the sympatogalvanic skin response and skin temperature. Bilateral heat injuries were produced on the medial surfaces of the calves with a 50 x 25 mm thermode (47 degrees C, 7 min) 45 min after the blocks. Pain intensity induced by heat, pain thresholds...... between sympathetic block and placebo for pain or mechanical allodynia during injury, or pain thresholds, pain responses to heat, or areas of secondary hyperalgesia after the injury. The comparisons were done for the period when the block was effective. CONCLUSION: Sympathetic nerve block did not change...

New micro waveforms firstly recorded on electrocardiogram in human.

Science.gov (United States)

Liu, Renguang; Chang, Qinghua; Chen, Juan

2015-10-01

In our study, not only the P-QRS-T waves but also the micro-wavelets before QRS complex (in P wave and PR segment) and after QRS complex (ST segment and upstroke of T wave) were first to be identified on surface electrocardiogram in human by the "new electrocardiogram" machine (model PHS-A10) according to conventional 12-lead electrocardiogram connection methods. By comparison to the conventional electrocardiogram in 100 cases of healthy individuals and several patients with arrhythmias, we have found that the wavelets before P wave theoretically reflected electrical activity of sinus node and the micro-wavelets before QRS complex may be related to atrioventricular conduction system (atrioventricular node, His bundle and bundle branch) potentials. Noninvasive atrioventricular node and His bundle potential tracing will contribute to differentiation of the origin of wide QRS and the location of the atrioventricular block. We also have found that the wavelets after QRS complex may be associated with phase 2 and 3 repolarization of ventricular action potential, which will further reveal ventricular repolarization changes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans.

Science.gov (United States)

Xue, Yumei; Zhan, Xianzhang; Wu, Shulin; Wang, Hongyue; Liu, Yang; Liao, Zili; Deng, Hai; Duan, Xuejing; Zeng, Shaoying; Liang, Dongpo; Elvan, Arif; Fang, Xianhong; Liao, Hongtao; Ramdat Misier, Anand R; Smit, Jaap Jan J; Metzner, Andreas; Heeger, Christian-Hendrik; Liu, Fangzhou; Wang, Feng; Zhang, Zhiwei; Kuck, Karl-Heinz; Yen Ho, Siew; Ouyang, Feifan

2017-06-01

Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication. Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months. Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients. © 2017 American Heart Association, Inc.

The Fate of the Tricuspid Valve Following the Transatrial Closure of the Ventricular Septal Defect.

Science.gov (United States)

Giordano, Raffaele; Cantinotti, Massimiliano; Di Tommaso, Luigi; Comentale, Giuseppe; Tozzi, Andrea; Pilato, Emanuele; Iannelli, Gabriele; Palma, Gaetano

2018-05-17

The transatrial repair of the ventricular septal defect (VSD) requires an adequate exposure of its rim. We retrospectively evaluated the impact of adopting the tricuspid valve incision (TVI) technique, either with detachment or radial incision, on the postoperative outcome of children undergoing surgical VSD repair. From January 2008 to September 2017 we retrospectively enrolled 141 patients, divided into two groups: 97 patients were subjected to TVI (68.8%) and 44 patients (31.2%) were not subjected to TVI. All patients received an echocardiogram upon discharge from the hospital and after 1 month, 3 months, 6 months and a year from the treatment. No perioperative or late deaths resulted in our dataset. TVI was associated with a slightly longer cardio-pulmonary bypass and cross-clamp time but there were no differences in the surgical outcome between the two groups. Moreover, no differences occurred concerning residual VSD, atrioventricular block or tricuspid regurgitation at discharge. Echocardiograms at follow-up were available for 134 patients (95%) with a median of 5.3 years (range 0.5-9.3) and the degree of tricuspid regurgitation did not differ between groups. No patient required reoperation for tricuspid regurgitation or residual interventricular shunt. Finally, no difference was found even when comparing the two TVI subgroups. TVI should be used whenever intraoperative exposure of VSD is compromised in order to avoid a residual shunt and atrioventricular block. Here we show that this procedure does not significantly compromise the tricuspid function although a large, multicenter, randomized controlled trial is advised to validate this hypothesis. Copyright © 2018. Published by Elsevier Inc.

Counting equations in algebraic attacks on block ciphers

DEFF Research Database (Denmark)

Knudsen, Lars Ramkilde; Miolane, Charlotte Vikkelsø

2010-01-01

This paper is about counting linearly independent equations for so-called algebraic attacks on block ciphers. The basic idea behind many of these approaches, e.g., XL, is to generate a large set of equations from an initial set of equations by multiplication of existing equations by the variables...... in the system. One of the most difficult tasks is to determine the exact number of linearly independent equations one obtain in the attacks. In this paper, it is shown that by splitting the equations defined over a block cipher (an SP-network) into two sets, one can determine the exact number of linearly...... independent equations which can be generated in algebraic attacks within each of these sets of a certain degree. While this does not give us a direct formula for the success of algebraic attacks on block ciphers, it gives some interesting bounds on the number of equations one can obtain from a given block...

Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects.

Science.gov (United States)

Calkoen, Emmeline E; Elbaz, Mohammed S M; Westenberg, Jos J M; Kroft, Lucia J M; Hazekamp, Mark G; Roest, Arno A W; van der Geest, Rob J

2015-11-01

During normal left ventricular (LV) filling, a vortex ring structure is formed distal to the left atrioventricular valve (LAVV). Vortex structures contribute to efficient flow organization. We aimed to investigate whether LAVV abnormality in patients with a corrected atrioventricular septal defect (AVSD) has an impact on vortex ring formation. Whole-heart 4D flow MRI was performed in 32 patients (age: 26 ± 12 years), and 30 healthy subjects (age: 25 ± 14 years). Vortex ring cores were detected at peak early (E-peak) and peak late filling (A-peak). When present, the 3-dimensional position and orientation of the vortex ring was defined, and the circularity index was calculated. Through-plane flow over the LAVV, and the vortex formation time (VFT), were quantified to analyze the relationship of vortex flow with the inflow jet. Absence of a vortex ring during E-peak (healthy subjects 0%, vs patients 19%; P = .015), and A-peak (healthy subjects 10% vs patients 44%; P = .008) was more frequent in patients. In 4 patients, this was accompanied by a high VFT (5.1-7.8 vs 2.4 ± 0.6 in healthy subjects), and in another 2 patients with abnormal valve anatomy. In patients compared with controls, the vortex cores had a more-anterior and apical position, closer to the ventricular wall, with a more-elliptical shape and oblique orientation. The shape of the vortex core closely resembled the valve shape, and its orientation was related to the LV inflow direction. This study quantitatively shows the influence of abnormal LAVV and LV inflow on 3D vortex ring formation during LV inflow in patients with corrected AVSD, compared with healthy subjects. Copyright © 2015. Published by Elsevier Inc.

Early and late arrhythmogenic effects of doxorubicin.

Science.gov (United States)

Kilickap, Saadettin; Barista, Ibrahim; Akgul, Ebru; Aytemir, Kudret; Aksoy, Sercan; Tekuzman, Gulten

2007-03-01

To determine the incidence of early and late arrhythmogenic effects of doxorubicin-containing chemotherapy regimens. A prospective study including 29 patients who were treated with doxorubicin-containing regimens. Cardiac evaluation was based on 24-hour electrocardiographic monitorization (Holter), which was performed during the first cycle of doxorubicin-containing regimens, as well as after the last cycle of chemotherapy. The mean age of the patients was 45.8 +/- 15.1 (range 18-69). Holter records obtained during the first cycle of treatment revealed varying arrhythmias in 19 patients (65.5%) and in 18 (62.1%) patients after completion of therapy. One patient presented with syncope and both Mobitz Type 2 atrioventricular block and complete atrioventricular block were demonstrated. The patient subsequently underwent permanent pacemaker implantation. Doxorubicin may result in arrhythmias both in early and late periods of treatment. These arrhythmias are rarely life threatening.

Isotopic cardiac pacemaker during pregnancy. Three cases

International Nuclear Information System (INIS)

Laurens, P.; Gavelle, P.; Maurice, P.; Haiat, R.; Chiche, P.

1976-01-01

Three cases of full term pregnancies, without complications, in women with isotopic pacemakers are reported. The newborn infants were normal. In one case, pregnancy occurred in a patient who already had a pacemaker. In two cases, the pacemaker was inserted during pregnancy (at 1 and 1/2 and 5 months respectively), in the treatment of syncopal attacks due to paroxysmal atrioventricular block. This type of pacemaker using a radioactive source (plutonium 238) is, by virtue of the low degree of radiation, harmless and may be used in women of childbearing age. Under the least favourable conditions (pacemaker box in abdominal situation), the dose delivered during pregnancy (57 mrem) is approximately 20 times less than the authorized dose (1125 mrem) [fr

Intra prediction using face continuity in 360-degree video coding

Science.gov (United States)

Hanhart, Philippe; He, Yuwen; Ye, Yan

2017-09-01

This paper presents a new reference sample derivation method for intra prediction in 360-degree video coding. Unlike the conventional reference sample derivation method for 2D video coding, which uses the samples located directly above and on the left of the current block, the proposed method considers the spherical nature of 360-degree video when deriving reference samples located outside the current face to which the block belongs, and derives reference samples that are geometric neighbors on the sphere. The proposed reference sample derivation method was implemented in the Joint Exploration Model 3.0 (JEM-3.0) for the cubemap projection format. Simulation results for the all intra configuration show that, when compared with the conventional reference sample derivation method, the proposed method gives, on average, luma BD-rate reduction of 0.3% in terms of the weighted spherical PSNR (WS-PSNR) and spherical PSNR (SPSNR) metrics.

Right heart failure due to loss of right ventricular capture in a patient with atrioventricular junction ablation and biventricular pacing.

Science.gov (United States)

Raffa, Santi; Fantoni, Cecilia; Restauri, Luigia; Auricchio, Angelo

2005-10-01

We describe the case of a patient with atrioventricular (AV) junction ablation and chronic biventricular pacing in which intermittent dysfunction of the right ventricular (RV) lead resulted in left ventricular (LV) stimulation alone and onset of severe right heart failure. Restoration of biventricular pacing by increasing device output and then performing lead revision resolved the issue. This case provides evidence that LV pacing alone in patients with AV junction ablation may lead to severe right heart failure, most likely as a result of iatrogenic mechanical dyssynchrony within the RV. Thus, probably this pacing mode should be avoided in pacemaker-dependent patients with heart failure.

Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block.

Science.gov (United States)

Lee, T H W; Barrington, M J; Tran, T M N; Wong, D; Hebbard, P D

2010-05-01

Transversus abdominis plane block provides postoperative analgesia following abdominal surgery by targeting thoracolumbar nerves between the internal oblique and transversus abdominis muscles. Posterior and subcostal approaches using ultrasound guidance have been described. However there have been inconsistent results in relation to the extent of the sensory block. This observational study evaluated the distributions of sensory block following either a posterior or subcostal approach and the quality of analgesia achieved. Following ethics committee approval, 50 patients undergoing minimally invasive and major abdominal surgery were recruited. A total of 81 transversus abdominis plane blocks were performed preoperatively under real-time ultrasound guidance. Postoperatively, patients received multimodal analgesia including morphine via patient-controlled pumps. Ninety-eight percent of patients had some degree of demonstrable sensory block and the dermatomal spread differed between posterior and subcostal approaches (P interquartile range 2 to 4), the most cephalad being T10 (interquartile range T9 to T10), while the subcostal approach blocked a median of four segments (interquartile range 3 to 5), the most cephalad being T8 (interquartile range T7 to T9, P interquartile range 17 to 50 mg) at 24 hours. Median pain scores at rest and with coughing were 20 (interquartile range 10 to 35) and 50 (interquartile range 29 to 67) respectively at 24 hours. The posterior approach appears to be more appropriate for lower abdominal surgery and the subcostal approach better suited to upper abdominal surgery. Whichever approach is used, transversus abdominis plane block is only one component of a multimodal analgesic technique.

Endomiocardiofibrose: resultados do tratamento cirúrgico com conservação das valvas atrioventriculares Endomyocardial fibrosis: results of the surgical treatment with atrioventricular valve preservation

Directory of Open Access Journals (Sweden)

Sérgio Almeida de Oliveira

1991-04-01

Full Text Available Entre abril de 1988 e janeiro de 1991, foram operados 25 pacientes consecutivos, para correção de endomiocardiofibrose, com técnica conservadora das valvas atrioventriculares. Dezenove pacientes eram do sexo feminino e seis do masculino. As idades variaram de 11 a 59 anos, com média de 40,6 anos. Dezesete pacientes apresentavam acometimento biventricular, seis com comprometimento do ventrículo esquerdo e apenas dois pacientes com lesão isolada do ventrículo direito. Todos estavam em grupos avançados de insuficiência cardíaca, sendo 19 em grupo IV da NYHA e seis no grupo III. No pré-operatório, 24 apresentavam insuficiência da valva tricúspide e 22 apresentavam insuficiência da valva mitral. Todos os pacientes foram operados com o auxílio de circulação extracorpórea e hipotermia sistêmica de 28ºC e pinçamento aórtico intermitente, para melhor exposição das cavidades ventriculares. A fibrose ventricular direita foi sempre ressecada através da valva tricúspide, enquanto que a fibrose do ventrículo esquerdo foi removida através de pequena ventriculotomia esquerda apical. Em todos os pacientes com insuficiência tricúspide, foi feita plástica anular do tipo DeVega. Dos pacientes com insuficiência mitral, sete tiveram correção espontânea após a ressecção da fibrose, e os outros 15 receberam anuloplastia. Houve apenas um (4% óbito no pós-operatório imediato e nenhum óbito tardio. A recuperação funcional foi boa, estando atualmente 16 pacientes em grupo funcional I e 8 em grupo II.Between April 1988 and January 1991 we operated on 25 consecutive patients with endomyocardial fibrosis (EMF with an approach to preserve the atrioventricular valves. Nineteen patients were females and six males. Their ages ranged from 11 to 5 years, with an average of 40.6 years. Seventeen patients had biventricular involvement, six had involvement of the left ventricle and only two patients had an isolated lesion of the right

Effect of preemptive nerve block on inflammation and hyperalgesia after human thermal injury

DEFF Research Database (Denmark)

Pedersen, J L; Crawford, M E; Dahl, J B

1996-01-01

compared to the opposite unblocked leg for 12 h after bilateral thermal injuries (15 x 25 mm, 49 degrees C for 5 min) in 20 healthy volunteers. Recovery from the block was identified by return of sensation to cold. RESULTS: Six subjects were excluded because of insufficient initial block (2 subjects......) or because the block lasted beyond the study period (4 subjects). The remaining 14 subjects experienced significantly reduced primary (P = 0.005) and secondary hyperplasia (P = 0.01) in the blocked leg after return of cold sensation compared to the unblocked leg. Erythema intensity and blister formation were...

Deleterious acute and chronic effects of bradycardic right ventricular apex pacing : consequences for arrhythmic outcome

NARCIS (Netherlands)

Stams, Thom R G; Dunnink, A; van Everdingen, W M; Beekman, H D M; van der Nagel, R.; Kok, B.; Bierhuizen, M F A; Cramer, M J; Meine, M; Vos, M A

In the chronic complete atrioventricular (AV) block dog (CAVB) model, both bradycardia and altered ventricular activation due to the uncontrolled idioventricular rhythm contribute to ventricular remodeling and the enhanced susceptibility to Torsade de Pointes (TdP) arrhythmias. We investigated the

Solid-phase route to Fmoc-protected cationic amino acid building blocks

DEFF Research Database (Denmark)

Clausen, Jacob Dahlqvist; Linderoth, Lars; Nielsen, Hanne Mørck

2012-01-01

Diamino acids are commonly found in bioactive compounds, yet only few are commercially available as building blocks for solid-phase peptide synthesis. In the present work a convenient, inexpensive route to multiple-charged amino acid building blocks with varying degree of hydrophobicity...... was developed. A versatile solid-phase protocol leading to selectively protected amino alcohol intermediates was followed by oxidation to yield the desired di- or polycationic amino acid building blocks in gram-scale amounts. The synthetic sequence comprises loading of (S)-1-(p-nosyl)aziridine-2-methanol onto...... of simple neutral amino acids as well as analogs displaying high bulkiness or polycationic side chains was prepared. Two building blocks were incorporated into peptide sequences using microwave-assisted solid-phase peptide synthesis confirming their general utility....

UV Blocking Glass: Low Cost Filters for Visible Light Photocatalytic Assessment

OpenAIRE

Dunnill, Charles W.

2014-01-01

A number of commercially available art protection products have been compared and assessed for their suitability as UV blocking filters in the application of “visible light” photocatalytic research. Many groups claiming visible light photocatalytic success employ filters to block out stray UV radiation in order to justify that their photocatalysts are indeed visible light photocatalysts and not UV light photocatalysts. These filters come in varying degrees of ability and price and many author...

Investigation of a new thermosensitive block copolymer micelle: hydrolysis, disruption, and release.

Science.gov (United States)

Pelletier, Maxime; Babin, Jérôme; Tremblay, Luc; Zhao, Yue

2008-11-04

Thermosensitive polymer micelles are generally obtained with block copolymers in which one block exhibits a lower critical solution temperature in aqueous solution. We investigate a different design that is based on the use of one block bearing a thermally labile side group, whose hydrolysis upon heating shifts the hydrophilic-hydrophobic balance toward the destabilization of block copolymer micelles. Atom transfer radical polymerization was utilized to synthesize a series of diblock copolymers composed of hydrophilic poly(ethylene oxide) (PEO) and hydrophobic poly(2-tetrahydropyranyl methacrylate) (PTHPMA). We show that micelles of PEO-b-PTHPMA in aqueous solution can be destabilized as a result of the thermosensitive hydrolytic cleavage of tetrahydropyranyl (THP) groups that transforms PTHPMA into hydrophilic poly(methacrylic acid). The three related processes occurring in aqueous solution, namely, hydrolytic cleavage of THP, destabilization of micelles, and release of loaded Nile Red (NR), were investigated simultaneously using 1H NMR, dynamic light scattering, and fluorescence spectroscopy, respectively. At 80 degrees C, the results suggest that the three events proceed with a similar kinetics. Although slower than at elevated temperatures, the disruption of PEO-b-PTHPMA micelles can take place at the body temperature (approximately 37 degrees C), and the release kinetics of NR can be adjusted by changing the relative lengths of the two blocks or the pH of the solution.

Nitric oxide synthase-3 promotes embryonic development of atrioventricular valves.

Directory of Open Access Journals (Sweden)

Yin Liu

Full Text Available Nitric oxide synthase-3 (NOS3 has recently been shown to promote endothelial-to-mesenchymal transition (EndMT in the developing atrioventricular (AV canal. The present study was aimed to investigate the role of NOS3 in embryonic development of AV valves. We hypothesized that NOS3 promotes embryonic development of AV valves via EndMT. To test this hypothesis, morphological and functional analysis of AV valves were performed in wild-type (WT and NOS3(-/- mice at postnatal day 0. Our data show that the overall size and length of mitral and tricuspid valves were decreased in NOS3(-/- compared with WT mice. Echocardiographic assessment showed significant regurgitation of mitral and tricuspid valves during systole in NOS3(-/- mice. These phenotypes were all rescued by cardiac specific NOS3 overexpression. To assess EndMT, immunostaining of Snail1 was performed in the embryonic heart. Both total mesenchymal and Snail1(+ cells in the AV cushion were decreased in NOS3(-/- compared with WT mice at E10.5 and E12.5, which was completely restored by cardiac specific NOS3 overexpression. In cultured embryonic hearts, NOS3 promoted transforming growth factor (TGFβ, bone morphogenetic protein (BMP2 and Snail1expression through cGMP. Furthermore, mesenchymal cell formation and migration from cultured AV cushion explants were decreased in the NOS3(-/- compared with WT mice. We conclude that NOS3 promotes AV valve formation during embryonic heart development and deficiency in NOS3 results in AV valve insufficiency.

Rest thallium-201 myocardial perfusion imaging in a patient with leukaemic infiltration of the heart

International Nuclear Information System (INIS)

Civelek, A.C.; Camargo, E.E.; Links, J.M.; Brinker, J.A.; Wagner, H.N. Jr.

1992-01-01

Despite the high incidence of leukaemic infiltration of the heart, only 8 cases of atrioventricular block due to leukemia have been reported in the literature. Improvement in the heart block associated with disappearance of the leukaemic infiltrate has not been reported. A rest thallium-201 study was used in a 65-year-old man to demonstrate leukaemic infiltration of the heart which was associated with complete heart block. After chemotherapy, when the tumour burden was reduced and the leukaemia in remission, his heart block resolved, and a follow-up thallium scan was normal. (orig.)

Proarrhythmic electrical remodelling is associated with increased beat-to-beat variability of repolarisation

DEFF Research Database (Denmark)

Thomsen, Morten Bækgaard; Oros, Avram; Schoenmakers, Marieke

2007-01-01

Acquired long-QT syndrome in combination with increased beat-to-beat variability of repolarisation duration (BVR) is associated with lethal torsades de pointes arrhythmias (TdP) in dogs with remodelled heart after atrioventricular block (AVB). We evaluated the relative contributions of bradycardi...

Feasibility of pacemaker therapy after dynamic cardiomyoplasty

NARCIS (Netherlands)

Van den Berg, MP; Nagelkerke, D; Brouwer, RMHJ; Mulder, H; De Boer, H; Crijns, HJGM

1999-01-01

A 54-year-old man presented with total atrioventricular (AV) block 3 months after dynamic cardiomyoplasty was performed because of heart failure due to idiopathic dilated cardiomyopathy. Though the cardiomyostimulator acted as a back-up pacemaker, a DDDR pacemaker was implanted to optimize

Controlling light oxidation flavor in milk by blocking riboflavin excitation wavelengths by interference.

Science.gov (United States)

Webster, J B; Duncan, S E; Marcy, J E; O'Keefe, S F

2009-01-01

Milk packaged in glass bottles overwrapped with iridescent films (treatments blocked either a single visible riboflavin [Rb] excitation wavelength or all visible Rb excitation wavelengths; all treatments blocked UV Rb excitation wavelengths) was exposed to fluorescent lighting at 4 degrees C for up to 21 d and evaluated for light-oxidized flavor. Controls consisted of bottles with no overwrap (light-exposed treatment; represents the light barrier properties of the glass packaging) and bottles overwrapped with aluminum foil (light-protected treatment). A balanced incomplete block multi-sample difference test, using a ranking system and a trained panel, was used for evaluation of light oxidation flavor intensity. Volatiles were evaluated by gas chromatography and Rb degradation was evaluated by fluorescence spectroscopy. Packaging overwraps limited production of light oxidation flavor over time but not to the same degree as the complete light block. Blocking all visible and UV Rb excitation wavelengths reduced light oxidation flavor better than blocking only a single visible excitation wavelength plus all UV excitation wavelengths. Rb degraded over time in all treatments except the light-protected control treatment and only minor differences in the amount of degradation among treatments was observed. Hexanal production was significantly higher in the light-exposed control treatment compared to the light-protected control treatment from day 7; it was only sporadically significantly higher in the 570 nm and 400 nm block treatments. Pentanal, heptanal, and an unidentified volatile compound also increased in concentration over time, but there were no significant differences in concentration among the packaging overwrap treatments for these compounds.

Deformation and velocity measurements at elevated temperature in a fractured 0.5 M block of tuff

International Nuclear Information System (INIS)

Blair, S.C.; Berge, P.A.

1996-01-01

This paper presents preliminary results of laboratory tests conducted on small block samples of Topopah Spring tuff, in support of the Yucca Mountain Site Characterization Project. The overall objective of these tests is to investigate the thermal-mechanical, thermal-hydrological, and thermal-chemical response of the rock to conditions similar to the near-field environment (NFE) of a potential nuclear waste repository. We present preliminary results of deformation and elastic wave velocity measurements on a 0.5-m-scale block of Topopah Spring tuff tested in uniaxial compression to 8.5 MPa and at temperatures to 85 degree C. The Young's modulus was found to be about 7 to 31 GPa for vertical measurements parallel to the stress direction across parts of the block containing no fractures or a few fractures, and 0.5 to 0.9 GPA for measurements across individual fractures, at ambient temperature and 8.5 MPa maximum stress. During stress cycles between 5 and 8.5 MPa, the deformation modulus values for the matrix with fractures were near 15-20 GPa at ambient temperature but dropped to about 10 GPa at 85 degree C. Compressional wave velocities were found to be about 3.6 to 4.7 km/s at ambient temperature and stress. After the stress was cycled, velocities dropped to values as low as 2.6 km/s in the south end of the block where vertical cracks developed. Heating the block to about 85 degree C raised velocities to as much as 5.6 km/s in the upper third of the block

Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels?

Directory of Open Access Journals (Sweden)

Cernica Daniel

2017-09-01

Full Text Available Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

Solubilization of Phenol Derivatives in Polymer Micelles Formed by Cationic Block Copolymer

Directory of Open Access Journals (Sweden)

Irma Fuentes

2017-01-01

Full Text Available The aggregation of cationic block copolymers formed by polystyrene (PS and poly(ethyl-4-vinylpyridine (PS-b-PE4VP was studied in aqueous solution. Diblock copolymers of PS and poly(4-vinylpyridine were synthesized by sequential anionic polymerization using BuLi as initiator. Subsequently, the 4-vinylpyridine units were quaternized with ethyl bromide to obtain cationic PS-b-PE4VP block copolymers with different quaternization degree. The self-aggregation of cationic block copolymers was studied by fluorescence probing, whereas the morphology and size of polymer micelles were determined by transmission electronic microscopy. Results indicate that spherical micelles with sizes lower than 100 nm were formed, whereas their micropolarity decreases with increasing quaternization degree. The partition of phenols between the micellar and aqueous phase was studied by using the pseudo-phase model, and the results show that the partition coefficients increase with increasing length of the side alkyl chain and are larger for star micelles. These results are discussed in terms of three-region model.

Pacemaker dependency after transcatheter aortic valve implantation with the self-expanding Medtronic CoreValve System.

Science.gov (United States)

van der Boon, Robert M A; Van Mieghem, Nicolas M; Theuns, Dominic A; Nuis, Rutger-Jan; Nauta, Sjoerd T; Serruys, Patrick W; Jordaens, Luc; van Domburg, Ron T; de Jaegere, Peter P T

2013-09-30

To determine pacemaker (PM) dependency at follow-up visit in patients who underwent new permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI). Single center prospective observational study including 167 patients without previous PM implantation who underwent TAVI with the self-expanding Medtronic CoreValve System (MCS) between November 2005 and February 2011. PM dependency was defined by the presence of a high degree atrioventricular block (HDAVB; second [AV2] and third degree [AV3B]), or a slow (atrial fibrilation with slow response (n=1, 2.8%) and left bundle branch block (n=1, 2.8%). Long term follow-up was complete for all patients and ranged from 1 to 40 months (median (IQR): 11.5 (5.0-18.0 months). Of those patients with a HDAVB, 16 out of the 30 patients (53.3%) were PM independent at follow-up visit (complete or partial resolution of the AV conduction abnormality). Overall, 20 out of the 36 patients (55.6%) who received a new PM following TAVI were PM independent at follow-up. Partial and even complete resolution of peri-operative AV conduction abnormalities after MCS valve implantation occurred in more than half of the patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Cardiovascular adaptations to marathon running : the marathoner's heart.

Science.gov (United States)

Thompson, Paul D

2007-01-01

Endurance exercise training produces a series of cardiac adaptations including resting bradycardia, first and second degree atrioventricular block, increased intolerance to orthostatic stress, and enlargement of the left ventricular walls and of all cardiac chambers. Cardiac dimensions may be increased beyond the upper limits of normal and some endurance athletes demonstrate mild reductions in estimated left ventricular ejection fraction. Among athletes, such adaptations occur primarily in well trained endurance athletes. Clinicians should be aware of the cardiac changes accompanying endurance training to avoid unnecessary evaluation of physiological changes. On the other hand, the presence of conduction abnormalities or cardiac enlargement in low level or recreational athletes should prompt a search for pathological causes. Many of these findings were presented in the 1977 report on the marathon and have simply been better defined with subsequent studies.

Anterior celiac plexus block for interventional biliary procedures

International Nuclear Information System (INIS)

Benenati, J.F.; Widlus, D.M.; Venbrux, A.C.; Lynch-Nyhan, A.; Osterman, F.A.; Taylor, D.R.; Tewes, P.A.; Cassidy, F.P.

1989-01-01

This paper reports temporary celiac ganglion block for pain relief during biliary procedures performed without complication in 65 patients. The block was given from an anterior approach, with 30 mL of bupivacaine injected over the right T-12 pedicle. Fluoroscopy was used to guide the needle 2 cm anterior to the spine. Patients were assigned to one of three groups based on degree of anesthesia. In group 1, there was no benefit (20%); in group 2, moderate regional anesthesia (22%); and in group 3, excellent anesthesia (58%). The procedure may be performed at the start of or any time during the examination and provides satisfactory regional anesthesia in 80% of patients

Analysis of Block OMP using Block RIP

OpenAIRE

Wang, Jun; Li, Gang; Zhang, Hao; Wang, Xiqin

2011-01-01

Orthogonal matching pursuit (OMP) is a canonical greedy algorithm for sparse signal reconstruction. When the signal of interest is block sparse, i.e., it has nonzero coefficients occurring in clusters, the block version of OMP algorithm (i.e., Block OMP) outperforms the conventional OMP. In this paper, we demonstrate that a new notion of block restricted isometry property (Block RIP), which is less stringent than standard restricted isometry property (RIP), can be used for a very straightforw...

Risk prediction of ventricular arrhythmias and myocardial function in Lamin A/C mutation positive subjects

DEFF Research Database (Denmark)

Hasselberg, Nina E; Edvardsen, Thor; Petri, Helle

2014-01-01

Mutations in the Lamin A/C gene may cause atrioventricular block, supraventricular arrhythmias, ventricular arrhythmias (VA), and dilated cardiomyopathy. We aimed to explore the predictors and the mechanisms of VA in Lamin A/C mutation-positive subjects.METHODS AND RESULTS: We included 41 Lamin A/C...

Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block.

Science.gov (United States)

Costa, Roberto; Silva, Katia Regina da; Martinelli Filho, Martino; Carrillo, Roger

2017-10-01

Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

31 CFR 595.301 - Blocked account; blocked property.

Science.gov (United States)

2010-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TERRORISM SANCTIONS REGULATIONS General Definitions § 595.301 Blocked account; blocked property. The terms blocked account and blocked...

Clinical Profile and Outcome of Myocarditis in Children at Dr. Hasan Sadikin General Hospital Bandung from 2008 to 2012

Directory of Open Access Journals (Sweden)

Erza Nurtriandari

2017-03-01

Full Text Available Background: Diagnosis of myocarditis in children is still challenging due to its inconsistent and wide spectrum of clinical manifestations. There is no specific laboratory test available. This may obscure the true incidence of myocarditis. The purpose of this study was to describe clinical profile and outcome of myocarditis in children. Methods: A descriptive study was performed using 80 medical records of hospitalized pediatrics patients with myocarditis in Dr. Hasan Sadikin General Hospital Bandung from January 2008 to December 2012. The obtained data were age, gender, nutritional status, etiology, chief complaint, physical examination, laboratory findings, other examinations and outcome of the disease. The collected data were analyzed and presented in the form of frequency distribution. Results: The mean age of the patients was 91.46 (45.93 months old, predominantly male. The most etiology was dengue infections (61%. High fever was found as the most common chief complaint (38% and the most common found in physical examinations were tachypnea (65% and hepatomegaly (55%. Electrocardiography (ECG showed the first degree atrioventricular block (AV block (35%, aspartate aminotransferase (AST and creatine kinase myocardial band (CKMB was increased in more than 80% of patients. The majority of patient was improved. Shock was the common complication. Conclusions: Dengue is the most etiology of myocarditis etiology. Tachypnea, hepatomegaly, the first degree AV block in ECG, elevated AST and CKMB were the most common presentations. Most of the patients were improved during treatment.

Nerve Blocks

Science.gov (United States)

... News Physician Resources Professions Site Index A-Z Nerve Blocks A nerve block is an injection to ... the limitations of Nerve Block? What is a Nerve Block? A nerve block is an anesthetic and/ ...

HEAO Block 2 study executive summary

International Nuclear Information System (INIS)

1976-03-01

An executive summary is presented of a preliminary study done on several potential High Energy Astronomy Observatory (HEAO) missions which are follow-on missions to the currently defined HEAO program. The purpose was to examine several typical missions and determine the relative complexities associated with them. The four payloads investigated were a 1.2 m Diameter x-ray Telescope observatory, a Large Area Moderate Angular Resolution (LAMAR) observatory, a cosmic ray observatory, and (4) a gamma ray observatory. Each of the four observatories was considered a national facility. Low cost approaches were stressed throughout, with considerable use of HEAO Block I experience and designs effected to provide a high degree of confidence that such approaches were achievable. The use of the Multi-Mission Spacecraft (MMS) and the HEAO Block I spacecraft was considered as a result of this low cost emphasis. Also, NASA standard components were considered, where applicable

Ventricular fibrillation occurring after atrioventricular node ablation despite minimal difference between pre- and post-ablation heart rates.

Science.gov (United States)

Squara, F; Theodore, G; Scarlatti, D; Ferrari, E

2017-02-01

We report the case of an 82-year-old man presenting with ventricular fibrillation (VF) occurring acutely after atrioventricular node (AVN) ablation. This patient had severe valvular cardiomyopathy, chronic atrial fibrillation (AF), and underwent prior to the AVN ablation a biventricular implantable cardiac defibrillator positioning. The VF was successfully cardioverted with one external electrical shock. What makes this presentation original is that the pre-ablation spontaneous heart rate in AF was slow (84 bpm), and that VF occurred after ablation despite a minimal heart rate drop of only 14 bpm. VF is the most feared complication of AVN ablation, but it had previously only been described in case of acute heart rate drop after ablation of at least 30 bpm (and more frequently>50 bpm). This case report highlights the fact that VF may occur after AVN ablation regardless of the heart rate drop, rendering temporary fast ventricular pacing mandatory whatever the pre-ablation heart rate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

Science.gov (United States)

Xu, C S; Zhao, X L; Zhou, H B; Qu, Z J; Yang, Q G; Wang, H J; Wang, G

2017-10-17

Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n =60) and the neurostimulator-guidedgroup (group N, n =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant( t =11.74, 10.09, 6.73, respectively, all P 0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. Conclusions: The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.

Testing block subdivision algorithms on block designs

Science.gov (United States)

Wiseman, Natalie; Patterson, Zachary

2016-01-01

Integrated land use-transportation models predict future transportation demand taking into account how households and firms arrange themselves partly as a function of the transportation system. Recent integrated models require parcels as inputs and produce household and employment predictions at the parcel scale. Block subdivision algorithms automatically generate parcel patterns within blocks. Evaluating block subdivision algorithms is done by way of generating parcels and comparing them to those in a parcel database. Three block subdivision algorithms are evaluated on how closely they reproduce parcels of different block types found in a parcel database from Montreal, Canada. While the authors who developed each of the algorithms have evaluated them, they have used their own metrics and block types to evaluate their own algorithms. This makes it difficult to compare their strengths and weaknesses. The contribution of this paper is in resolving this difficulty with the aim of finding a better algorithm suited to subdividing each block type. The proposed hypothesis is that given the different approaches that block subdivision algorithms take, it's likely that different algorithms are better adapted to subdividing different block types. To test this, a standardized block type classification is used that consists of mutually exclusive and comprehensive categories. A statistical method is used for finding a better algorithm and the probability it will perform well for a given block type. Results suggest the oriented bounding box algorithm performs better for warped non-uniform sites, as well as gridiron and fragmented uniform sites. It also produces more similar parcel areas and widths. The Generalized Parcel Divider 1 algorithm performs better for gridiron non-uniform sites. The Straight Skeleton algorithm performs better for loop and lollipop networks as well as fragmented non-uniform and warped uniform sites. It also produces more similar parcel shapes and patterns.

A novel 360-degree shape measurement using a simple setup with two mirrors and a laser MEMS scanner

Science.gov (United States)

Jin, Rui; Zhou, Xiang; Yang, Tao; Li, Dong; Wang, Chao

2017-09-01

There is no denying that 360-degree shape measurement technology plays an important role in the field of threedimensional optical metrology. Traditional optical 360-degree shape measurement methods are mainly two kinds: the first kind, by placing multiple scanners to achieve 360-degree measurements; the second kind, through the high-precision rotating device to get 360-degree shape model. The former increases the number of scanners and costly, while the latter using rotating devices lead to time consuming. This paper presents a low cost and fast optical 360-degree shape measurement method, which possesses the advantages of full static, fast and low cost. The measuring system consists of two mirrors with a certain angle, a laser projection system, a stereoscopic calibration block, and two cameras. And most of all, laser MEMS scanner can achieve precise movement of laser stripes without any movement mechanism, improving the measurement accuracy and efficiency. What's more, a novel stereo calibration technology presented in this paper can achieve point clouds data registration, and then get the 360-degree model of objects. A stereoscopic calibration block with special coded patterns on six sides is used in this novel stereo calibration method. Through this novel stereo calibration technology we can quickly get the 360-degree models of objects.

Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block

DEFF Research Database (Denmark)

Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V

2015-01-01

BACKGROUND AND OBJECTIVES: The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. METHODS: Sixteen...... healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated...... into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block...

LYME CARDITIS - CLINICAL CHARACTERISTICS OF 105 CASES

NARCIS (Netherlands)

VANDERLINDE, MR

1991-01-01

105 North American and European cases of Lyme carditis, being documented and in part published in the period 1977-1990, are reviewed and compared. The male: female ratio was 3:1, as well in Europe as in the USA. Transient atrioventricular block is the most frequent manifestation of Lyme carditis,

Prenatal diagnosis of long QT syndrome with the superior vena cava-aorta Doppler approach.

Science.gov (United States)

Chabaneix, Julie; Andelfinger, Gregor; Fournier, Anne; Fouron, Jean-Claude; Raboisson, Marie-Josée

2012-10-01

We describe a fetus at 36 weeks with long QT syndrome presenting with variable types of atrioventricular blocks, ventricular premature beats, and torsades de pointes. All these diagnoses were made with the superior vena cava-aorta Doppler approach and confirmed with postnatal electrocardiography. Copyright © 2012 Mosby, Inc. All rights reserved.

Atriofascicular Mahaim with Ebstein anomaly: A case report

Directory of Open Access Journals (Sweden)

Kazushi Ueshima, MD

2017-10-01

Full Text Available We report a case of a 7-year-old girl with atriofascicular Mahaim (AFM pathway concomitant with Ebstein's anomaly. The QRS wave showed left bundle branch block pattern on electrocardiogram. Holter electrocardiogram showed prolongation of the PR interval and QRS morphological change during sinus tachycardia. An electrophysiological study demonstrated that the distal His potential appeared earlier than the proximal His potential, which suggested retrograde His conduction toward the atrioventricular node. Conduction from the Mahaim fiber to the His bundle was faster than that from the atrioventricular node towards the His bundle. The findings of this important case allowed a differential diagnosis between AFM and Wolff-Parkinson-White (WPW syndrome.

31 CFR 594.301 - Blocked account; blocked property.

Science.gov (United States)

2010-07-01

... (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS General Definitions § 594.301 Blocked account; blocked property. The terms blocked account and...

Role of PR-Interval In Predicting the Occurrence of Atrial Fibrillation

DEFF Research Database (Denmark)

Bidstrup, Signe Brøker; Salling Olesen, Morten; Hastrup Svendsen, Jesper

2013-01-01

The identification of individuals at high risk of developing atrial fibrillation (AF) is important to prevent potentially lethal and invalidating complications of this arrhythmia. Recently, several studies have investigated the association between PR-interval and the risk of AF and have tested...... the value of PR-interval in personalized risk scores for AF. However, the results of these studies are generally conflicting. When looking for an association between a prolonged PR-interval (first-degree atrioventricular [AV] block vs. normal PR-interval) and an increased risk of AF, not all studies were...... able to find a consistent and statistically significant association. In two recent studies, however, the investigators were able to show an increased risk of AF for individuals with PR-intervals in the short range compared with individuals in the middle range. The existence of a true U...

Micellar Self-Assembly of Recombinant Resilin-/Elastin-Like Block Copolypeptides.

Science.gov (United States)

Weitzhandler, Isaac; Dzuricky, Michael; Hoffmann, Ingo; Garcia Quiroz, Felipe; Gradzielski, Michael; Chilkoti, Ashutosh

2017-08-14

Reported here is the synthesis of perfectly sequence defined, monodisperse diblock copolypeptides of hydrophilic elastin-like and hydrophobic resilin-like polypeptide blocks and characterization of their self-assembly as a function of structural parameters by light scattering, cryo-TEM, and small-angle neutron scattering. A subset of these diblock copolypeptides exhibit lower critical solution temperature and upper critical solution temperature phase behavior and self-assemble into spherical or cylindrical micelles. Their morphologies are dictated by their chain length, degree of hydrophilicity, and hydrophilic weight fraction of the ELP block. We find that (1) independent of the length of the corona-forming ELP block there is a minimum threshold in the length of the RLP block below which self-assembly does not occur, but that once that threshold is crossed, (2) the RLP block length is a unique molecular parameter to independently tune self-assembly and (3) increasing the hydrophobicity of the corona-forming ELP drives a transition from spherical to cylindrical morphology. Unlike the self-assembly of purely ELP-based block copolymers, the self-assembly of RLP-ELPs can be understood by simple principles of polymer physics relating hydrophilic weight fraction and polymer-polymer and polymer-solvent interactions to micellar morphology, which is important as it provides a route for the de novo design of desired nanoscale morphologies from first principles.

Zero-fluoroscopy cryothermal ablation of atrioventricular nodal re-entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial).

Science.gov (United States)

Luani, Blerim; Zrenner, Bernhard; Basho, Maksim; Genz, Conrad; Rauwolf, Thomas; Tanev, Ivan; Schmeisser, Alexander; Braun-Dullaeus, Rüdiger C

2018-01-01

Stochastic damage of the ionizing radiation to both patients and medical staff is a drawback of fluoroscopic guidance during catheter ablation of cardiac arrhythmias. Therefore, emerging zero-fluoroscopy catheter-guidance techniques are of great interest. We investigated, in a prospective pilot study, the feasibility and safety of the cryothermal (CA) slow-pathway ablation in patients with symptomatic atrioventricular-nodal-re-entry-tachycardia (AVNRT) using solely intracardiac echocardiography (ICE) for endovascular and endocardial catheter visualization. Twenty-five consecutive patients (mean age 55.6 ± 12.0 years, 17 female) with ECG-documentation or symptoms suggesting AVNRT underwent an electrophysiology study (EPS) in our laboratory utilizing ICE for catheter navigation. Supraventricular tachycardia was inducible in 23 (92%) patients; AVNRT was confirmed by appropriate stimulation maneuvers in 20 (80%) patients. All EPS in the AVNRT subgroup could be accomplished without need for fluoroscopy, relying solely on ICE-guidance. CA guided by anatomical location and slow-pathway potentials was successful in all patients, median cryo-mappings = 6 (IQR:3-10), median cryo-ablations = 2 (IQR:1-3). Fluoroscopy was used to facilitate the trans-septal puncture and localization of the ablation substrate in the remaining 3 patients (one focal atrial tachycardia and two atrioventricular-re-entry-tachycardias). Mean EPS duration in the AVNRT subgroup was 99.8 ± 39.6 minutes, ICE guided catheter placement 11.9 ± 5.8 minutes, time needed for diagnostic evaluation 27.1 ± 10.8 minutes, and cryo-application duration 26.3 ± 30.8 minutes. ICE-guided zero-fluoroscopy CA in AVNRT patients is feasible and safe. Real-time visualization of the true endovascular borders and cardiac structures allow for safe catheter navigation during the ICE-guided EPS and might be an alternative to visualization technologies using geometry reconstructions. © 2017 Wiley Periodicals, Inc.

High-tension electrical injury to the heart as assessed by radionuclide imaging

Energy Technology Data Exchange (ETDEWEB)

Iino, Hitoshi; Chikamori, Taishiro; Hatano, Tsuguhisa [Tokyo Medical Coll. (Japan)] [and others

2002-12-01

The purpose of this study was to evaluate cardiac complications associated with electrical injury, 7 patients with high-tension electrical injury (6,600 V alternating current) underwent {sup 201}Tl and {sup 123}I-metaiodobenzylguanidine (MIBG) imaging in addition to conventional electrocardiographic and echocardiographic assessments. Electrocardiography showed transient atrial fibrillation, second degree atrioventricular block, ST-segment depression, and sinus bradycardia in each patient. Echocardiography showed mild hypokinesis of the anterior wall in only 2 patients, but {sup 201}Tl and {sup 123}I-MIBG myocardial scintigraphy showed an abnormal scan image in 6/7 and 5/6 patients, respectively. Decreased radionuclide accumulation was seen primarily in areas extending from the anterior wall to the septum. Decreased radionuclide accumulation was smaller in extent and milder in degree in {sup 123}I-MIBG than in {sup 201}Tl imaging. These results suggest that even in patients without definite evidence of severe cardiac complications in conventional examinations, radionuclide imaging detects significant damage due to high-tension electrical injury, in which sympathetic nerve dysfunction might be milder than myocardial cell damage. (author)

Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block.

Science.gov (United States)

Lampe, Brigitte; Hammerstingl, Christoph; Schwab, Jörg Otto; Mellert, Fritz; Stoffel-Wagner, Birgit; Grigull, Andreas; Fimmers, Rolf; Maisch, Bernhard; Nickenig, Georg; Lewalter, Thorsten; Yang, Alexander

2012-10-01

The impact of atrial fibrillation (AF) on heart failure (HF) was evaluated in patients with preserved left ventricular (LV) function and long-term right ventricular (RV) pacing for complete heart block. Clinical, echocardiographic, and laboratory parameters of HF were assessed in 35 patients with established AF who had undergone ablation of the atrioventricular node and pacemaker implantation (Group A) and 31 patients who received dual-chamber pacing for spontaneous complete heart block (Group B). During a follow-up period of 12.7 ± 7.5 years, New York Heart Association (NYHA) functional class increased from 1.3 ± 0.5 to 2.1 ± 0.6 (p Left ventricular ejection fraction (LVEF) decreased from 59.7 ± 5.1 to 53.0 ± 8.2 (p function were moderately depressed in Group A compared with those in Group B: NYHA class 2.1 ± 0.6 versus 1.6 ± 0.7, p = 0.001; LVEF 53.0 ± 8.2 versus 56.9 ± 7.0 %, p brain natriuretic peptide (NT-proBNP) 1116.8 ± 883.9 versus 622.9 ± 1059.4 pg/ml, p 10 %, increasing NYHA class ≥1, and NT-proBNP levels >1,000 pg/ml. Permanent AF was associated with adverse effects on LV function and symptoms of HF in patients with long-term RV pacing for complete heart block, and appears to play an important role in the development of HF in this specific patient cohort.

Degree-degree correlations in random graphs with heavy-tailed degrees

NARCIS (Netherlands)

Hofstad, van der R.W.; Litvak, N.

2014-01-01

Mixing patterns in large self-organizing networks, such as the Internet, the World Wide Web, social, and biological networks are often characterized by degree-degree dependencies between neighboring nodes. In assortative networks, the degree-degree dependencies are positive (nodes with similar

Degree-Degree Dependencies in Random Graphs with Heavy-Tailed Degrees

NARCIS (Netherlands)

van der Hofstad, Remco; Litvak, Nelly

2014-01-01

Mixing patterns in large self-organizing networks, such as the Internet, the World Wide Web, social, and biological networks are often characterized by degree-degree dependencies between neighboring nodes. In assortative networks, the degree-degree dependencies are positive (nodes with similar

Antiarrhythmic properties of a rapid delayed-rectifier current activator in rabbit models of acquired long QT syndrome

DEFF Research Database (Denmark)

Diness, Thomas G; Yeh, Yung-Hsin; Qi, Xiao Yan

2008-01-01

effect of a novel compound (NS1643) that activates the rapid delayed-rectifier K+ current, I(Kr), in two rabbit models of acquired LQTS. METHODS AND RESULTS: We used two clinically relevant in vivo rabbit models of TdP in which we infused NS1643 or vehicle: (i) three-week atrioventricular block...

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

DEFF Research Database (Denmark)

Ståhlberg, Marcus; Damgaard, Morten; Norsk, Peter

2009-01-01

AIMS: The aim of this study was to study the haemodynamic effect of atrioventricular delay (AVD) modifications within a narrow range in different body positions and during exercise in patients receiving cardiac resynchronization therapy (CRT). METHODS: The previously optimized AVD was shortened...... and prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor......, the estimated pulmonary artery diastolic pressure (ePAD) was analysed. RESULTS: The magnitude of CO response to AVD changes was greater in CRT patients than in controls (0.25 vs. 0.20 L/min, Psize (r=0...

Incipient microphase separation in short chain perfluoropolyether-block-poly(ethylene oxide) copolymers.

Science.gov (United States)

Chintapalli, Mahati; Timachova, Ksenia; Olson, Kevin R; Banaszak, Michał; Thelen, Jacob L; Mecham, Sue J; DeSimone, Joseph M; Balsara, Nitash P

2017-06-07

Incipient microphase separation is observed by wide angle X-ray scattering (WAXS) in short chain multiblock copolymers consisting of perfluoropolyether (PFPE) and poly(ethylene oxide) (PEO) segments. Two PFPE-PEO block copolymers were studied; one with dihydroxyl end groups and one with dimethyl carbonate end groups. Despite having a low degree of polymerization (N ∼ 10), these materials exhibited significant scattering intensity, due to disordered concentration fluctuations between their PFPE-rich and PEO-rich domains. The disordered scattering intensity was fit to a model based on a multicomponent random phase approximation to determine the value of the interaction parameter, χ, and the radius of gyration, R g . Over the temperature range 30-90 °C, the values of χ were determined to be very large (∼2-2.5), indicating a high degree of immiscibility between the PFPE and PEO blocks. In PFPE-PEO, due to the large electron density contrast between the fluorinated and non-fluorinated block and the high value of χ, disordered scattering was detected at intermediate scattering angles, (q ∼ 2 nm -1 ) for relatively small polymer chains. Our ability to detect concentration fluctuations was enabled by both a relatively large value of χ and significant scattering contrast.

Protograph based LDPC codes with minimum distance linearly growing with block size

Science.gov (United States)

Divsalar, Dariush; Jones, Christopher; Dolinar, Sam; Thorpe, Jeremy

2005-01-01

We propose several LDPC code constructions that simultaneously achieve good threshold and error floor performance. Minimum distance is shown to grow linearly with block size (similar to regular codes of variable degree at least 3) by considering ensemble average weight enumerators. Our constructions are based on projected graph, or protograph, structures that support high-speed decoder implementations. As with irregular ensembles, our constructions are sensitive to the proportion of degree-2 variable nodes. A code with too few such nodes tends to have an iterative decoding threshold that is far from the capacity threshold. A code with too many such nodes tends to not exhibit a minimum distance that grows linearly in block length. In this paper we also show that precoding can be used to lower the threshold of regular LDPC codes. The decoding thresholds of the proposed codes, which have linearly increasing minimum distance in block size, outperform that of regular LDPC codes. Furthermore, a family of low to high rate codes, with thresholds that adhere closely to their respective channel capacity thresholds, is presented. Simulation results for a few example codes show that the proposed codes have low error floors as well as good threshold SNFt performance.

E-Block: A Tangible Programming Tool with Graphical Blocks

Directory of Open Access Journals (Sweden)

Danli Wang

2013-01-01

Full Text Available This paper designs a tangible programming tool, E-Block, for children aged 5 to 9 to experience the preliminary understanding of programming by building blocks. With embedded artificial intelligence, the tool defines the programming blocks with the sensors as the input and enables children to write programs to complete the tasks in the computer. The symbol on the programming block's surface is used to help children understanding the function of each block. The sequence information is transferred to computer by microcomputers and then translated into semantic information. The system applies wireless and infrared technologies and provides user with feedbacks on both screen and programming blocks. Preliminary user studies using observation and user interview methods are shown for E-Block's prototype. The test results prove that E-Block is attractive to children and easy to learn and use. The project also highlights potential advantages of using single chip microcomputer (SCM technology to develop tangible programming tools for children.

E-Block: A Tangible Programming Tool with Graphical Blocks

OpenAIRE

Danli Wang; Yang Zhang; Shengyong Chen

2013-01-01

This paper designs a tangible programming tool, E-Block, for children aged 5 to 9 to experience the preliminary understanding of programming by building blocks. With embedded artificial intelligence, the tool defines the programming blocks with the sensors as the input and enables children to write programs to complete the tasks in the computer. The symbol on the programming block's surface is used to help children understanding the function of each block. The sequence information is transfer...

New method for protecting mine roadways in thin coal seams by means of prefabricated yielding blocks

Energy Technology Data Exchange (ETDEWEB)

Peknik, J

1983-05-01

The use of concrete blocks for strata control in mine roadways driven in thin coal seams is evaluated. Two types of prefabricated blocks are used: BZT blocks made of reinforced concrete and yielding elements or popilbet blocks made of a mixture of fly ash (from coal power plants) and concrete. When the popilbet blocks were used no yielding elements were necessary. Mechanical properties of blocks made of reinforced concrete were controlled by yielding elements. Mechanical properties (compression strength) of the popilbet blocks were controlled by proportion of water, cement and fly ash. The BZT and the popilbet blocks were used for strata control in mine roadways in coal seams from 60 to 80 cm thick and dip angle from 5 to 18 degrees. Use of the BZT and the popilbet blocks reduced roadway deformation by about 50% in comparison to traditional strata control methods (timber cribbings, use of waste rock, etc.). Use of the blocks is explained. The BZT and the popilbet blocks were placed in a roadway wall. Height of the block wall equaled coal seam thickness. Yielding arched steel supports and timber liners were used for strata control in the roadway. The popilbet blocks were 50% less expensive than the BZT blocks. 9 references

An antibiotic recipe for an arrhythmic disaster.

Science.gov (United States)

McCutcheon, Keir; Manga, Pravin

2015-01-01

We describe the case of a patient who developed torsade de pointes during temporary pacemaker insertion after administration of intravenous erythromycin. The case highlights the dangers of administering drugs that prolong the QT interval in patients with complete atrioventricular block, and we discuss the underlying pathophysiological recipe that can lead to a potential arrhythmic disaster.

Hypobaric spinal anaesthesia with bupivacaine (0.1%) gives selective sensory block for ano-rectal surgery.

Science.gov (United States)

Maroof, M; Khan, R M; Siddique, M; Tariq, M

1995-08-01

Twenty adult male patients undergoing anorectal surgery in the jackknife position under spinal anaesthesia were studied for the anaesthetic properties of 5 ml hypobaric 0.1% bupivacaine. The patients were positioned in the prone, jack-knife position with a pillow under the hips and with an operating table break angulation of 30 degrees with head down tilt of 20 degrees. In this position a 25-gauge Quincke spinal needle was inserted intrathecally through L3-4 and 5 ml solution, prepared by mixing 1 ml bupivacaine 0.5% with 4 ml of distilled water with a specific gravity of 1.001 at 20 degrees C, was given over 15-20 sec. Onset time, progression and upper level of sensory blockade evaluated by pin prick, and the extent of motor block (1 = full motor movement at ankle and knee joint, 2 = restricted motor movements, 3 = full motor block, no movements) were measured at one minute intervals for the first five minutes, then every five minutes for 30 min. The number of dermatomes blocked was also noted. The median level of cephalad sensory blockage was of L1, with a range from T10-L3. On average, nine dermatomes were blocked (range 7-12). Motor blockade was not observed in any patient. Changes in heart rate and blood pressure were minimal. The average duration of postoperative analgesia was 339.5 +/- 182.9 min. Post-spinal headache was not observed in any patients. In conclusion, 5 ml intrathecal hypobaric bupivacaine, 0.1%, provided excellent perioperative analgesia without motor blockade and haemodynamic stability in patients undergoing anorectal surgery in jackknife position.

Celiac ganglia block

International Nuclear Information System (INIS)

Akinci, Devrim; Akhan, Okan

2005-01-01

Pain occurs frequently in patients with advanced cancers. Tumors originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract and from compressing enlarged lymph nodes can cause severe abdominal pain, which do not respond satisfactorily to medical treatment or radiotherapy. Percutaneous celiac ganglia block (CGB) can be performed with high success and low complication rates under imaging guidance to obtain pain relief in patients with upper abdominal malignancies. A significant relationship between pain relief and degree of tumoral celiac ganglia invasion according to CT features was described in the literature. Performing the procedure in the early grades of celiac ganglia invasion on CT can increase the effectiveness of the CGB, which is contrary to World Health Organization criteria stating that CGB must be performed in patients with advanced stage cancer. CGB may also be effectively performed in patients with chronic pancreatitis for pain palliation

Progress report on pre-test calculations for the large block test

International Nuclear Information System (INIS)

Lee, K.H.

1995-01-01

The U.S. Department of Energy's (DOE) Yucca Mountain Site Characterization Project (YMP) is investigating the suitability of the Topopah Spring tuff in the thick vadose zone at Yucca Mountain, Nevada, as a host rock for permanent disposal of high-level radioactive waste. As part of the YMP, a group of field tests, referred to as the Large Block Test (LBT), will be conducted on a large electrically heated block of Topopah Spring tuff, isolated at Fran Ridge, Nevada Test Site. The block, which will be 3 x 3 m in horizontal dimensions and 4.5 m in height, will be heated by electrical heaters. The goals of the LBT axe to gain information on the coupled thermal-mechanical-hydrological-chemical processes active in the near-field environment of a repository; to provide field data for testing and calibrating models; and to help the development of measurement systems and techniques. This progress report presents results of on-going numerical modeling calculations carried out in support of the LBT design. An equivalent continuum model with an upper boundary temperature of 60 degrees C was used to simulate the hydrothermal response of the block to heating over a one-year period. The total heating power was started at 1500 W and later reduced to maintain an approximately uniform temperature of 138-140 degrees C. For a homogeneous bulk permeability case, the results show the formation of a distinct dry-out zone in and around the heater plane, and well-developed condensation zones above and below the heater plane. For a heterogeneous permeability distribution, the condensation zone above the heater plane was not well developed. This difference in results suggests that water saturation changes might be sensitive to changes in bulk permeability distribution. Rock temperatures were almost unaffected by permeability distribution. Heat flow was dominated by conduction. No liquid flow through the top of the block was predicted

Poly(ferrocenylsilane)-block-Polylactide Block Copolymers

NARCIS (Netherlands)

Roerdink, M.; van Zanten, Thomas S.; Hempenius, Mark A.; Zhong, Zhiyuan; Feijen, Jan; Vancso, Gyula J.

2007-01-01

A PFS/PLA block copolymer was studied to probe the effect of strong surface interactions on pattern formation in PFS block copolymer thin films. Successful synthesis of PFS-b-PLA was demonstrated. Thin films of these polymers show phase separation to form PFS microdomains in a PLA matrix, and

A New Look at the Roles of Spinning and Blocking

OpenAIRE

Johnson, Ryan; Athanassoulis, Manos; Stoica, Radu; Ailamaki, Anastasia

2009-01-01

Database engines face growing scalability challenges as core counts exponentially increase each processor generation, and the efficiency of synchronization primitives used to protect internal data structures is a crucial factor in overall database performance. The trade-offs between different implementation approaches for these primitives shift significantly with increasing degrees of available hardware parallelism. Blocking synchronization, which has long been the favored approach in databas...

Geologic and petrophysic analysis of a travertine block as hydrocarbon reservoir analogue

International Nuclear Information System (INIS)

Basso, Mateus; Kuroda, Michelle Chaves; Vidal, Alexandre Campane

2017-01-01

Microbialitic limestones are gaining space in petroleum geology due to the existence of many reservoirs composed of these lithologies in the pre-salt producing fields. Travertine, calcareous tufa and stromatolites figure among the rocks proposed as analogous for the microbialitic rocks. This work conduces the study of geological, petrophysical and geophysical parameters of a travertine block measuring 1,60 x 1,60 x 2,70 m, weighing 21,2 tons and available in the Centro de Estudo do Petroleo (CEPETRO) at the Universidade Estadual de Campinas. The Italian block, named T-block, corresponds to the representative elementary volume of its original formation and allows the study in an intermediate scale between the hand sample and the outcrop scale. Permeability tests and gamma ray spectrometry measurements were conducted and the porosity was calculated by image analysis. Models were generated from the obtained data and then associated with descriptive geology of the block. A reduction in permeability, porosity and concentration of elements potassium (K), uranium (U) and thorium (Th) was recorded, following a gradient towards the top of the T-block accompanying the reduction in the degree of development of the rock fabric. (author)

Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects.

Science.gov (United States)

Myers, Patrick O; del Nido, Pedro J; Marx, Gerald R; Emani, Sitaram; Mayer, John E; Pigula, Frank A; Baird, Christopher W

2012-08-01

Left ventricular outflow tract obstruction (LVOTO) is the second most frequent reason for reoperation after atrioventricular canal (AVC) defect repair. Limited data are available on the mechanisms of LVOTO, their treatment, and outcomes. Between 1998 and 2010, 56 consecutive children with AVC underwent 68 LVOTO procedures. The AVC was partial in 4, transitional in 9, and complete in 43. The LVOTO procedure was required in 21 patients at the primary AVC repair, and the initial LVOTO procedure in 35 patients was a late reoperation after AVC repair. During a mean follow-up of 50±41 months, 5 patients (24%) with LVOTO repair at AVC repair required a reoperation for LVOTO, and 7 patients (20%) whose initial LVOTO repair was a reoperation required a second reoperation for LVOTO repair. Overall freedom from LVOTO reoperation was 98.5% at 1 year, 92.5% at 3 years, 81% at 5 years, 72.2% at 7 years, and 52.5% at 10 and 12 years. The freedom from reoperation was neither significantly different between partial, transitional, and complete AVC (p=0.78) nor between timing of the LVOT procedure (p=0.49). Modified single-patch AVC repair was associated with a higher LVOTO reoperation rate (p=0.04). Neither the mechanisms leading to LVOTO nor the surgical techniques used were independent predictors of reoperation. LVOTO in AVC is a complex and multifactorial disease. Aggressive surgical repair has improved late outcomes; however, risk factors for reoperation and the ideal approach for repair remain to be defined. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

LDPC Codes with Minimum Distance Proportional to Block Size

Science.gov (United States)

Divsalar, Dariush; Jones, Christopher; Dolinar, Samuel; Thorpe, Jeremy

2009-01-01

Low-density parity-check (LDPC) codes characterized by minimum Hamming distances proportional to block sizes have been demonstrated. Like the codes mentioned in the immediately preceding article, the present codes are error-correcting codes suitable for use in a variety of wireless data-communication systems that include noisy channels. The previously mentioned codes have low decoding thresholds and reasonably low error floors. However, the minimum Hamming distances of those codes do not grow linearly with code-block sizes. Codes that have this minimum-distance property exhibit very low error floors. Examples of such codes include regular LDPC codes with variable degrees of at least 3. Unfortunately, the decoding thresholds of regular LDPC codes are high. Hence, there is a need for LDPC codes characterized by both low decoding thresholds and, in order to obtain acceptably low error floors, minimum Hamming distances that are proportional to code-block sizes. The present codes were developed to satisfy this need. The minimum Hamming distances of the present codes have been shown, through consideration of ensemble-average weight enumerators, to be proportional to code block sizes. As in the cases of irregular ensembles, the properties of these codes are sensitive to the proportion of degree-2 variable nodes. A code having too few such nodes tends to have an iterative decoding threshold that is far from the capacity threshold. A code having too many such nodes tends not to exhibit a minimum distance that is proportional to block size. Results of computational simulations have shown that the decoding thresholds of codes of the present type are lower than those of regular LDPC codes. Included in the simulations were a few examples from a family of codes characterized by rates ranging from low to high and by thresholds that adhere closely to their respective channel capacity thresholds; the simulation results from these examples showed that the codes in question have low

Use of an Android application "clinometer" for measurement of head down tilt given during subarachnoid block.

Science.gov (United States)

Dixit, R B; Neema, M M

2016-01-01

Head down tilt is given to patients after sub arachnoid block for adjustment of height of block. However, the amount of tilt given is subjective and cannot be documented. We used an android application named "clinometer" to measure exact degree of tilt given by anesthesiologists as their routine practice. This observational study, at a medical college hospital, was done in 130 patients given sub arachnoid block for lower abdominal surgeries. We observed and documented vital data of patients and measured tilt given by application "clinometer." We observed that the application was easy to use and measured tilt each time. The result obtained can be documented, digitally saved and transferred. In 130 patients studied, we observed incidence of degree of tilt as follows: 6-8° tilt in 38 patients (29.23%), 8-10 in 36 patients (27.69%), 10-12 in 30 patients (23.08%), 12-14 in 12 patients (9.23%) and 14-16° tilt in 14 patients (10.77%). Use of application was received with enthusiasm by practicing anesthesiologists. Various possible uses of this application are discussed.

Cardiac pacing in heart failure patients with left bundle branch block: impact of pacing site for optimizing left ventricular resynchronization.

Science.gov (United States)

Pappone, C; Rosanio, S; Oreto, G; Tocchi, M; Gulletta, S; Salvati, A; Dicandia, C; Santinelli, V; Mazzone, P; Veglia, F; Ding, J; Sallusti, L; Spinelli, J; Vicedomini, G

2000-07-01

Acute left ventricular pacing has been associated with hemodynamic improvement in patients with congestive heart failure and wide QRS complex. We hypothesized that pacing two left ventricular sites simultaneously would produce faster activation and better systolic function than single-site pacing. We selected 14 heart failure patients (NYHA functional class III or IV) in normal sinus rhythm with left bundle branch block and QRS > 150 ms. An 8F dual micromanometer catheter was placed in the aorta for measuring +dP/dt (mmHg/s), aortic pulse pressure (mmHg), and end-diastolic pressure (mmHg). Pacing leads were positioned via coronary veins at the posterior base and lateral wall. Patients were acutely paced VDD at the posterior base, lateral wall, and both sites (dual-site) with 5 atrioventricular delays (from 8 ms to PR -30 ms). Pacing sequences were executed in randomized order using a custom external computer (FlexStim, Guidant CRM). Dual-site pacing increased peak +dP/dt significantly more than posterior base and lateral wall pacing. Dual-site and posterior base pacing raised aortic pulse pressure significantly more than lateral wall pacing. Dual-site pacing shortened QRS duration by 22 %, whereas posterior base and lateral wall pacing increased it by 2 and 12%, respectively (p = 0.006). In heart failure patients with left bundle branch block, dual-site pacing improves systolic function more than single-site stimulation. Improved ventricular activation synchrony, expressed by paced QRS narrowing, may account for the additional benefit of dual- vs single-site pacing in enhancing contractility. This novel approach deserves consideration for future heart failure pacing studies.

Acquired tricuspid valve stenosis due to intentionally redundant transvenous lead placement for VDD pacing in two small dogs.

Science.gov (United States)

Gunther-Harrington, Catherine T; Michel, Adam O; Stern, Joshua A

2015-12-01

Placement of an endocardial VDD pacing lead in small dogs (stenosis in two small dogs between 8 months and 4 years after VDD pacemaker placement for third-degree atrioventricular block. Echocardiography and Doppler echocardiography identified elevated transtricuspid flow velocities, prolonged pressure half-times, decreased valve leaflet excursions, and tricuspid regurgitation in both cases. Both cases were euthanized secondary to this pacing complication. Necropsy was performed in one case and confirmed adherence between the redundant lead loop, atrial and valve tissue. While VDD pacing in dogs has proven hemodynamic benefits, these benefits have not been demonstrated in terms of survival benefit or clinical signs. The requirement of redundant lead placement in small dogs for appropriate VDD lead function creates potential deleterious effects that should be weighed against the possible clinical value of VDD pacing in these patients. Copyright © 2015 Elsevier B.V. All rights reserved.

Block and sub-block boundary strengthening in lath martensite

NARCIS (Netherlands)

Du, C.; Hoefnagels, J.P.M.; Vaes, R.; Geers, M.G.D.

2016-01-01

Well-defined uniaxial micro-tensile tests were performed on lath martensite single block specimens and multi-block specimens with different number of block boundaries parallel to the loading direction. Detailed slip trace analyses consistently revealed that in the {110}<111> slip system with the

On the Eigenvalues and Eigenvectors of Block Triangular Preconditioned Block Matrices

KAUST Repository

Pestana, Jennifer

2014-01-01

Block lower triangular matrices and block upper triangular matrices are popular preconditioners for 2×2 block matrices. In this note we show that a block lower triangular preconditioner gives the same spectrum as a block upper triangular preconditioner and that the eigenvectors of the two preconditioned matrices are related. © 2014 Society for Industrial and Applied Mathematics.

Locking mechanisms in degree-4 vertex origami structures

Science.gov (United States)

Fang, Hongbin; Li, Suyi; Xu, Jian; Wang, K. W.

2016-04-01

Origami has emerged as a potential tool for the design of mechanical metamaterials and metastructures whose novel properties originate from their crease patterns. Most of the attention in origami engineering has focused on the wellknown Miura-Ori, a folded tessellation that is flat-foldable for folded sheet and stacked blocks. This study advances the state of the art and expands the research field to investigate generic degree-4 vertex (4-vertex) origami, with a focus on facet-binding. In order to understand how facet-binding attributes to the mechanical properties of 4-vertex origami structures, geometries of the 4-vertex origami cells are analyzed and analytically expressed. Through repeating and stacking 4-vertex cells, origami sheets and stacked origami blocks can be constructed. Geometry analyses discover four mechanisms that will lead to the self-locking of 4-vertex origami cells, sheets, and stacked blocks: in-cell facet-binding, inlayer facet-binding, inter-layer facet binding, and in-layer and inter-layer facet-bindings. These mechanisms and the predicted self-locking phenomena are verified through 3D simulations and prototype experiments. Finally, this paper briefly introduces the unusual mechanical properties caused by the locking of 4-vertex origami structures. The research reported in this paper could foster a new breed of self-locking structures with various engineering applications.

Properties of concrete blocks prepared with low grade recycled aggregates.

Science.gov (United States)

Poon, Chi-Sun; Kou, Shi-cong; Wan, Hui-wen; Etxeberria, Miren

2009-08-01

Low grade recycled aggregates obtained from a construction waste sorting facility were tested to assess the feasibility of using these in the production of concrete blocks. The characteristics of the sorted construction waste are significantly different from that of crushed concrete rubbles that are mostly derived from demolition waste streams. This is due to the presence of higher percentages of non-concrete components (e.g. >10% soil, brick, tiles etc.) in the sorted construction waste. In the study reported in this paper, three series of concrete block mixtures were prepared by using the low grade recycled aggregates to replace (i) natural coarse granite (10mm), and (ii) 0, 25, 50, 75 and 100% replacement levels of crushed stone fine (crushed natural granite concrete blocks. Test results on properties such as density, compressive strength, transverse strength and drying shrinkage as well as strength reduction after exposure to 800 degrees C are presented below. The results show that the soil content in the recycled fine aggregate was an important factor in affecting the properties of the blocks produced and the mechanical strength deceased with increasing low grade recycled fine aggregate content. But the higher soil content in the recycled aggregates reduced the reduction of compressive strength of the blocks after exposure to high temperature due probably to the formation of a new crystalline phase. The results show that the low grade recycled aggregates obtained from the construction waste sorting facility has potential to be used as aggregates for making non-structural pre-cast concrete blocks.

Powder wastes confinement block and manufacturing process of this block

International Nuclear Information System (INIS)

Dagot, L.; Brunel, G.

1996-01-01

This invention concerns a powder wastes containment block and a manufacturing process of this block. In this block, the waste powder is encapsulated in a thermo hardening polymer as for example an epoxy resin, the encapsulated resin being spread into cement. This block can contain between 45 and 55% in mass of wastes, between 18 and 36% in mass of polymer and between 14 and 32% in mass of cement. Such a containment block can be used for the radioactive wastes storage. (O.M.). 4 refs

Blocked Randomization with Randomly Selected Block Sizes

Directory of Open Access Journals (Sweden)

Jimmy Efird

2010-12-01

Full Text Available When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes.

Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine

Directory of Open Access Journals (Sweden)

Yu-Ying Tang

2012-01-01

Full Text Available Background. It was suggested that labor may influence the spread of intrathecal bupivacaine using combined spinal epidural (CSE technique. However, no previous studies investigated this proposition. We designed this study to investigate the spinal block characteristics of plain bupivacaine between nonlaboring and laboring parturients using CSE technique. Methods. Twenty-five nonlaboring (Group NL and twenty-five laboring parturients (Group L undergoing cesarean delivery were enrolled. Following identification of the epidural space at the L3-4 interspace, plain bupivacaine 10 mg was administered intrathecally using CSE technique. The level of sensory block, degree of motor block, and hemodynamic changes were assessed. Results. The baseline systolic blood pressure (SBP and the maximal decrease of SBP in Group L were significantly higher than those in Group NL (=0.002 and =0.03, resp.. The median sensory level tested by cold stimulation was T6 for Group NL and T5 for Group L (=0.46. The median sensory level tested by pinprick was T7 for both groups (=0.35. The degree of motor block was comparable between the two groups (=0.85. Conclusion. We did not detect significant differences in the sensory block levels between laboring and nonlaboring parturients using CSE technique with intrathecal plain bupivacaine.

Population Blocks.

Science.gov (United States)

Smith, Martin H.

1992-01-01

Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…

Association and Structure of Thermo Sensitive Comblike Block Copolymers in Aqueous Solutions

International Nuclear Information System (INIS)

Cheng, Gang

2008-01-01

The structures and association properties of thermo sensitive poly(methoxyoligo(ethylene glycol) norbornenyl esters) block copolymers in D2O were investigated by Small Angle Neutron Scattering (SANS). Each block is a comb-like polymer with a polynorbornene (PNB) backbone and oligo ethylene glycol (OEG) side chains (one side chain per NB monomer). The chemical formula of the block copolymer is (OEG3NB)79-(OEG6.6NB)67, where subscripts represent the degree of polymerization (DP) of OEG and NB in each block The polymer concentration was fixed at 2.0 wt % and the structural changes were investigated over a temperature range between 25 C and 68 C. It was found that at room temperature polymers associate to form micelles with a spherical core formed by the block (OEG3NB)79 and corona formed by the block (OEG6.6NB)67 and that the shape of the polymer in the corona could be described by the form factor of rigid cylinders. At elevated temperatures, the aggregation number increases and the micelles become more compact. At temperatures round the cloud point temperature (CPT) T = 60 C a correlation peak started to appear and became pronounced at 68 C due to the formation of a partially ordered structure with a correlation length ∼ 349

Block Preconditioning to Enable Physics-Compatible Implicit Multifluid Plasma Simulations

Science.gov (United States)

Phillips, Edward; Shadid, John; Cyr, Eric; Miller, Sean

2017-10-01

Multifluid plasma simulations involve large systems of partial differential equations in which many time-scales ranging over many orders of magnitude arise. Since the fastest of these time-scales may set a restrictively small time-step limit for explicit methods, the use of implicit or implicit-explicit time integrators can be more tractable for obtaining dynamics at time-scales of interest. Furthermore, to enforce properties such as charge conservation and divergence-free magnetic field, mixed discretizations using volume, nodal, edge-based, and face-based degrees of freedom are often employed in some form. Together with the presence of stiff modes due to integrating over fast time-scales, the mixed discretization makes the required linear solves for implicit methods particularly difficult for black box and monolithic solvers. This work presents a block preconditioning strategy for multifluid plasma systems that segregates the linear system based on discretization type and approximates off-diagonal coupling in block diagonal Schur complement operators. By employing multilevel methods for the block diagonal subsolves, this strategy yields algorithmic and parallel scalability which we demonstrate on a range of problems.

Morphology, microstructure, and hardness of titanium (Ti-6Al-4V) blocks deposited by wire-feed additive layer manufacturing (ALM)

Energy Technology Data Exchange (ETDEWEB)

Brandl, Erhard, E-mail: erhard.brandl@eads.net [EADS Innovation Works, Metallic Technologies and Surface Engineering, D-81663 Munich (Germany); Schoberth, Achim, E-mail: achim.schoberth@eads.net [EADS Innovation Works, Metallic Technologies and Surface Engineering, D-81663 Munich (Germany); Leyens, Christoph, E-mail: christoph.leyens@tu-dresden.de [Technical University of Dresden, Institute of Materials Science, Chair of Materials Technology, Berndt-Bau, Helmholtzstr. 7, D-01062 Dresden (Germany)

2012-01-15

Highlights: Black-Right-Pointing-Pointer The microstructure and hardness of deposited Ti-6Al-4V blocks are investigated. Black-Right-Pointing-Pointer Hardness is influenced by post heat treatment rather than by process parameters. Black-Right-Pointing-Pointer Microstructure within the prior {beta}-grains varies to some extent from grain to grain. Black-Right-Pointing-Pointer A 600 Degree-Sign C/4 h treatment significantly increased the average hardness. - Abstract: Additive layer manufacturing offers a potential for time and cost savings, especially for aerospace components made from costly titanium alloys. In this paper, the morphology, microstructure, chemical composition, and hardness of additive manufactured Ti-6Al-4V blocks are investigated and discussed. Blocks (7 beads wide, 7 layers high) were deposited using Ti-6Al-4V wire and a Nd:YAG laser. Two different sets of parameters are used and three different post heat treatment conditions (as-built, 600 Degree-Sign C/4 h, 1200 Degree-Sign C/2 h) are investigated. The experiments reveal elementary properties of additive manufactured Ti-6Al-4V material in correlation to process parameters and heat treatments, which are discussed comprehensively.

Case report: an unstable wide QRS complexes tachycardia after ablation of a poster-septal accessory pathway: What is the mechanism?

Science.gov (United States)

Wang, Huan; Che, Xiaoru

2018-03-01

Differentiation of wide QRS complex tachycardia required repeated electrophysiological stimuli and mapping. However, instability of tachycardia would increase the difficulty in differential diagnosis. In this paper, we reported a wide QRS tachycardia following ablation of an atrioventricular reentrant tachycardia participated by a poster-septal accessory pathway. Limited differentiation strategy was performed because the wide QRS tachycardia was self-limited and with unstable hemodynamics. We analyzed the mechanism of the wide QRS tachycardia by only 4 beats ventricular overpacing. On the basis of the last ventricular pacing, an atypical atrioventricular nodal reentrant tachycardia was confirmed. After slow-pathway modification, the wide QRS tachycardia was eliminated. It was an atypical atrial-ventricular node reentrant tachycardia with right bundle branch block. Reasonable analysis based on electrophysiological electrophysiologic knowledge was the basis of successful diagnosis and treatment.

Minimum description length block finder, a method to identify haplotype blocks and to compare the strength of block boundaries.

Science.gov (United States)

Mannila, H; Koivisto, M; Perola, M; Varilo, T; Hennah, W; Ekelund, J; Lukk, M; Peltonen, L; Ukkonen, E

2003-07-01

We describe a new probabilistic method for finding haplotype blocks that is based on the use of the minimum description length (MDL) principle. We give a rigorous definition of the quality of a segmentation of a genomic region into blocks and describe a dynamic programming algorithm for finding the optimal segmentation with respect to this measure. We also describe a method for finding the probability of a block boundary for each pair of adjacent markers: this gives a tool for evaluating the significance of each block boundary. We have applied the method to the published data of Daly and colleagues. The results expose some problems that exist in the current methods for the evaluation of the significance of predicted block boundaries. Our method, MDL block finder, can be used to compare block borders in different sample sets, and we demonstrate this by applying the MDL-based method to define the block structure in chromosomes from population isolates.

Atrioventricular canal defect and associated genetic disorders: new insights into polydactyly syndromes

Directory of Open Access Journals (Sweden)

M. Cristina Digilio

2011-07-01

Full Text Available Atrioventricular canal defect (AVCD is a common congenital heart defect (CHD, representing 7.4% of all cardiac malformations, considered secondary to an extracellular matrix anomaly. The AVCD is associated with extracardiac defects in about 75% of the cases. In this review we analyzed different syndromic AVCDs, in particular those associated with polydactyly disorders, which show remarkable genotype-phenotype correlations. Chromo - some imbalances more frequently associated with AVCD include Down syndrome, deletion 8p23 and deletion 3p25, while mendelian disorders include Noonan syndrome and related RASopathies, several polydactyly syndromes, CHARGE and 3C (cranio-cerebello-cardiac syndrome. The complete form of AVCD is prevalent in patients with chromosomal imbalances. Additional cardiac defects are found in patients affected by chromosomal imbalances different from Down syndrome. Left-sided obstructive lesions are prevalently found in patients with RASopathies. Patients with deletion 8p23 often display AVCD with tetralogy of Fallot or with pulmonary valve stenosis. Tetralogy of Fallot is the only additional cardiac defect found in patients with Down syndrome and AVCD. On the other hand, the association of AVCD and tetralogy of Fallot is also quite characteristic of CHARGE and 3C syndromes. Heterotaxia defects, including common atrium and anomalous pulmonary venous return, occur in patients with AVCD associated with polydactyly syndromes (Ellis-van Creveld, short rib polydactyly, oral-facial-digital, Bardet-Biedl, and Smith-Lemli-Opitz syndromes. The initial clinical evidence of anatomic similarities between AVCD and heterotaxia in polydactyly syndromes was corroborated and explained by experimental studies in transgenic mice. These investigations have suggested the involvement of the Sonic Hedgehog pathway in syndromes with postaxial polydactyly and heterotaxia, and ciliary dysfunction was detected as pathomechanism for these disorders

Load-dependent extracellular matrix organization in atrioventricular heart valves: differences and similarities.

Science.gov (United States)

Alavi, S Hamed; Sinha, Aditi; Steward, Earl; Milliken, Jeffrey C; Kheradvar, Arash

2015-07-15

The extracellular matrix of the atrioventricular (AV) valves' leaflets has a key role in the ability of these valves to properly remodel in response to constantly varying physiological loads. While the loading on mitral and tricuspid valves is significantly different, no information is available on how collagen fibers change their orientation in response to these loads. This study delineates the effect of physiological loading on AV valves' leaflets microstructures using Second Harmonic Generation (SHG) microscopy. Fresh natural porcine tricuspid and mitral valves' leaflets (n = 12/valve type) were cut and prepared for the experiments. Histology and immunohistochemistry were performed to compare the microstructural differences between the valves. The specimens were imaged live during the relaxed, loading, and unloading phases using SHG microscopy. The images were analyzed with Fourier decomposition to mathematically seek changes in collagen fiber orientation. Despite the similarities in both AV valves as seen in the histology and immunohistochemistry data, the microstructural arrangement, especially the collagen fiber distribution and orientation in the stress-free condition, were found to be different. Uniaxial loading was dependent on the arrangement of the fibers in their relaxed mode, which led the fibers to reorient in-line with the load throughout the depth of the mitral leaflet but only to reorient in-line with the load in deeper layers of the tricuspid leaflet. Biaxial loading arranged the fibers in between the two principal axes of the stresses independently from their relaxed states. Unlike previous findings, this study concludes that the AV valves' three-dimensional extracellular fiber arrangement is significantly different in their stress-free and uniaxially loaded states; however, fiber rearrangement in response to the biaxial loading remains similar. Copyright © 2015 the American Physiological Society.

Preparation of gold microparticles using halide ions in bulk block copolymer phases via photoreduction

International Nuclear Information System (INIS)

Cha, Sang-Ho; Kim, Ki-Hyun; Lee, Won-Ki; Lee, Jong-Chan

2009-01-01

Gold microparticles were prepared from the gold salt in the solid bulk phase of a poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymer via a photoreduction process in the presence of halide ions. The shapes and sizes of the gold microparticles were found to be dependent on the types and amount of halide ions as well as the types of cations used due to the combined effects of the adsorption power and oxidative dissolution ability of the additives on gold surfaces. Gold nanorods were obtained when poly(ethylene oxide) was used instead of the block copolymer. This suggests that the poly(propylene oxide) (PPO) parts in the block copolymer are essential for the formation of gold microparticles, even though the degree of the direct interaction between the PPO blocks and gold salt is not significant. - Graphical abstract: Gold microparticles were successfully prepared using halide ions as additives in the polymeric bulk phase via photoreduction with the glow lamp irradiation.

Self-seeding in one dimension: a route to uniform fiber-like nanostructures from block copolymers with a crystallizable core-forming block.

Science.gov (United States)

Qian, Jieshu; Lu, Yijie; Chia, Anselina; Zhang, Meng; Rupar, Paul A; Gunari, Nikhil; Walker, Gilbert C; Cambridge, Graeme; He, Feng; Guerin, Gerald; Manners, Ian; Winnik, Mitchell A

2013-05-28

One-dimensional micelles formed by the self-assembly of crystalline-coil poly(ferrocenyldimethylsilane) (PFS) block copolymers exhibit self-seeding behavior when solutions of short micelle fragments are heated above a certain temperature and then cooled back to room temperature. In this process, a fraction of the fragments (the least crystalline fragments) dissolves at elevated temperature, but the dissolved polymer crystallizes onto the ends of the remaining seed fragments upon cooling. This process yields longer nanostructures (up to 1 μm) with uniform width (ca. 15 nm) and a narrow length distribution. In this paper, we describe a systematic investigation of factors that affect the self-seeding behavior of PFS block copolymer micelle fragments. For PI(1000)-PFS(50) (the subscripts refer to the number average degree of polymerization) in decane, these factors include the presence of a good solvent (THF) for PFS and the effect of annealing the fragments prior to the self-seeding experiments. THF promoted the dissolution of the micelle fragments, while preannealing improved their stability. We also extended our experiments to other PFS block copolymers with different corona-forming blocks. These included PI(637)-PFS(53) in decane, PFS(60)-PDMS(660) in decane (PDMS = polydimethylsiloxane), and PFS(30)-P2VP(300) in 2-propanol (P2VP = poly(2-vinylpyridine)). The most remarkable result of these experiments is our finding that the corona-forming chain plays an important role in affecting how the PFS chains crystallize in the core of the micelles and, subsequently, the range of temperatures over which the micelle fragments dissolve. Our results also show that self-seeding is a versatile approach to generate uniform PFS fiber-like nanostructures, and in principle, the method should be extendable to a wide variety of crystalline-coil block copolymers.

Alterations in electrocardiogram of adenosine test for 99Tcm-MIBI myocardial perfusion imaging

International Nuclear Information System (INIS)

Xie Boqia; Tian Yueqin; Zheng Lihui

2011-01-01

Objective: To analyze alterations in electrocardiogram (ECG) of adenosine test in 99 Tc m -MIBI myocardial perfusion imaging(MPI)SPECT study. Methods: A total of 641 patients were included in the study. The patients each underwent 99 Tc m -MIBI MPI with adenosine test. The ECGs were taken before, during, and after adenosine infusion. Results: In all, abnormal ECGs were found in 205(32.0%) patients. During adenosine infusion, 20.6%(132/641) of patients suffered from arrhythmia, 29.5%(39/132) had atrial premature beats, 34.1% (45/132) had premature ventricular beats, and 6.1% (8/132) had sinoatrial block. In addition, 5.3% (7/132) had first-, 24.2% (32/132) had second-, and 0.8% (1/132) had third-degree atrioventricular block (AVB). After adenosine infusion, 4.4%( 28/641) of patients suffered from arrhythmia, 57.1% (16/28) had atrial premature beats, 39.3% (11/28) had premature ventricular beats, and 3.6% (1/28) had sinoatrial block. The perfusion images showed ischemia in 36 patients and infarction in 8 patients. Adenosine infusion was terminated in 39 patients (6.1%) because of poorly tolerated side effects. However, no death or acute myocardial infarction occurred in the study. Conclusions: Adenosine pharmacologic test for 99 Tc m -MIBI MPI may result in relatively high incidence of arrhythmia in ECG monitoring. (authors)

Evidences of the ultrarapid delayed rectifier potassium current (IKur on pacemaker activity in sinoatrial and atrioventricular nodes of Rat

Directory of Open Access Journals (Sweden)

Mohammad reza Nikmaram

2008-09-01

Full Text Available Background: Sinoatrial node (SAN is the primary pacemaker of the heart. If the SAN activity fails in any way, then the atrioventricular node (AVN immediately starts to regulate the activities of the heart. The aim of this study was to assess the existence or non existence of ultrarapid delayed rectifier potassium current (Ikur and its role on pacemaker activity of two intact SAN and AVN of rat. Methods: The pacemaker activities of distinct intact SAN and AVN by two separate metal microelectrodes that contact the endothelial surface of nodes were recorded and cycle length (CL of action potential was measured. The recording was done before and during 50µM 4-Aminopyridine (4-AP as an Ikur blocker. Results: Compared to control condition, CL of action potentials of SAN and VAN preparations had increased by 17.60 +/-2.9% and 35.90 +/-2.9%, respectively (P<0.05. Conclusion: It is possible to conclude that the Ikur was present in AVN and SAN and the effect of 4-AP on CL of action potential nodes was significantly different.

Fabrication of carbonate apatite block based on internal dissolution-precipitation reaction of dicalcium phosphate and calcium carbonate.

Science.gov (United States)

Daitou, Fumikazu; Maruta, Michito; Kawachi, Giichiro; Tsuru, Kanji; Matsuya, Shigeki; Terada, Yoshihiro; Ishikawa, Kunio

2010-05-01

In this study, we investigated a novel method for fabrication of carbonate apatite block without ionic movement between precursor and solution by using precursor that includes all constituent ions of carbonate apatite. A powder mixture prepared from dicalcium phosphate anhydrous and calcite at appropriate Ca/P ratios (1.5, 1.67, and 1.8) was used as starting material. For preparation of specimens, the slurry made from the powder mixture and distilled water was packed in a split stainless steel mold and heat - treated, ranging from 60 degrees C to 100 degrees C up to 48 hours at 100% humidity. It appeared that carbonate apatite could be obtained above 70 degrees C and monophasic carbonate apatite could be obtained from the powder mixture at Ca/P ratio of 1.67. Carbonate content of the specimen was about 5-7%. Diametral tensile strength of the carbonate apatite blocks slightly decreased with increasing treatment temperature. The decrease in diametral tensile strength is thought to be related to the crystal size of the carbonate apatite formed.

Highly Efficient One-Pot Synthesis of COS-Based Block Copolymers by Using Organic Lewis Pairs.

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Yang, Jia-Liang; Cao, Xiao-Han; Zhang, Cheng-Jian; Wu, Hai-Lin; Zhang, Xing-Hong

2018-01-31

A one-pot synthesis of block copolymer with regioregular poly(monothiocarbonate) block is described via metal-free catalysis. Lewis bases such as guanidine, quaternary onium salts, and Lewis acid triethyl borane (TEB) were equivalently combined and used as the catalysts. By using polyethylene glycol (PEG) as the macromolecular chain transfer agent (CTA), narrow polydispersity block copolymers were obtained from the copolymerization of carbonyl sulfide (COS) and propylene oxide (PO). The block copolymers had a poly(monothiocarbonate) block with perfect alternating degree and regioregularity. Unexpectedly, the addition of CTA to COS/PO copolymerization system could dramatically improve the turnover frequency (TOF) of PO (up to 240 h -1 ), higher than that of the copolymerization without CTA. In addition, the conversion of CTA could be up to 100% in most cases, as revealed by ¹H NMR spectra. Of consequence, the number-average molecular weights ( M n s) of the resultant block copolymers could be regulated by varying the feed ratio of CTA to PO. Oxygen-sulfur exchange reaction (O/S ER), which can generate randomly distributed thiocarbonate and carbonate units, was effectively suppressed in all of the cases in the presence of CTA, even at 80 °C. This work presents a versatile method for synthesizing sulfur-containing block copolymers through a metal-free route, providing an array of new block copolymers.

Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB-TAVI Study.

Science.gov (United States)

Massoullié, Grégoire; Bordachar, Pierre; Irles, Didier; Caussin, Christophe; Da Costa, Antoine; Defaye, Pascal; Jean, Frédéric; Mechulan, Alexis; Mondoly, Pierre; Souteyrand, Géraud; Pereira, Bruno; Ploux, Sylvain; Eschalier, Romain

2016-10-26

Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His-ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV algorithm based on electrophysiological study and remote monitoring of CIEDs in the prediction of high-grade conduction disturbances in patients with LBBB after TAVI. The primary end point is to compare the incidence (rate and time to onset) of high-grade conduction disturbances in patients with LBBB after TAVI between the two groups at 12 months. Given the proportion of high-grade conduction disturbances (20-40%), a sample of 200 subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has been in an active recruiting phase since September 2015 (21 patients already included). Local ethics committee authorisation was obtained in May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. NCT02482844; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The relationship between mean anomaly block sizes and spherical harmonic representations. [of earth gravity

Science.gov (United States)

Rapp, R. H.

1977-01-01

The frequently used rule specifying the relationship between a mean gravity anomaly in a block whose side length is theta degrees and a spherical harmonic representation of these data to degree l-bar is examined in light of the smoothing parameter used by Pellinen (1966). It is found that if the smoothing parameter is not considered, mean anomalies computed from potential coefficients can be in error by about 30% of the rms anomaly value. It is suggested that the above mentioned rule should be considered only a crude approximation.

Generalized Block Failure

DEFF Research Database (Denmark)

Jönsson, Jeppe

2015-01-01

Block tearing is considered in several codes as a pure block tension or a pure block shear failure mechanism. However in many situations the load acts eccentrically and involves the transfer of a substantial moment in combination with the shear force and perhaps a normal force. A literature study...... shows that no readily available tests with a well-defined substantial eccentricity have been performed. This paper presents theoretical and experimental work leading towards generalized block failure capacity methods. Simple combination of normal force, shear force and moment stress distributions along...... yield lines around the block leads to simple interaction formulas similar to other interaction formulas in the codes....

Epidural block

Science.gov (United States)

... page: //medlineplus.gov/ency/patientinstructions/000484.htm Epidural block - pregnancy To use the sharing features on this page, please enable JavaScript. An epidural block is a numbing medicine given by injection (shot) ...

Therapeutic effects of selective atrioventricular node vagal stimulation in atrial fibrillation and heart failure.

Science.gov (United States)

Zhang, Youhua; Popović, Zoran B; Kusunose, Kenya; Mazgalev, Todor N

2013-01-01

Atrial fibrillation (AF) and heart failure (HF) frequently coexist. We have previously demonstrated that selective atrioventricular node (AVN) vagal stimulation (AVN-VS) can be used to control ventricular rate during AF. Due to withdrawal of vagal activity in HF, the therapeutic effects of AVN-VS may be compromised in the combined condition of AF and HF. Accordingly, this study was designed to evaluate the therapeutic effects of AVN-VS to control ventricular rate in AF and HF. A combined model of AF and HF was created by implanting a dual chamber pacemaker in 24 dogs. A newly designed bipolar electrode was inserted into the ganglionic AVN fat pad and connected to a nerve stimulator for delivering AVN-VS. In all dogs, HF was induced by high rate ventricular pacing at 220 bpm for 4 weeks. AF was then induced and maintained by rapid atrial pacing at 600 bpm after discontinuation of ventricular pacing. These HF + AF dogs were randomized into control (n = 9) and AVN-VS (n = 15) groups. In the latter group, vagal stimulation (310 μs, 20 Hz, 3-7 mA) was delivered continuously for 6 months. Compared with the control, AVN-VS had a consistent effect on ventricular rate slowing (by >50 bpm, all P AVN-VS was well tolerated by the treated animals. AVN-VS achieved consistent rate slowing, which was associated with improved ventricular function in a canine AF and HF model. Thus, AVN-VS may be a novel, effective therapeutic option in the combined condition of AF and HF. © 2012 Wiley Periodicals, Inc.

Molecular Mobility in Phase Segregated Bottlebrush Block Copolymer Melts

Science.gov (United States)

Yavitt, Benjamin; Gai, Yue; Song, Dongpo; Winter, H. Henning; Watkins, James

We investigate the linear viscoelastic behavior of poly(styrene)-block-poly(ethylene oxide) (PS-b-PEO) brush block copolymer (BBCP) materials over a range of vol. fractions and with side chain lengths below the entanglement molecular weights. The high chain mobility of the brush architecture results in rapid micro-phase segregation of the brush copolymer segments, which occurs during thermal annealing at mild temperatures. Master curves of the dynamic moduli were obtained by time-temperature superposition. The reduced degree of chain entanglements leads to a unique liquid-like rheology similar to that of bottlebrush homopolymers, even in the phase segregated state. We also explore the alignment of phase segregated domains at exceptionally low strain amplitudes (γ = 0.01) and mild processing temperatures using small angle X-ray scattering (SAXS). Domain orientation occurred readily at strains within the linear viscoelastic regime without noticeable effect on the moduli. This interplay of high molecular mobility and rapid phase segregation that are exhibited simultaneously in BBCPs is in contrast to the behavior of conventional linear block copolymer (LBCP) analogs and opens up new possibilities for processing BBCP materials for a wide range of nanotechnology applications. NSF Center for Hierarchical Manufacturing at the University of Massachusetts, Amherst (CMMI-1025020).

Solvothermal Vapor Annealing of Lamellar Poly(styrene)-block-poly(d,l-lactide) Block Copolymer Thin Films for Directed Self-Assembly Application.

Science.gov (United States)

Cummins, Cian; Mokarian-Tabari, Parvaneh; Andreazza, Pascal; Sinturel, Christophe; Morris, Michael A

2016-03-01

Solvothermal vapor annealing (STVA) was employed to induce microphase separation in a lamellar forming block copolymer (BCP) thin film containing a readily degradable block. Directed self-assembly of poly(styrene)-block-poly(d,l-lactide) (PS-b-PLA) BCP films using topographically patterned silicon nitride was demonstrated with alignment over macroscopic areas. Interestingly, we observed lamellar patterns aligned parallel as well as perpendicular (perpendicular microdomains to substrate in both cases) to the topography of the graphoepitaxial guiding patterns. PS-b-PLA BCP microphase separated with a high degree of order in an atmosphere of tetrahydrofuran (THF) at an elevated vapor pressure (at approximately 40-60 °C). Grazing incidence small-angle X-ray scattering (GISAXS) measurements of PS-b-PLA films reveal the through-film uniformity of perpendicular microdomains after STVA. Perpendicular lamellar orientation was observed on both hydrophilic and relatively hydrophobic surfaces with a domain spacing (L0) of ∼32.5 nm. The rapid removal of the PLA microdomains is demonstrated using a mild basic solution for the development of a well-defined PS mask template. GISAXS data reveal the through-film uniformity is retained following wet etching. The experimental results in this article demonstrate highly oriented PS-b-PLA microdomains after a short annealing period and facile PLA removal to form porous on-chip etch masks for nanolithography application.

Predictability of blocking

International Nuclear Information System (INIS)

Tosi, E.; Ruti, P.; Tibaldi, S.; D'Andrea, F.

1994-01-01

Tibaldi and Molteni (1990, hereafter referred to as TM) had previously investigated operational blocking predictability by the ECMWF model and the possible relationships between model systematic error and blocking in the winter season of the Northern Hemisphere, using seven years of ECMWF operational archives of analyses and day 1 to 10 forecasts. They showed that fewer blocking episodes than in the real atmosphere were generally simulated by the model, and that this deficiency increased with increasing forecast time. As a consequence of this, a major contribution to the systematic error in the winter season was shown to derive from the inability of the model to properly forecast blocking. In this study, the analysis performed in TM for the first seven winter seasons of the ECMWF operational model is extended to the subsequent five winters, during which model development, reflecting both resolution increases and parametrisation modifications, continued unabated. In addition the objective blocking index developed by TM has been applied to the observed data to study the natural low frequency variability of blocking. The ability to simulate blocking of some climate models has also been tested

Use of an Android application “clinometer” for measurement of head down tilt given during subarachnoid block

Science.gov (United States)

Dixit, RB; Neema, MM

2016-01-01

Context: Head down tilt is given to patients after sub arachnoid block for adjustment of height of block. However, the amount of tilt given is subjective and cannot be documented. Aims: We used an android application named “clinometer” to measure exact degree of tilt given by anesthesiologists as their routine practice. Settings and Design: This observational study, at a medical college hospital, was done in 130 patients given sub arachnoid block for lower abdominal surgeries. Materials and Methods: We observed and documented vital data of patients and measured tilt given by application “clinometer.” Results: We observed that the application was easy to use and measured tilt each time. The result obtained can be documented, digitally saved and transferred. In 130 patients studied, we observed incidence of degree of tilt as follows: 6-8° tilt in 38 patients (29.23%), 8-10 in 36 patients (27.69%), 10-12 in 30 patients (23.08%), 12-14 in 12 patients (9.23%) and 14-16° tilt in 14 patients (10.77%). Use of application was received with enthusiasm by practicing anesthesiologists. Various possible uses of this application are discussed. PMID:26955307

Inhibitory effects of Urtica dioica L. root on electrophysiological properties of isolated rabbit atrioventricular node

Directory of Open Access Journals (Sweden)

A. Enayati

2017-11-01

Full Text Available Background and objectives: The ideal drug for treatment of a wide range of supraventricular arrhythmia hasn't yet been developed. Previous studies have shown antihypertensive and negative inotropic effects of the Urtica dioica L. (nettle. Therefore, the aim of present study is to determine the rate dependent inhibitory effects of ethanol extract of nettle root and investigate the role of adrenoceptors in the anti-arrhythmic mechanism of nettle on the isolated rabbit atrio-ventricular node. Methods: Urtica dioica roots were collected from Gorgan (Golestan, Iran. Male New Zealand rabbits (n=7 were used in all of the experiments. Experimental stimulation protocols (WBCL; Recovery, Facilitation, Fatigue were applied to assess electrophysiological properties of Node. All protocols were repeated in the presence and absence (control of different concentration (0.25-0.5 w/v % of nettle and 1 μM nadolol. Data were shown as Mean±SE, difference between groups statistically were assessed by SPSS software. Results: Nettle (0.5 w/v significantly decreased basic and functional properties of node as WBCL, ERP, FRP, AVCT and magnitude of fatigue (∆AH significantly increased but ∆FRP significantly decreased. In the presence of nadolol (1μM as a nonselective β-blocker, nettle (0.3 mg/L could not repeat its effects on electrophysiological properties of AV-node. Conclusion: The results showed the modifying properties of Urtica dioica root extract. It may be considered as a candidate for the treatment of supraventicular arrhythmias.

Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE.

Science.gov (United States)

Steinberg, Benjamin A; Wehrenberg, Scott; Jackson, Kevin P; Hayes, David L; Varma, Niraj; Powell, Brian D; Day, John D; Frazier-Mills, Camille G; Stein, Kenneth M; Jones, Paul W; Piccini, Jonathan P

2015-12-01

Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure, yet response rates are variable. We sought to determine whether physician-specified CRT programming was associated with improved outcomes. Using data from the ALTITUDE remote follow-up cohort, we examined sensed atrioventricular (AV) and ventricular-to-ventricular (VV) programming and their associated outcomes in patients with de novo CRT from 2009-2010. Outcomes included arrhythmia burden, left ventricular (LV) pacing, and all-cause mortality at 4 years. We identified 5709 patients with de novo CRT devices; at the time of implant, 34% (n = 1959) had entirely nominal settings programmed, 40% (n = 2294) had only AV timing adjusted, 11% (n = 604) had only VV timing adjusted, and 15% (n = 852) had both AV and VV adjusted from nominal programming. Suboptimal LV pacing (5% was lowest in the AV-only adjusted group (17.9%) and highest in the nominal (27.7%) and VV-only adjusted (28.3%) groups. Adjusted all-cause mortality was significantly higher among patients with non-nominal AV delay >120 vs. 180 vs. ≤180 ms, p = 0.4). Nominal settings for de novo CRT implants are frequently altered, most commonly the AV delay. There is wide variability in reprogramming. Patients with nominal or AV-only adjustments appear to have favorable pacing and arrhythmia outcomes. Sensed AV delays less than 120 ms are associated with improved survival.

Design of permanent block stopping to resist strata convergence

Energy Technology Data Exchange (ETDEWEB)

Ray, R.E.

1985-11-01

Conventional concrete block plastered with a cementitious coating is the most common material used in the construction of permanent stoppings to direct airflow in underground mines in the US. All mines experience various degrees of strata convergence depending on depth of overburden, geological conditions, and type of roof support employed. Strata convergence will cause cracks and joint openings in masonry stoppings, resulting in significant air leakage losses. Where strata convergence is severe, complete structural failure of the stopping can ultimately occur. Reconstruction of damaged or destroyed stoppings adds expensive overheads to mining operations, and even greater expenses are incurred from the additional fan horsepower required to overcome leakage losses. Ideally, a stopping should maintain high resistance to airflow while yielding to strata convergence. By properly incorporating a polyisocyanurate rigid foam material within the masonry block structure, stopping service life can be increased in mines experiencing strata convergence problems such as floor heave, roof loading, and lateral rib movement.

A controlled release system for proteins based on poly(ether ester) block-copolymers: polymer network characterization

NARCIS (Netherlands)

Bezemer, J.M.; Grijpma, Dirk W.; Dijkstra, Pieter J.; van Blitterswijk, Clemens; Feijen, Jan

1999-01-01

The properties of a series of multiblock copolymers, based on hydrophilic poly(ethylene glycol) (PEG) and hydrophobic poly(butylene terephthalate) (PBT) blocks were investigated with respect to their application as a matrix for controlled release of proteins. The degree of swelling, Q, of the

Homogeneous bilateral block shifts

Indian Academy of Sciences (India)

Douglas class were classified in [3]; they are unilateral block shifts of arbitrary block size (i.e. dim H(n) can be anything). However, no examples of irreducible homogeneous bilateral block shifts of block size larger than 1 were known until now.

Degree-degree correlations in directed networks with heavy-tailed degrees

NARCIS (Netherlands)

van der Hoorn, W.L.F.; Litvak, Nelli

2013-01-01

In network theory, Pearson's correlation coefficients are most commonly used to measure the degree assortativity of a network. We investigate the behavior of these coefficients in the setting of directed networks with heavy-tailed degree sequences. We prove that for graphs where the in- and

Degree-degree dependencies in directed networks with heavy-tailed degrees

NARCIS (Netherlands)

van der Hoorn, W.L.F.; Litvak, Nelly

2015-01-01

In network theory, Pearson’s correlation coefficients are most commonly used to measure the degree assortativity of a network. We investigate the behavior of these coefficients in the setting of directed networks with heavy-tailed degree sequences. We prove that for graphs where the in- and

Demand Response Technology Readiness Levels for Energy Management in Blocks of Buildings

Directory of Open Access Journals (Sweden)

Tracey Crosbie

2018-01-01

Full Text Available Fossil fuels deliver most of the flexibility in contemporary electricity systems. The pressing need to reduce CO2 emissions requires new methods to provide this flexibility. Demand response (DR offers consumers a significant role in the delivery of flexibility by reducing or shifting their electricity usage during periods of stress or constraint. Blocks of buildings offer more flexibility in the timing and use of energy than single buildings, however, and a lack of relevant scalable ICT tools hampers DR in blocks of buildings. To ameliorate this problem, a current innovation project called “Demand Response in Blocks of Buildings” (DR-BoB: www.dr-bob.eu has integrated existing technologies into a scalable cloud-based solution for DR in blocks of buildings. The degree to which the DR-BoB energy management solution can increase the ability of any given site to participate in DR is dependent upon its current energy systems, i.e., the energy metering, the telemetry and control technologies in building management systems, and the existence/capacity of local power generation and storage plants. To encourage the owners and managers of blocks of buildings to participate in DR, a method of assessing and validating the technological readiness to participate in DR energy management solutions at any given site is required. This paper describes the DR-BoB energy management solution and outlines what we have called the demand response technology readiness levels (DRTRLs for the implementation of such a solution in blocks of buildings.

Detection block

International Nuclear Information System (INIS)

Bezak, A.

1987-01-01

A diagram is given of a detection block used for monitoring burnup of nuclear reactor fuel. A shielding block is an important part of the detection block. It stabilizes the fuel assembly in the fixing hole in front of a collimator where a suitable gamma beam is defined for gamma spectrometry determination of fuel burnup. The detector case and a neutron source case are placed on opposite sides of the fixing hole. For neutron measurement for which the water in the tank is used as a moderator, the neutron detector-fuel assembly configuration is selected such that neutrons from spontaneous fission and neutrons induced with the neutron source can both be measured. The patented design of the detection block permits longitudinal travel and rotation of the fuel assembly to any position, and thus more reliable determination of nuclear fuel burnup. (E.S.). 1 fig

Distrofia muscular de Emery-Dreifuss: relato de caso Emery-Dreifuss muscular dystrophy: case report

Directory of Open Access Journals (Sweden)

Ana Lucila Moreira Carsten

2006-06-01

Full Text Available A distrofia muscular de Emery-Dreifuss é uma forma de distrofia muscular freqüentemente associada a contraturas articulares e defeitos de condução cardíaca, que pode ser causada pela deficiência da proteína emerina na membrana nuclear interna das fibras musculares. Descrevemos o caso de um homem de 19 anos com diminuição de força muscular, hipotrofia nas cinturas escapular e pélvica, disfagia, contraturas articulares em cotovelos e tornozelos, apresentando história familiar compatível com herança ligada ao cromossomo X. A investigação mostrou creatinaquinase sérica elevada, eletrocardiograma com bloqueio atrioventricular de primeiro grau e bloqueio de ramo direito, eletroneuromiografia normal, biópsia muscular com alterações miopáticas e a análise por imuno-histoquímica mostrou deficiência de emerina. São discutidas as manifestações clínicas e genéticas, alterações laboratoriais e eletroneuromiográficas, bem como, a importância do estudo do padrão de herança no aconselhamento genético destas famílias.The Emery-Dreifuss muscular dystrophy is a form of muscular dystrophy that frequently presents early contractures and cardiac conduction defects, caused by emerin deficiency in the inner nuclear membrane of the muscular fibers. A 19-years-old man it presented muscle weakness and hypotrophy in the proximal upper and lower limbs, dysphagia and early contractures in elbows and ankles, with familiar history compatible with X-linked inheritance form. The investigation showed increased serum creatinekinase levels electrocardiogram had a first degree atrioventricular block and right bundle branch block normal electromyography and nerve conduction study muscle biopsy disclosed myopathic characteristics and nuclear protein immunohystochemical analysis showed deficiency of emerin. The clinical and genetics manifestations, laboratorial and electromyography changes, as well as, the study of the pattern of inheritance for

Universal and blocking primer mismatches limit the use of high-throughput DNA sequencing for the quantitative metabarcoding of arthropods.

Science.gov (United States)

Piñol, J; Mir, G; Gomez-Polo, P; Agustí, N

2015-07-01

The quantification of the biological diversity in environmental samples using high-throughput DNA sequencing is hindered by the PCR bias caused by variable primer-template mismatches of the individual species. In some dietary studies, there is the added problem that samples are enriched with predator DNA, so often a predator-specific blocking oligonucleotide is used to alleviate the problem. However, specific blocking oligonucleotides could coblock nontarget species to some degree. Here, we accurately estimate the extent of the PCR biases induced by universal and blocking primers on a mock community prepared with DNA of twelve species of terrestrial arthropods. We also compare universal and blocking primer biases with those induced by variable annealing temperature and number of PCR cycles. The results show that reads of all species were recovered after PCR enrichment at our control conditions (no blocking oligonucleotide, 45 °C annealing temperature and 40 cycles) and high-throughput sequencing. They also show that the four factors considered biased the final proportions of the species to some degree. Among these factors, the number of primer-template mismatches of each species had a disproportionate effect (up to five orders of magnitude) on the amplification efficiency. In particular, the number of primer-template mismatches explained most of the variation (~3/4) in the amplification efficiency of the species. The effect of blocking oligonucleotide concentration on nontarget species relative abundance was also significant, but less important (below one order of magnitude). Considering the results reported here, the quantitative potential of the technique is limited, and only qualitative results (the species list) are reliable, at least when targeting the barcoding COI region. © 2014 John Wiley & Sons Ltd.

Synthesis of amylose-block-polystyrene rod-coil block copolymers

NARCIS (Netherlands)

Loos, Katja; Stadler, Reimund

1997-01-01

In the present communication we demonstrate the synthesis of a hybrid block copolymer based on the combination of a biopolymer (amylose) with a synthetic block (polystyrene). To obtain such materials, amino-functionalized polymers were modified with maltoheptaose moieties that serve as initiators

Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study.

Directory of Open Access Journals (Sweden)

Nai-Liang Li

Full Text Available Paravertebral block placement was the main anesthetic technique for modified radical mastectomy in our hospital until February 2014, when its combination with blocks targeting the pectoral musculature was initiated. We compared the analgesic effects of paravertebral blocks with or without blocks targeting the pectoral musculature for modified radical mastectomy.We retrospectively collected data from a single surgeon and anesthesiologist from June 1, 2012, to May 31, 2015. Intraoperative sedatives and analgesic requirements, time to the first analgesic request, postoperative analgesic doses, patient satisfaction, and complications were compared.Fifty-four patients received a paravertebral block alone (PECS 0, and 46 received a paravertebral block combined with blocks targeting the pectoral musculature (PECS 1. The highest intraoperative effect-site concentration of propofol was significantly lower in the PECS 1 group than in the PECS 0 group [2.3 (1.5, 2.8 vs 2.5 (1.5, 4 μg/mL, p = 0.0014]. The intraoperative rescue analgesic dose was significantly lower in the PECS 1 group [0 (0, 25 vs 0 (0, 75 mg of ketamine, p = 0.0384]. Furthermore, the PECS 1 group had a significantly longer time to the first analgesic request [636.5 (15, 720 vs 182.5 (14, 720 min, p = 0.0001]. After further adjustment for age, body mass index, American Society of Anesthesiologists Physical Status classification, chronic pain history, incidence of a superficial cervical plexus block placement, and operation duration, blocks targeting the pectoral musculature were determined to be the only significant factor (hazard ratio, 0.36; 95% confidence interval, 0.23-0.58; p < 0.0001. Very few patients used potent analgesics including morphine and ketorolac; the cumulative use of morphine or ketorolac was similar in the study groups. However, the incidence of all analgesic use, namely morphine, ketorolac, acetaminophen, and celecoxib, was significantly lower in the PECS 1 group [3

Rates and timing of vertical-axis block rotations across the Sierra Nevada-Walker Lane transition in the Bodie Hills

Science.gov (United States)

Rood, D. H.; Herman, S.; Burbank, D.; Bogue, S.

2008-12-01

We use paleomagnetic data from Tertiary volcanic rocks to address the rates and timing of vertical-axis block rotation across the Sierra Nevada-Walker Lane transition in the Bodie Hills, California/Nevada. In zones of continental deformation, block rotations are an important mechanism for permanent stain accommodation, and thus may be crucial to testing geodetic block models and resolving geologic-geodetic slip discrepancies. In our study, data included in the paleomagetic site means are high quality AF demagnetization results (least squared fits that generally include 5-7 points with MAD values less than 1). Thermal demagnetization results match the AF directions, and both thermal demag and rockmag results indicate strong ChRM, mostly carried by single domain magnetite. The site means used to calculate the VGPs all have a95 values less than 10 (mostly 2-5) and include 6-11 sites each. Each site (and thus site mean) has a reasonably well-known structural correction. The VGP scatter values range from 12 to 16 degrees, indicating that they include appropriate secular variation. The mean declinations and 95 percent confidence limits for each VGP timeslice are statistically distinct from one another (71 ± 9, 39 ± 13, and 11 ± 11 degrees). The slope of a linear regression fit to the age versus declination data gives a rate of vertical axis block rotation of approximately 3-4 degrees/Myr. Fitting two separate lines to the age vs. declination data would indicate an increase in the rates of rotation since ~10 Ma. Two possible interpretations of the data are: (1) the rotations began during or before the Middle Miocene, or (2) rates of rotation were high initially (e.g. ~10 Ma) and decelerated until the Pliocene. These data have implications for the (1) timing and spatial extent of distributed strain accumulation related to the initiation of the San Andreas Fault-Eastern California Shear Zone-Walker Lane transform plate boundary, (2) transfer of transform plate boundary

Normal mode analysis of macromolecular systems with the mobile block Hessian method

International Nuclear Information System (INIS)

Ghysels, An; Van Speybroeck, Veronique; Van Neck, Dimitri; Waroquier, Michel; Brooks, Bernard R.

2015-01-01

Until recently, normal mode analysis (NMA) was limited to small proteins, not only because the required energy minimization is a computationally exhausting task, but also because NMA requires the expensive diagonalization of a 3N a ×3N a matrix with N a the number of atoms. A series of simplified models has been proposed, in particular the Rotation-Translation Blocks (RTB) method by Tama et al. for the simulation of proteins. It makes use of the concept that a peptide chain or protein can be seen as a subsequent set of rigid components, i.e. the peptide units. A peptide chain is thus divided into rigid blocks with six degrees of freedom each. Recently we developed the Mobile Block Hessian (MBH) method, which in a sense has similar features as the RTB method. The main difference is that MBH was developed to deal with partially optimized systems. The position/orientation of each block is optimized while the internal geometry is kept fixed at a plausible - but not necessarily optimized - geometry. This reduces the computational cost of the energy minimization. Applying the standard NMA on a partially optimized structure however results in spurious imaginary frequencies and unwanted coordinate dependence. The MBH avoids these unphysical effects by taking into account energy gradient corrections. Moreover the number of variables is reduced, which facilitates the diagonalization of the Hessian. In the original implementation of MBH, atoms could only be part of one rigid block. The MBH is now extended to the case where atoms can be part of two or more blocks. Two basic linkages can be realized: (1) blocks connected by one link atom, or (2) by two link atoms, where the latter is referred to as the hinge type connection. In this work we present the MBH concept and illustrate its performance with the crambin protein as an example

Influence of anchor block size on the thickness of adsorbed block copolymer layers

NARCIS (Netherlands)

Belder, G.F; ten Brinke, G.; Hadziioannou, G

1997-01-01

We present surface force data on three different polystyrene/poly(2-vinylpyridine) block copolymers (PS/P2VP) with a fixed size of the nonadsorbing PS block but widely varying sizes of the adsorbing P2VP block. With respect to the sizes of the two blocks, they range from moderately to highly

[Interscalene block for total shoulder arthroplasty: comparative study (ultrasound vs. neurostimulation)].

Science.gov (United States)

Mejía-Terrazas, Gabriel Enrique; Ruiz-Suárez, Michell; Gaspar-Carrillo, Sandra Patricia; Valero-González, Fernando; Unzueta-Navarro, David; Encalada-Díaz, Iván

2014-01-01

Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty. We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured. We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023. Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.

Combined KHFAC + DC nerve block without onset or reduced nerve conductivity after block

Science.gov (United States)

Franke, Manfred; Vrabec, Tina; Wainright, Jesse; Bhadra, Niloy; Bhadra, Narendra; Kilgore, Kevin

2014-10-01

Objective. Kilohertz frequency alternating current (KHFAC) waveforms have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Approach. A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC + CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC + CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 s (range: 318-1563 s) of cumulative dc to investigate the impact of combined KHFAC + CBDC on nerve viability. Main results. The peak onset force was reduced significantly from 20.73 N (range: 18.6-26.5 N) with KHFAC alone to 0.45 N (range: 0.2-0.7 N) with the combined CBDC and KHFAC block waveform (p conductivity was observed after application of the combined KHFAC + CBDC block relative to KHFAC waveforms. Significance. The distal application of CBDC can significantly reduce or even completely prevent the KHFAC onset response without a change in nerve conductivity.

Block spins and chirality in Heisenberg model on Kagome and triangular lattices

International Nuclear Information System (INIS)

Subrahmanyam, V.

1994-01-01

The spin-1/2 Heisenberg model (HM) is investigated using a block-spin renormalization approach on Kagome and triangular lattices. In both cases, after coarse graining the triangles on original lattice and truncation of the Hilbert space to the triangular ground state subspace, HM reduces to an effective model on a triangular lattice in terms of the triangular-block degrees of freedom viz. the spin and the chirality quantum numbers. The chirality part of the effective Hamiltonian captures the essential difference between the two lattices. It is seen that simple eigenstates can be constructed for the effective model whose energies serve as upper bounds on the exact ground state energy of HM, and chiral ordered variational states have high energies compared to the other variational states. (author). 12 refs, 2 figs

UV Blocking Glass: Low Cost Filters for Visible Light Photocatalytic Assessment

Directory of Open Access Journals (Sweden)

Charles W. Dunnill

2014-01-01

Full Text Available A number of commercially available art protection products have been compared and assessed for their suitability as UV blocking filters in the application of “visible light” photocatalytic research. Many groups claiming visible light photocatalytic success employ filters to block out stray UV radiation in order to justify that their photocatalysts are indeed visible light photocatalysts and not UV light photocatalysts. These filters come in varying degrees of ability and price and many authors fail to correctly characterise their filters in individual papers. The use of effective filters to prevent both false positive and false negative results is important to maintain scientific rigor and create accurate understanding of the subject. The optimum UV filter would have the highest UV blocking properties (<390 nm and simultaneously the highest visible light transmission (390–750 nm. Single and double layers of each of the glass products were assessed as well as laminate products. The conclusions show an inexpensive and highly effective setup for the conduction of visible light photochemistry that should be incorporated as a standard part in any researcher’s work where the claim of visible light activity is made.

Abdominal wall blocks in adults

DEFF Research Database (Denmark)

Børglum, Jens; Gögenür, Ismail; Bendtsen, Thomas F

2016-01-01

been introduced with success. Future research should also investigate the effect of specific abdominal wall blocks on neuroendocrine and inflammatory stress response after surgery.  Summary USG abdominal wall blocks in adults are commonplace techniques today. Most abdominal wall blocks are assigned......Purpose of review Abdominal wall blocks in adults have evolved much during the last decade; that is, particularly with the introduction of ultrasound-guided (USG) blocks. This review highlights recent advances of block techniques within this field and proposes directions for future research.......  Recent findings Ultrasound guidance is now considered the golden standard for abdominal wall blocks in adults, even though some landmark-based blocks are still being investigated. The efficiency of USG transversus abdominis plane blocks in relation to many surgical procedures involving the abdominal wall...

Manual Intracardiac Electrogram Method Is Accurate Alternative to Echocardiography for Atrioventricular and Interventricular Optimization in Cardiac Resynchronization Therapy.

Science.gov (United States)

Pezo Nikolić, Borka; Lovrić, Daniel; Ljubas Maček, Jana; Rešković Lukšić, Vlatka; Matasić, Richard; Šeparović Hanževački, Jadranka

2017-12-01

Some manufacturers do not provide automated intracardiac electrogram method (IEGM) systems for atrioventricular (AV) and interventricular (VV) delay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the accuracy of manual IEGM method in 48 patients previously implanted with Medtronic Syncra CRT. All patients underwent standard device interrogation followed by CRT optimization by IEGM method and by echocardiography one month after implantation. The patient mean age was 60.7±11.8 years and there were 33 (68.8%) males. After CRT implantation, the left ventricular ejection fraction increased from 28.0±7.9% to 39.1±11.0% (p<0.001). Optimal aortic flow Velocity Time Integral (aVTI) was obtained when VV was set to 20-50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (R=0.823, p<0.001). We found no significant difference in AV, VV and aVTI values between echocardiography and IEGM method. However, IEGM was significantly less time-consuming than echocardiography [20 (10-28) vs. 40 (35-60) minutes, p<0.001]. Manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems in as many CRT devices as possible.

Id4 functions downstream of Bmp signaling to restrict TCF function in endocardial cells during atrioventricular valve development.

Science.gov (United States)

Ahuja, Suchit; Dogra, Deepika; Stainier, Didier Y R; Reischauer, Sven

2016-04-01

The atrioventricular canal (AVC) connects the atrial and ventricular chambers of the heart and its formation is critical for the development of the cardiac valves, chamber septation and formation of the cardiac conduction system. Consequently, problems in AVC formation can lead to congenital defects ranging from cardiac arrhythmia to incomplete cardiac septation. While our knowledge about early heart tube formation is relatively comprehensive, much remains to be investigated about the genes that regulate AVC formation. Here we identify a new role for the basic helix-loop-helix factor Id4 in zebrafish AVC valve development and function. id4 is first expressed in the AVC endocardium and later becomes more highly expressed in the atrial chamber. TALEN induced inactivation of id4 causes retrograde blood flow at the AV canal under heat induced stress conditions, indicating defects in AV valve function. At the molecular level, we found that id4 inactivation causes misexpression of several genes important for AVC and AV valve formation including bmp4 and spp1. We further show that id4 appears to control the number of endocardial cells that contribute to the AV valves by regulating Wnt signaling in the developing AVC endocardium. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative study between ultrasound guided TAP block and paravertebral block in upper abdominal surgeries

Directory of Open Access Journals (Sweden)

Ruqaya M Elsayed Goda

2017-01-01

Conclusion: We concluded that ultrasound guided transverses abdominis plane block and thoracic paravertebral block were safe and effective anesthetic technique for upper abdominal surgery with longer and potent postoperative analgesia in thoracic paravertebral block than transverses abdominis block.

Fermion-scalar conformal blocks

Energy Technology Data Exchange (ETDEWEB)

Iliesiu, Luca [Joseph Henry Laboratories, Princeton University,Washington Road, Princeton, NJ 08544 (United States); Kos, Filip [Department of Physics, Yale University,217 Prospect Street, New Haven, CT 06520 (United States); Poland, David [Department of Physics, Yale University,217 Prospect Street, New Haven, CT 06520 (United States); School of Natural Sciences, Institute for Advanced Study,1 Einstein Dr, Princeton, New Jersey 08540 (United States); Pufu, Silviu S. [Joseph Henry Laboratories, Princeton University,Washington Road, Princeton, NJ 08544 (United States); Simmons-Duffin, David [School of Natural Sciences, Institute for Advanced Study,1 Einstein Dr, Princeton, New Jersey 08540 (United States); Yacoby, Ran [Joseph Henry Laboratories, Princeton University,Washington Road, Princeton, NJ 08544 (United States)

2016-04-13

We compute the conformal blocks associated with scalar-scalar-fermion-fermion 4-point functions in 3D CFTs. Together with the known scalar conformal blocks, our result completes the task of determining the so-called ‘seed blocks’ in three dimensions. Conformal blocks associated with 4-point functions of operators with arbitrary spins can now be determined from these seed blocks by using known differential operators.

Inhibition of sarcoplasmic reticulum Ca(2+)-ATPase decreases atrioventricular node-paced heart rate in rabbits.

Science.gov (United States)

Cheng, Hongwei; Smith, Godfrey L; Orchard, Clive H; Hancox, Jules C; Burton, Francis L

2012-10-01

Recent data indicate that Ca(2+) cycling in isolated atrioventricular node (AVN) cells contributes to setting spontaneous rate. The aim of the present study was to extend this observation to the intact AVN in situ, by evaluating the effects of inhibiting sarcoplasmic reticulum Ca(2+) uptake with cyclopiazonic acid (CPA) on intact AVN spontaneous activity and its response to isoprenaline. A model of the AVN-paced heart was produced to investigate intact AVN automaticity, by surgical ablation of the sino-atrial node (SAN) in the rabbit Langendorff-perfused heart. Electrograms were recorded from a site close to the AVN (triangle of Koch), an atrial site above the AVN, the left atrium and right ventricle, enabling AVN pacing of the preparation to be confirmed. Before SAN ablation, the heart rate was 166.8 ± 5.4 beats min(-1). Ablation of the SAN was clearly indicated by a sudden and significant decrease of heart rate to 108.6 ± 9.6 beats min(-1) (P AVN rate to 187.8 ± 12.0 beats min(-1) after 1 min of application (P AVN rate to 81.6 ± 4.8 (n = 9) and 77.4 ± 6.0 beats min(-1) (n = 7), respectively [P AVN rate increase in response to isoprenaline from 78.8 ± 10.0 to 46.8 ± 6.8 and 26.7 ± 5.3%, respectively (P AVN rate and its response to isoprenaline indicate that Ca(2+) cycling is important to the intact AVN spontaneous activity and its acceleration during sympathetic stimulation.

Unintended consequences of increasing block tariffs pricing policy in urban water

Science.gov (United States)

Dahan, Momi; Nisan, Udi

2007-03-01

We exploit a unique data set to estimate the degree of economies of scale in water consumption, controlling for the standard demand factors. We found a linear Engel curve in water consumption: each additional household member consumes the same water quantity regardless of household size, except for a single-person household. Our evidence suggests that the increasing block tariffs (IBT) structure, which is indifferent to household size, has unintended consequences. Large households, which are also likely to be poor given the negative correlation between income and household size, are charged a higher price for water. The degree of economies of scale found here erodes the effectiveness of IBT price structure as a way to introduce an equity consideration. This implication is important in view of the global trend toward the use of IBT.

Block Cipher Analysis

DEFF Research Database (Denmark)

Miolane, Charlotte Vikkelsø

ensurethat no attack violatesthe securitybounds specifiedbygeneric attack namely exhaustivekey search and table lookup attacks. This thesis contains a general introduction to cryptography with focus on block ciphers and important block cipher designs, in particular the Advanced Encryption Standard(AES...... on small scale variants of AES. In the final part of the thesis we present a new block cipher proposal Present and examine its security against algebraic and differential cryptanalysis in particular....

Main-chain supramolecular block copolymers.

Science.gov (United States)

Yang, Si Kyung; Ambade, Ashootosh V; Weck, Marcus

2011-01-01

Block copolymers are key building blocks for a variety of applications ranging from electronic devices to drug delivery. The material properties of block copolymers can be tuned and potentially improved by introducing noncovalent interactions in place of covalent linkages between polymeric blocks resulting in the formation of supramolecular block copolymers. Such materials combine the microphase separation behavior inherent to block copolymers with the responsiveness of supramolecular materials thereby affording dynamic and reversible materials. This tutorial review covers recent advances in main-chain supramolecular block copolymers and describes the design principles, synthetic approaches, advantages, and potential applications.

Ultrasound guided supraclavicular block.

LENUS (Irish Health Repository)

Hanumanthaiah, Deepak

2013-09-01

Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

Congenital heart block maternal sera autoantibodies target an extracellular epitope on the α1G T-type calcium channel in human fetal hearts.

Directory of Open Access Journals (Sweden)

Linn S Strandberg

Full Text Available Congenital heart block (CHB is a transplacentally acquired autoimmune disease associated with anti-Ro/SSA and anti-La/SSB maternal autoantibodies and is characterized primarily by atrioventricular (AV block of the fetal heart. This study aims to investigate whether the T-type calcium channel subunit α1G may be a fetal target of maternal sera autoantibodies in CHB.We demonstrate differential mRNA expression of the T-type calcium channel CACNA1G (α1G gene in the AV junction of human fetal hearts compared to the apex (18-22.6 weeks gestation. Using human fetal hearts (20-22 wks gestation, our immunoprecipitation (IP, Western blot analysis and immunofluorescence (IF staining results, taken together, demonstrate accessibility of the α1G epitope on the surfaces of cardiomyocytes as well as reactivity of maternal serum from CHB affected pregnancies to the α1G protein. By ELISA we demonstrated maternal sera reactivity to α1G was significantly higher in CHB maternal sera compared to controls, and reactivity was epitope mapped to a peptide designated as p305 (corresponding to aa305-319 of the extracellular loop linking transmembrane segments S5-S6 in α1G repeat I. Maternal sera from CHB affected pregnancies also reacted more weakly to the homologous region (7/15 amino acids conserved of the α1H channel. Electrophysiology experiments with single-cell patch-clamp also demonstrated effects of CHB maternal sera on T-type current in mouse sinoatrial node (SAN cells.Taken together, these results indicate that CHB maternal sera antibodies readily target an extracellular epitope of α1G T-type calcium channels in human fetal cardiomyocytes. CHB maternal sera also show reactivity for α1H suggesting that autoantibodies can target multiple fetal targets.

Permanent and temporary pacemaker implantation after orthotopic heart transplantation

Directory of Open Access Journals (Sweden)

Bacal Fernando

2000-01-01

Full Text Available PURPOSE:To determine the indication for and incidence and evolution of temporary and permanent pacemaker implantation in cardiac transplant recipients. METHODS: A retrospective review of 114 patients who underwent orthotopic heart transplantation InCor (Heart Institute USP BR between March 1985 and May 1993. We studied the incidence of and indication for temporary pacing, the relationship between pacing and rejection, the need for pemanent pacing and the clinical follow-up. RESULTS: Fourteen of 114 (12%heart transplant recipients required temporary pacing and 4 of 114 (3.5% patients required permanent pacing. The indication for temporary pacing was sinus node dysfunction in 11 patients (78.5% and atrioventricular (AV block in 3 patients (21.4%. The indication for permanent pacemaker implantation was sinus node dysfunction in 3 patients (75% and atrioventricular (AV block in 1 patient (25%. We observed rejection in 3 patients (21.4% who required temporary pacing and in 2 patients (50% who required permanent pacing. The previous use of amiodarone was observed in 10 patients (71.4% with temporary pacing. Seven of the 14 patients (50% died during follow-up. CONCLUSION: Sinus node dysfunction was the principal indication for temporary and permanent pacemaker implantation in cardiac transplant recipients. The need for pacing was related to worse prognosis after cardiac transplantation.

Magnetic field control of 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign domain wall resistance

Energy Technology Data Exchange (ETDEWEB)

Majidi, Roya, E-mail: royamajidi@gmail.com [Department of Physics, Shahid Rajaee Teacher Training University, Lavizan, 16788-15811 Tehran (Iran, Islamic Republic of)

2012-10-01

In the present work, we have compared the resistance of the 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign domain walls in the presence of external magnetic field. The calculations are based on the Boltzmann transport equation within the relaxation time approximation. One-dimensional Neel-type domain walls between two domains whose magnetization differs by angle of 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign are considered. The results indicate that the resistance of the 360 Degree-Sign DW is more considerable than that of the 90 Degree-Sign and 180 Degree-Sign DWs. It is also found that the domain wall resistance can be controlled by applying transverse magnetic field. Increasing the strength of the external magnetic field enhances the domain wall resistance. In providing spintronic devices based on magnetic nanomaterials, considering and controlling the effect of domain wall on resistivity are essential.

Adductor Canal Block versus Femoral Nerve Block and Quadriceps Strength

DEFF Research Database (Denmark)

Jæger, Pia Therese; Nielsen, Zbigniew Jerzy Koscielniak; Henningsen, Lene Marianne

2013-01-01

: The authors hypothesized that the adductor canal block (ACB), a predominant sensory blockade, reduces quadriceps strength compared with placebo (primary endpoint, area under the curve, 0.5-6 h), but less than the femoral nerve block (FNB; secondary endpoint). Other secondary endpoints were...

Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty

DEFF Research Database (Denmark)

Jaeger, Pia; Zaric, Dusanka; Fomsgaard, Jonna Storm

2013-01-01

Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps...

From Artisanal to CAD-CAM Blocks: State of the Art of Indirect Composites.

Science.gov (United States)

Mainjot, A K; Dupont, N M; Oudkerk, J C; Dewael, T Y; Sadoun, M J

2016-05-01

Indirect composites have been undergoing an impressive evolution over the last few years. Specifically, recent developments in computer-aided design-computer-aided manufacturing (CAD-CAM) blocks have been associated with new polymerization modes, innovative microstructures, and different compositions. All these recent breakthroughs have introduced important gaps among the properties of the different materials. This critical state-of-the-art review analyzes the strengths and weaknesses of the different varieties of CAD-CAM composite materials, especially as compared with direct and artisanal indirect composites. Indeed, new polymerization modes used for CAD-CAM blocks-especially high temperature (HT) and, most of all, high temperature-high pressure (HT-HP)-are shown to significantly increase the degree of conversion in comparison with light-cured composites. Industrial processes also allow for the augmentation of the filler content and for the realization of more homogeneous structures with fewer flaws. In addition, due to their increased degree of conversion and their different monomer composition, some CAD-CAM blocks are more advantageous in terms of toxicity and monomer release. Finally, materials with a polymer-infiltrated ceramic network (PICN) microstructure exhibit higher flexural strength and a more favorable elasticity modulus than materials with a dispersed filler microstructure. Consequently, some high-performance composite CAD-CAM blocks-particularly experimental PICNs-can now rival glass-ceramics, such as lithium-disilicate glass-ceramics, for use as bonded partial restorations and crowns on natural teeth and implants. Being able to be manufactured in very low thicknesses, they offer the possibility of developing innovative minimally invasive treatment strategies, such as "no prep" treatment of worn dentition. Current issues are related to the study of bonding and wear properties of the different varieties of CAD-CAM composites. There is also a crucial

Block That Pain!

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Skip Navigation Bar Home Current Issue Past Issues Block That Pain! Past Issues / Fall 2007 Table of ... contrast, most pain relievers used for surgical procedures block activity in all types of neurons. This can ...

High degree-of-freedom dynamic manipulation

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Murphy, Michael P.; Stephens, Benjamin; Abe, Yeuhi; Rizzi, Alfred A.

2012-06-01

The creation of high degree of freedom dynamic mobile manipulation techniques and behaviors will allow robots to accomplish difficult tasks in the field. We are investigating the use of the body and legs of legged robots to improve the strength, velocity, and workspace of an integrated manipulator to accomplish dynamic manipulation. This is an especially challenging task, as all of the degrees of freedom are active at all times, the dynamic forces generated are high, and the legged system must maintain robust balance throughout the duration of the tasks. To accomplish this goal, we are utilizing trajectory optimization techniques to generate feasible open-loop behaviors for our 28 dof quadruped robot (BigDog) by planning the trajectories in a 13 dimensional space. Covariance Matrix Adaptation techniques are utilized to optimize for several criteria such as payload capability and task completion speed while also obeying constraints such as torque and velocity limits, kinematic limits, and center of pressure location. These open-loop behaviors are then used to generate feed-forward terms, which are subsequently used online to improve tracking and maintain low controller gains. Some initial results on one of our existing balancing quadruped robots with an additional human-arm-like manipulator are demonstrated on robot hardware, including dynamic lifting and throwing of heavy objects 16.5kg cinder blocks, using motions that resemble a human athlete more than typical robotic motions. Increased payload capacity is accomplished through coordinated body motion.

Bundle Branch Block

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... known cause. Causes can include: Left bundle branch block Heart attacks (myocardial infarction) Thickened, stiffened or weakened ... myocarditis) High blood pressure (hypertension) Right bundle branch block A heart abnormality that's present at birth (congenital) — ...

A randomized trial comparing surgeon-administered intraoperative transversus abdominis plane block with anesthesiologist-administered transcutaneous block.

Science.gov (United States)

Narasimhulu, D M; Scharfman, L; Minkoff, H; George, B; Homel, P; Tyagaraj, K

2018-04-27

Injection of local anesthetic into the transversus abdominis plane (TAP block) decreases systemic morphine requirements after abdominal surgery. We compared intraoperative surgeon-administered TAP block (surgical TAP) to anesthesiologist-administered transcutaneous ultrasound-guided TAP block (conventional TAP) for post-cesarean analgesia. We hypothesized that surgical TAP blocks would take less time to perform than conventional TAP blocks. We performed a randomized trial, recruiting 41 women undergoing cesarean delivery under neuraxial anesthesia, assigning them to either surgical TAP block (n=20) or conventional TAP block (n=21). Time taken to perform the block was the primary outcome, while postoperative pain scores and 24-hour opioid requirements were secondary outcomes. Student's t-test was used to compare block time and Kruskal-Wallis test opioid consumption and pain-scores. Time taken to perform the block (2.4 vs 12.1 min, P consumption (P=0.17) and postoperative pain scores at 4, 8, 24 and 48 h were not significantly different between the groups. Surgical TAP blocks are feasible and less time consuming than conventional TAP blocks, while providing comparable analgesia after cesarean delivery. Copyright © 2018 Elsevier Ltd. All rights reserved.

The generation of random directed networks with prescribed 1-node and 2-node degree correlations

International Nuclear Information System (INIS)

Zamora-Lopez, Gorka; Kurths, Juergen; Zhou Changsong; Zlatic, Vinko

2008-01-01

The generation of random networks is a very common problem in complex network research. In this paper, we have studied the correlation nature of several real networks and found that, typically, a large number of links are deterministic, i.e. they cannot be randomized. This finding permits fast generation of ensembles of maximally random networks with prescribed 1-node and 2-node degree correlations. When the introduction of self-loops or multiple-links are not desired, random network generation methods typically reach blocked states. Here, a mechanism is proposed, the 'force-and-drop' method, to overcome such states. Our algorithm can be easily simplified for undirected graphs and reduced to account for any subclass of 2-node degree correlations

Override of the radiation-induced mitotic block in human tumour cells by methylxanthines and its relationship to the potentiation of cytotoxicity

International Nuclear Information System (INIS)

Musk, S.R.R.; Steel, G.G.

1990-01-01

Caffeine, theophylline, theobromine and paraxanthine, were tested for ability to override mitotic block induced by ionizing radiation in the human bladder carcinoma cell line RT112. All were found to partially override the block, at a concentration of 1mM in the order caffeine > theophylline > theobromine = paraxanthine. At a concentration of 1 mM only caffeine was found to potentiate cell killing as well as causing block override; at higher concentrations all had a significant effect on survival but little or no further influence on the degree of block override. It is concluded that override of a mitotic block is not in itself sufficient to cause increased killing when irradiated cells are incubated in the presence of caffeine, and that caffeine exerts its potentiating effect by directly inhibiting repair of damage in DNA or by causing override of radiation-induced inhibition of DNA synthesis. (author)

Override of the radiation-induced mitotic block in human tumour cells by methylxanthines and its relationship to the potentiation of cytotoxicity

Energy Technology Data Exchange (ETDEWEB)

Musk, S.R.R.; Steel, G.G. (Institute of Cancer Research, Sutton (UK). Surrey Branch)

1990-06-01

Caffeine, theophylline, theobromine and paraxanthine, were tested for ability to override mitotic block induced by ionizing radiation in the human bladder carcinoma cell line RT112. All were found to partially override the block, at a concentration of 1mM in the order caffeine > theophylline > theobromine = paraxanthine. At a concentration of 1 mM only caffeine was found to potentiate cell killing as well as causing block override; at higher concentrations all had a significant effect on survival but little or no further influence on the degree of block override. It is concluded that override of a mitotic block is not in itself sufficient to cause increased killing when irradiated cells are incubated in the presence of caffeine, and that caffeine exerts its potentiating effect by directly inhibiting repair of damage in DNA or by causing override of radiation-induced inhibition of DNA synthesis. (author).

Thinking Outside the Block: An Innovative Alternative to 4X4 Block Scheduling.

Science.gov (United States)

Frank, Myra

2002-01-01

Introduces a 4x1 block scheduling method that was developed as an alternative to 4x4 block scheduling. Schedules Fridays for summer school, test preparation, and enrichment and elective courses. Includes suggestions on how to alleviate drawbacks of the 4x1 block schedule. (YDS)

Distribution of short block copolymer chains in Binary Blends of Block Copolymers Having Hydrogen Bonding

Science.gov (United States)

Kwak, Jongheon; Han, Sunghyun; Kim, Jin Kon

2014-03-01

A binary mixture of two block copolymers whose blocks are capable of forming the hydrogen bonding allows one to obtain various microdomains that could not be expected for neat block copolymer. For instance, the binary blend of symmetric polystyrene-block-poly(2-vinylpyridine) copolymer (PS-b-P2VP) and polystyrene-block-polyhydroxystyrene copolymer (PS-b-PHS) blends where the hydrogen bonding occurred between P2VP and PHS showed hexagonally packed (HEX) cylindrical and body centered cubic (BCC) spherical microdomains. To know the exact location of short block copolymer chains at the interface, we synthesized deuterated polystyrene-block-polyhydroxystyrene copolymer (dPS-b-PHS) and prepared a binary mixture with PS-b-P2VP. We investigate, via small angle X-ray scattering (SAXS) and neutron reflectivity (NR), the exact location of shorter dPS block chain near the interface of the microdomains.

Myocarditis Complicated by Complete Atrioventricular Block: Nine Years' Experience in a Medical Center

Directory of Open Access Journals (Sweden)

Shao-Ju Chien

2008-12-01

Conclusion: The outcome of CAVB complicated with myocarditis is variable. Most of our patients resumed normal heart function. The incidence of persistent CAVB was 22%. VT is a common and serious complication, but it can be effectively treated medically. Persistent low cardiac output after pacemaker implantation and late onset VT should be considered as risk factors of mortality.

Minimum Description Length Block Finder, a Method to Identify Haplotype Blocks and to Compare the Strength of Block Boundaries

OpenAIRE

Mannila, H.; Koivisto, M.; Perola, M.; Varilo, T.; Hennah, W.; Ekelund, J.; Lukk, M.; Peltonen, L.; Ukkonen, E.

2003-01-01

We describe a new probabilistic method for finding haplotype blocks that is based on the use of the minimum description length (MDL) principle. We give a rigorous definition of the quality of a segmentation of a genomic region into blocks and describe a dynamic programming algorithm for finding the optimal segmentation with respect to this measure. We also describe a method for finding the probability of a block boundary for each pair of adjacent markers: this gives a tool for evaluating the ...

Effects of Grafting Density on Block Polymer Self-Assembly: From Linear to Bottlebrush.

Science.gov (United States)

Lin, Tzu-Pin; Chang, Alice B; Luo, Shao-Xiong; Chen, Hsiang-Yun; Lee, Byeongdu; Grubbs, Robert H

2017-11-28

Grafting density is an important structural parameter that exerts significant influences over the physical properties of architecturally complex polymers. In this report, the physical consequences of varying the grafting density (z) were studied in the context of block polymer self-assembly. Well-defined block polymers spanning the linear, comb, and bottlebrush regimes (0 ≤ z ≤ 1) were prepared via grafting-through ring-opening-metathesis polymerization. ω-Norbornenyl poly(d,l-lactide) and polystyrene macromonomers were copolymerized with discrete comonomers in different feed ratios, enabling precise control over both the grafting density and molecular weight. Small-angle X-ray scattering experiments demonstrate that these graft block polymers self-assemble into long-range-ordered lamellar structures. For 17 series of block polymers with variable z, the scaling of the lamellar period with the total backbone degree of polymerization (d* ∼ N bb α ) was studied. The scaling exponent α monotonically decreases with decreasing z and exhibits an apparent transition at z ≈ 0.2, suggesting significant changes in the chain conformations. Comparison of two block polymer systems, one that is strongly segregated for all z (System I) and one that experiences weak segregation at low z (System II), indicates that the observed trends are primarily caused by the polymer architectures, not segregation effects. A model is proposed in which the characteristic ratio (C ∞ ), a proxy for the backbone stiffness, scales with N bb as a function of the grafting density: C ∞ ∼ N bb f(z) . The scaling behavior disclosed herein provides valuable insights into conformational changes with grafting density, thus introducing opportunities for block polymer and material design.

A Solvent-Vapor Approach toward the Control of Block Ionomer Morphologies

Energy Technology Data Exchange (ETDEWEB)

Mineart, Kenneth P.; Lee, Byeongdu; Spontak, Richard J.

2016-04-26

Sulfonated block ionomers possess advantageous properties for a wide range of diverse applications such as desalination membranes, fuel cells, electroactive media, and photovoltaic devices. Unfortunately, their inherently high incompatibilities and glass transition temperatures e ff ectively prevent the use of thermal annealing, routinely employed to re fi ne the morphologies of nonionic block copolymers. An alternative approach is therefore required to promote morphological equilibration in block ionomers. The present study explores the morphological characteristics of midblock- sulfonated pentablock ionomers (SBIs) di ff ering in their degree of sulfonation (DOS) and cast from solution followed by solvent-vapor annealing (SVA). Transmission electron microscopy con fi rms that fi lms deposited from di ff erent solvent systems form nonequilibrium morphologies due to solvent-regulated self-assembly and drying. A series of SVA tests performed with solvents varying in polarity reveals that exposing cast fi lms to tetrahydrofuran (THF) vapor for at least 2 h constitutes the most e ff ective SVA protocol, yielding the anticipated equilibrium morphology. That is, three SBI grades subjected to THF-SVA self-assemble into well-ordered lamellae wherein the increase in DOS is accompanied by an increase in lamellar periodicity, as measured by small-angle X-ray scattering.

High quality sub-10 nm graphene nanoribbons by on-chip PS-b-PDMS block copolymer lithography

DEFF Research Database (Denmark)

Rasappa, Sozaraj; Caridad, Jose; Schulte, Lars

2015-01-01

block and the graphene under PS. Raman analysis supports the formation of graphene nanoribbons with an average distance between defects corresponding to the oxidized PDMS pitch, with no sign of defects generated in the ribbon channel. This suggests a high degree of protection of the nanoribbons...... by the hard oxidized PDMS mask formed in situ during oxygen plasma etching....

The system Cu-Rh-S at 900 degrees, 700 degrees, 540 degrees and 500 degrees C

DEFF Research Database (Denmark)

Karup-Møller, Sven; Makovicky, E.

2007-01-01

Phase relations in the dry condensed system Cu-Rh-S were determined at 900, 700, 540 and 500 degrees C. At 900 degrees C, the system contains digenite, four rhodium sulfides (Rh17S15, Rh3S4, Rh2S3 and RhS similar to 3), three ternary sulfides (CuRh2S4, CuxRhS3+x and a fibrous sulfide in the range...

Eigenvalue routines in NASTRAN: A comparison with the Block Lanczos method

Science.gov (United States)

Tischler, V. A.; Venkayya, Vipperla B.

1993-01-01

The NASA STRuctural ANalysis (NASTRAN) program is one of the most extensively used engineering applications software in the world. It contains a wealth of matrix operations and numerical solution techniques, and they were used to construct efficient eigenvalue routines. The purpose of this paper is to examine the current eigenvalue routines in NASTRAN and to make efficiency comparisons with a more recent implementation of the Block Lanczos algorithm by Boeing Computer Services (BCS). This eigenvalue routine is now available in the BCS mathematics library as well as in several commercial versions of NASTRAN. In addition, CRAY maintains a modified version of this routine on their network. Several example problems, with a varying number of degrees of freedom, were selected primarily for efficiency bench-marking. Accuracy is not an issue, because they all gave comparable results. The Block Lanczos algorithm was found to be extremely efficient, in particular, for very large size problems.

Biodegradable shape-memory block co-polymers for fast self-expandable stents.

Science.gov (United States)

Xue, Liang; Dai, Shiyao; Li, Zhi

2010-11-01

Block co-polymers PCTBVs (M(n) of 36,300-65,300 g/mol, T(m) of 39-40 and 142 degrees C) containing hyperbranched three-arm poly(epsilon-caprolactone) (PCL) as switching segment and microbial polyester PHBV as crystallizable hard segment were designed as biodegradable shape-memory polymer (SMP) for fast self-expandable stent and synthesized in 96% yield by the reaction of three-arm PCL-triol (M(n) of 4200 g/mol, T(m) of 47 degrees C) with methylene diphenyl 4,4'-diisocyanate isocynate (MDI) to form the hyperbrached MDI-linked PCL (PTCM; M(n) of 25,400 g/mol and a T(m) of 38 degrees C), followed by further polymerization with PHBV-diol (M(n) of 2200 g/mol, T(m) of 137 and 148 degrees C). The polymers were characterized by (1)H NMR, GPC, DSC, tensile test, and cyclic thermomechanical tensile test. PCTBVs showed desired thermal properties, mechanical properties, and ductile nature. PCTBV containing 25 wt% PHBV (PCTBV-25) demonstrated excellent shape-memory property at 40 degrees C, with R(f) of 94%, R(r) of 98%, and shape recovery within 25s. PCTBV-25 was also shown as a safe material with good biocompatibility by cytotoxicity tests and cell growth experiments. The stent made from PCTBV-25 film showed nearly complete self-expansion at 37 degrees C within only 25 s, which is much better and faster than the best known self-expandable stents. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

The wild tapered block bootstrap

DEFF Research Database (Denmark)

Hounyo, Ulrich

In this paper, a new resampling procedure, called the wild tapered block bootstrap, is introduced as a means of calculating standard errors of estimators and constructing confidence regions for parameters based on dependent heterogeneous data. The method consists in tapering each overlapping block...... of the series first, the applying the standard wild bootstrap for independent and heteroscedastic distrbuted observations to overlapping tapered blocks in an appropriate way. Its perserves the favorable bias and mean squared error properties of the tapered block bootstrap, which is the state-of-the-art block......-order asymptotic validity of the tapered block bootstrap as well as the wild tapered block bootstrap approximation to the actual distribution of the sample mean is also established when data are assumed to satisfy a near epoch dependent condition. The consistency of the bootstrap variance estimator for the sample...

I Scratch and Sense but Can I Program? An Investigation of Learning with a Block Based Programming Language

Science.gov (United States)

Simpkins, N. K.

2014-01-01

This article reports an investigation into undergraduate student experiences and views of a visual or "blocks" based programming language and its environment. An additional and central aspect of this enquiry is to substantiate the perceived degree of transferability of programming skills learnt within the visual environment to a typical…

Enhancing fermentative digestion of cereal straws by using urea-molasses multinutrient blocks

International Nuclear Information System (INIS)

El Fouly, H.A.; Leng, R.A.

1987-01-01

Research trials connected with the preparation of licks are described. In vivo experiments carried out on lambs indicated that the rate of consumption from the licks is governed by the degree of solidification of the block, the urea level, the supplementary minerals content and by the adaptability of lambs to licking behaviour. The ruminal ammonia-N concentrations of lambs receiving the urea-molasses licks fluctuated less and were maintained between 107 and 224 mg/L during the diurnal cycle. (author)

[The pacemaker and implantable cardioverter-defibrillator registry of the Italian Association Arrhythmology Cardiac Pacing and cardiac pacing - annual report 2013].

Science.gov (United States)

Proclemer, Alessandro; Zecchin, Massimo; D'Onofrio, Antonio; Botto, Giovanni Luca; Rebellato, Luca; Ghidina, Marco; Bianco, Giulia; Bernardelli, Emanuela; Pucher, Elsa; Gregori, Dario

2014-11-01

The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2013 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. PM Registry: data about 25 419 PM implantations were collected (19 134 first implant and 6285 replacements). The number of collaborating centers was 275. Median age of treated patients was 80 years (74 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 43.6% of first PM implants, sick sinus syndrome in 24.7%, atrial fibrillation plus bradycardia in 12.9%, other in 18.8%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (23.2% of first implants). Use of single-chamber PMs was reported in 27.2% of first implants, of dual-chamber PMs in 62.6%, of PMs with cardiac resynchronization therapy (CRT) in 1.8%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 8.4%. ICD Registry: data about 16 519 ICD implantations were collected (11 474 first implants and 5045 replacements). The number of collaborating centers was 430. Median age of treated patients was 71 years (63 quartile I; 77 quartile III). Primary prevention indication was reported in 76% of first implants, secondary prevention in 24.0% (cardiac arrest in 7.8%). A single-chamber ICD was used in 27.2% of first implants, dual-chamber in 35.9% and biventricular in 36.8%. The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic

Elastic Cube Actuator with Six Degrees of Freedom Output

Directory of Open Access Journals (Sweden)

Pengchuan Wang

2015-09-01

Full Text Available Unlike conventional rigid actuators, soft robotic technologies possess inherent compliance, so they can stretch and twist along every axis without the need for articulated joints. This compliance is exploited here using dielectric elastomer membranes to develop a novel six degrees of freedom (6-DOF polymer actuator that unifies ordinarily separate components into a simple cubic structure. This cube actuator design incorporates elastic dielectric elastomer membranes on four faces which are coupled by a cross-shaped end effector. The inherent elasticity of each membrane greatly reduces kinematic constraint and enables a 6-DOF actuation output to be produced via the end effector. An electro-mechanical model of the cube actuator is presented that captures the non-linear hyperelastic behaviour of the active membranes. It is demonstrated that the model accurately predicts actuator displacement and blocking moment for a range of input voltages. Experimental testing of a prototype 60 mm device demonstrates 6-DOF operation. The prototype produces maximum linear and rotational displacements of ±2.6 mm (±4.3% and ±4.8° respectively and a maximum blocking moment of ±76 mNm. The capacity for full 6-DOF actuation from a compact, readily scalable and easily fabricated polymeric package enables implementation in a range of mechatronics and robotics applications.

Designers Block 2002

DEFF Research Database (Denmark)

Dickson, Thomas

2002-01-01

Artiklen indleder med: ved siden aaf Londons etablerede designmesse '100% Design', er der vokset et undergrundsmiljø af designudstillinger op. Det dominerende og mest kendte initiativ er Designers Block, der i år udstillede to steder i byen. Designers Block er et mere uformelt udstillingsforum...

When Graduate Degrees Prostitute the Educational Process: Degrees Gone Wild

Science.gov (United States)

Lumadue, Richard T.

2006-01-01

Graduate degrees prostitute the educational process when they are sold to consumers by unaccredited degree/diploma mills as being equivalent to legitimate, bona-fide degrees awarded by accredited graduate schools. This article carefully analyzes the serious problems of bogus degrees and their association with the religious higher education…

Bupivacaine-induced cellular entry of QX-314 and its contribution to differential nerve block

Science.gov (United States)

Brenneis, C; Kistner, K; Puopolo, M; Jo, S; Roberson, DP; Sisignano, M; Segal, D; Cobos, EJ; Wainger, BJ; Labocha, S; Ferreirós, N; Hehn, C; Tran, J; Geisslinger, G; Reeh, PW; Bean, BP; Woolf, C J

2014-01-01

Background and Purpose: Selective nociceptor fibre block is achieved by introducing the cell membrane impermeant sodium channel blocker lidocaine N-ethyl bromide (QX-314) through transient receptor potential V1 (TRPV1) channels into nociceptors. We screened local anaesthetics for their capacity to activate TRP channels, and characterized the nerve block obtained by combination with QX-314. Experimental Approach: We investigated TRP channel activation in dorsal root ganglion (DRG) neurons by calcium imaging and patch-clamp recordings, and cellular QX-314 uptake by MS. To characterize nerve block, compound action potential (CAP) recordings from isolated nerves and behavioural responses were analysed. Key Results: Of the 12 compounds tested, bupivacaine was the most potent activator of ruthenium red-sensitive calcium entry in DRG neurons and activated heterologously expressed TRPA1 channels. QX-314 permeated through TRPA1 channels and accumulated intracellularly after activation of these channels. Upon sciatic injections, QX-314 markedly prolonged bupivacaine's nociceptive block and also extended (to a lesser degree) its motor block. Bupivacaine's blockade of C-, but not A-fibre, CAPs in sciatic nerves was extended by co-application of QX-314. Surprisingly, however, this action was the same in wild-type, TRPA1-knockout and TRPV1/TRPA1-double knockout mice, suggesting a TRP-channel independent entry pathway. Consistent with this, high doses of bupivacaine promoted a non-selective, cellular uptake of QX-314. Conclusions and Implications: Bupivacaine, combined with QX-314, produced a long-lasting sensory nerve block. This did not require QX-314 permeation through TRPA1, although bupivacaine activated these channels. Regardless of entry pathway, the greatly extended duration of block produced by QX-314 and bupivacaine may be clinically useful. PMID:24117225

Type A Wolff-Parkinson-White Syndrome Generating an Antidromic Atrioventricular (AV Reentrant Tachycardia (AVRT and an Orthodromic AVRT with a Long RP Interval Initiated only after Incomplete Impairment of an AV Accessory Pathway

Directory of Open Access Journals (Sweden)

Kazushi Tanaka, MD PhD

2011-01-01

Full Text Available We report on a case of a 23-year-old male with Wolff-Parkinson-White syndrome. At baseline, constant right atrial pacing induced antidromic atrioventricular reentrant tachycardia (AVRT, whereas constant right ventricular (RV pacing only revealed a normal His-Purkinje system. Mapping below the mitral annulus during sinus rhythm revealed fusion of atrial and ventricular potentials at multiple lateral sites. After unsuccessful ablation at these sites, constant RV pacing induced a long RP interval, orthodromic AVRT with the earliest atrial site being located at an anterior aspect, where successful ablation was later achieved. These phenomena may indicate an unexpected arrhythmogenic effect of initial ablations.

Ellipsometry measurements of glass transition breadth in bulk films of random, block, and gradient copolymers.

Science.gov (United States)

Mok, M M; Kim, J; Marrou, S R; Torkelson, J M

2010-03-01

Bulk films of random, block and gradient copolymer systems were studied using ellipsometry to demonstrate the applicability of the numerical differentiation technique pioneered by Kawana and Jones for studying the glass transition temperature (T (g)) behavior and thermal expansivities of copolymers possessing different architectures and different levels of nanoheterogeneity. In a series of styrene/n -butyl methacrylate (S/nBMA) random copolymers, T (g) breadths were observed to increase from approximately 17( degrees ) C in styrene-rich cases to almost 30( degrees ) C in nBMA-rich cases, reflecting previous observations of significant nanoheterogeneity in PnBMA homopolymers. The derivative technique also revealed for the first time a substantial increase in glassy-state expansivity with increasing nBMA content in S/nBMA random copolymers, from 1.4x10(-4) K-1 in PS to 3.5x10(-4) K-1 in PnBMA. The first characterization of block copolymer T (g) 's and T (g) breadths by ellipsometry is given, examining the impact of nanophase-segregated copolymer structure on ellipsometric measurements of glass transition. The results show that, while the technique is effective in detecting the two T (g) 's expected in certain block copolymer systems, the details of the glass transition can become suppressed in ellipsometry measurements of a rubbery minor phase under conditions where the matrix is glassy; meanwhile, both transitions are easily discernible by differential scanning calorimetry. Finally, broad glass transition regions were measured in gradient copolymers, yielding in some cases extraordinary T (g) breadths of 69- 71( degrees ) C , factors of 4-5 larger than the T (g) breadths of related homopolymers and random copolymers. Surprisingly, one gradient copolymer demonstrated a slightly narrower T (g) breadth than the S/nBMA random copolymers with the highest nBMA content. This highlights the fact that nanoheterogeneity relevant to the glass transition response in selected

Arthroscopic medial meniscus trimming or repair under nerve blocks: Which nerves should be blocked?

Science.gov (United States)

Taha, AM; Abd-Elmaksoud, AM

2016-01-01

Background: This study aimed to determine the role of the sciatic and obturator nerve blocks (in addition to femoral block) in providing painless arthroscopic medial meniscus trimming/repair. Materials and Methods: One hundred and twenty patients with medial meniscus tear, who had been scheduled to knee arthroscopy, were planned to be included in this controlled prospective double-blind study. The patients were randomly allocated into three equal groups; FSO, FS, and FO. The femoral, sciatic, and obturator nerves were blocked in FSO groups. The femoral and sciatic nerves were blocked in FS group, while the femoral and obturator nerves were blocked in FO group. Intraoperative pain and its causative surgical maneuver were recorded. Results: All the patients (n = 7, 100%) in FO group had intraoperative pain. The research was terminated in this group but completed in FS and FSO groups (40 patients each). During valgus positioning of the knee for surgical management of the medial meniscus tear, the patients in FS group experienced pain more frequently than those in FSO group (P = 0.005). Conclusion: Adding a sciatic nerve block to the femoral nerve block is important for painless knee arthroscopy. Further adding of an obturator nerve block may be needed when a valgus knee position is required to manage the medial meniscus tear. PMID:27375382

The generation of random directed networks with prescribed 1-node and 2-node degree correlations

Energy Technology Data Exchange (ETDEWEB)

Zamora-Lopez, Gorka; Kurths, Juergen [Institute of Physics, University of Potsdam, PO Box 601553, 14415 Potsdam (Germany); Zhou Changsong [Department of Physics, Hong Kong Baptist University, Kowloon Tong, Hong Kong (China); Zlatic, Vinko [Rudjer Boskovic Institute, PO Box 180, HR-10002 Zagreb (Croatia)

2008-06-06

The generation of random networks is a very common problem in complex network research. In this paper, we have studied the correlation nature of several real networks and found that, typically, a large number of links are deterministic, i.e. they cannot be randomized. This finding permits fast generation of ensembles of maximally random networks with prescribed 1-node and 2-node degree correlations. When the introduction of self-loops or multiple-links are not desired, random network generation methods typically reach blocked states. Here, a mechanism is proposed, the 'force-and-drop' method, to overcome such states. Our algorithm can be easily simplified for undirected graphs and reduced to account for any subclass of 2-node degree correlations.

HOLE-BLOCKING LAYERS FOR SILICON/ORGANIC HETEROJUNCTIONS: A NEW CLASS OF HIGH-EFFICIENCY LOW-COST PV

Energy Technology Data Exchange (ETDEWEB)

Sturm, James [Princeton Univ., NJ (United States)

2017-12-04

This project is the first investigation of the use of thin titanium dioxide layers on silicon as a hole-blocking / electron-transparent selective contact to silicon. The work was motivated by the goal of a high-efficiency low-cost silicon-based solar cells that could be processed entirely at low temperature (300 Degree Celsius) or less, without requiring plasma-processing.

Acute atrial fibrillation during dengue hemorrhagic fever

Directory of Open Access Journals (Sweden)

Henrique Horta Veloso

Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

Acute atrial fibrillation during dengue hemorrhagic fever

Directory of Open Access Journals (Sweden)

Veloso Henrique Horta

2003-01-01

Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

Digoxin Toxicity in a 14 Days Old Newborn: A Case Report

Directory of Open Access Journals (Sweden)

İclal Sucaklı

2006-01-01

Full Text Available Digoxin is one of the most commonly used positive inotropic agent. Digitalis toxicity may occur easily because of digoxin has a narrow therapeutic window. Digitalis toxicity may result during treatment with digoxin or from accidental overdose of digoxin. An elevated serum level of digoxin (>2ng/ml is likely to be associated with toxicity, overdose of digoxin (>5ng/ml may lead to life-threatening arrhythmias. A 14-days old newborn with VSD, which had been prescribed the droplet form of digoxin but given the tablet form by the drugstore, was diagnosed as digitalis toxicity and hospitalized to our clinic. His mother expressed that she had given two tablets mashed with spoon and diluted. Bradycardia and grade 3/6 pansystolic murmur was determined in physical examination. Digoxin level in serum was >5 ng/ml and there was third degree atrioventricular block in ECG findings. The case has been presented to emphasize the importance of better evaluation of digoxin indications and making families of the patients conscious of the usage of digoxin.

Second-degree discrete Painleve equations conceal first-degree ones

International Nuclear Information System (INIS)

Ramani, A; Grammaticos, B; Joshi, N

2010-01-01

We examine various second-degree difference equations which have been proposed over the years and according to their authors' claims should be integrable. This study is motivated by the fact that we consider that second-degree discrete systems cannot be integrable due to the proliferation of the images (and pre-images) of the initial point. We show that in the present cases no contradiction exists. In all cases examined, we show that there exists an underlying integrable first-degree mapping which allows us to obtain an appropriate solution of the second-degree one.

Coastal protection using topological interlocking blocks

Science.gov (United States)

Pasternak, Elena; Dyskin, Arcady; Pattiaratchi, Charitha; Pelinovsky, Efim

2013-04-01

The coastal protection systems mainly rely on the self-weight of armour blocks to ensure its stability. We propose a system of interlocking armour blocks, which form plate-shape assemblies. The shape and the position of the blocks are chosen in such a way as to impose kinematic constraints that prevent the blocks from being removed from the assembly. The topological interlocking shapes include simple convex blocks such as platonic solids, the most practical being tetrahedra, cubes and octahedra. Another class of topological interlocking blocks is so-called osteomorphic blocks, which form plate-like assemblies tolerant to random block removal (almost 25% of blocks need to be removed for the assembly to loose integrity). Both classes require peripheral constraint, which can be provided either by the weight of the blocks or post-tensioned internal cables. The interlocking assemblies provide increased stability because lifting one block involves lifting (and bending) the whole assembly. We model the effect of interlocking by introducing an equivalent additional self-weight of the armour blocks. This additional self-weight is proportional to the critical pressure needed to cause bending of the interlocking assembly when it loses stability. Using beam approximation we find an equivalent stability coefficient for interlocking. It is found to be greater than the stability coefficient of a structure with similar blocks without interlocking. In the case when the peripheral constraint is provided by the weight of the blocks and for the slope angle of 45o, the effective stability coefficient for a structure of 100 blocks is 33% higher than the one for a similar structure without interlocking. Further increase in the stability coefficient can be reached by a specially constructed peripheral constraint system, for instance by using post-tension cables.

Nalbuphine as an adjuvant to 0.25% levobupivacaine in ultrasound-guided supraclavicular block provided prolonged sensory block and similar motor block durations (RCT).

Science.gov (United States)

Abdelhamid, Bassant Mohamed; Omar, Heba

2018-05-28

Prolonged postoperative analgesia with early motor recovery for early rehabilitation is a challenge in regional block. The purpose of this study is to evaluate the effect of adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular brachial plexus block. One hundred thirty-five (135) patients scheduled for hand and forearm surgeries with supraclavicular block were randomly allocated into three equal groups. Group L received 25 ml of 0.5% levobupivacaine + 1 ml normal saline; group H received 25 ml of 0.25% levobupivacaine + 1 ml normal saline; and group N received 25 ml of 0.25% levobupivacaine + 1 ml (20 mg) nalbuphine. Onset time and duration of sensory and motor block, and time to first analgesic dose were recorded. Sensory block onset was comparable between the three groups. Motor block onset in group L and group N was comparable (13.16 ± 3.07 and 13.84 ± 3.05 min, respectively) and was shorter than that in group H (15.71 ± 2 0.91 min). Sensory block duration in group L and group N was comparable (522.22 ± 69.57 and 533.78 ± 66.03 min, respectively) and was longer than that in group H (342.67 ± 92.80 min). Motor block duration in group N and group H was comparable (272.00 ± 59.45 and 249.78 ± 66.01 min, respectively) and was shorter than that in group L (334.67 ± 57.90 min). Time to first analgesic dose was significantly longer in group N (649.78 ± 114.76 min) than that of group L and group H (575.56 ± 96.85 and 375.56 ± 84.49 min, respectively) and longer in group L when compared to group H. Adding 20 mg nalbuphine to 25 ml of 0.25% levobupivacaine in supraclavicular block provided prolonged duration of sensory block with similar duration of motor block.

Approximate design theory for a simple block design with random block effects

OpenAIRE

Christof, Karin

1985-01-01

Approximate design theory for a simple block design with random block effects / K. Christof ; F. Pukelsheim. - In: Linear statistical inference / ed. by T. Calinski ... - Berlin u. a. : Springer, 1985. - S. 20-28. - (Lecture notes in statistics ; 35)

Empirical Assessment of the Mean Block Volume of Rock Masses Intersected by Four Joint Sets

Science.gov (United States)

Morelli, Gian Luca

2016-05-01

The estimation of a representative value for the rock block volume ( V b) is of huge interest in rock engineering in regards to rock mass characterization purposes. However, while mathematical relationships to precisely estimate this parameter from the spacing of joints can be found in literature for rock masses intersected by three dominant joint sets, corresponding relationships do not actually exist when more than three sets occur. In these cases, a consistent assessment of V b can only be achieved by directly measuring the dimensions of several representative natural rock blocks in the field or by means of more sophisticated 3D numerical modeling approaches. However, Palmström's empirical relationship based on the volumetric joint count J v and on a block shape factor β is commonly used in the practice, although strictly valid only for rock masses intersected by three joint sets. Starting from these considerations, the present paper is primarily intended to investigate the reliability of a set of empirical relationships linking the block volume with the indexes most commonly used to characterize the degree of jointing in a rock mass (i.e. the J v and the mean value of the joint set spacings) specifically applicable to rock masses intersected by four sets of persistent discontinuities. Based on the analysis of artificial 3D block assemblies generated using the software AutoCAD, the most accurate best-fit regression has been found between the mean block volume (V_{{{{b}}_{{m}} }}) of tested rock mass samples and the geometric mean value of the spacings of the joint sets delimiting blocks; thus, indicating this mean value as a promising parameter for the preliminary characterization of the block size. Tests on field outcrops have demonstrated that the proposed empirical methodology has the potential of predicting the mean block volume of multiple-set jointed rock masses with an acceptable accuracy for common uses in most practical rock engineering applications.

Serotonin potentiates transforming growth factor-beta3 induced biomechanical remodeling in avian embryonic atrioventricular valves.

Directory of Open Access Journals (Sweden)

Philip R Buskohl

Full Text Available Embryonic heart valve primordia (cushions maintain unidirectional blood flow during development despite an increasingly demanding mechanical environment. Recent studies demonstrate that atrioventricular (AV cushions stiffen over gestation, but the molecular mechanisms of this process are unknown. Transforming growth factor-beta (TGFβ and serotonin (5-HT signaling modulate tissue biomechanics of postnatal valves, but less is known of their role in the biomechanical remodeling of embryonic valves. In this study, we demonstrate that exogenous TGFβ3 increases AV cushion biomechanical stiffness and residual stress, but paradoxically reduces matrix compaction. We then show that TGFβ3 induces contractile gene expression (RhoA, aSMA and extracellular matrix expression (col1α2 in cushion mesenchyme, while simultaneously stimulating a two-fold increase in proliferation. Local compaction increased due to an elevated contractile phenotype, but global compaction appeared reduced due to proliferation and ECM synthesis. Blockade of TGFβ type I receptors via SB431542 inhibited the TGFβ3 effects. We next showed that exogenous 5-HT does not influence cushion stiffness by itself, but synergistically increases cushion stiffness with TGFβ3 co-treatment. 5-HT increased TGFβ3 gene expression and also potentiated TGFβ3 induced gene expression in a dose-dependent manner. Blockade of the 5HT2b receptor, but not 5-HT2a receptor or serotonin transporter (SERT, resulted in complete cessation of TGFβ3 induced mechanical strengthening. Finally, systemic 5-HT administration in ovo induced cushion remodeling related defects, including thinned/atretic AV valves, ventricular septal defects, and outflow rotation defects. Elevated 5-HT in ovo resulted in elevated remodeling gene expression and increased TGFβ signaling activity, supporting our ex-vivo findings. Collectively, these results highlight TGFβ/5-HT signaling as a potent mechanism for control of biomechanical

Solving block linear systems with low-rank off-diagonal blocks is easily parallelizable

Energy Technology Data Exchange (ETDEWEB)

Menkov, V. [Indiana Univ., Bloomington, IN (United States)

1996-12-31

An easily and efficiently parallelizable direct method is given for solving a block linear system Bx = y, where B = D + Q is the sum of a non-singular block diagonal matrix D and a matrix Q with low-rank blocks. This implicitly defines a new preconditioning method with an operation count close to the cost of calculating a matrix-vector product Qw for some w, plus at most twice the cost of calculating Qw for some w. When implemented on a parallel machine the processor utilization can be as good as that of those operations. Order estimates are given for the general case, and an implementation is compared to block SSOR preconditioning.

Rolling block mazes are PSPACE-complete

NARCIS (Netherlands)

Buchin, K.; Buchin, M.

2012-01-01

In a rolling block maze, one or more blocks lie on a rectangular board with square cells. In most mazes, the blocks have size k × m × n where k, m, n are integers that determine the size of the block in terms of units of the size of the board cells. The task of a rolling block maze is to roll a

A PMT-Block test bench

International Nuclear Information System (INIS)

Adragna, P.; Antonaki, A.

2006-01-01

The front-end electronics of the ATLAS hadronic calorimeter (Tile Cal) is housed in a unit, called PMT-Block. The PMT-Block is a compact instrument comprising a light mixer, a PMT together with its divider and a 3-in-1 card, which provides shaping, amplification and integration for the signals. This instrument needs to be qualified before being assembled on the detector. A PMT-Block test bench has been developed for this purpose. This test bench is a system which allows fast, albeit accurate enough, measurements of the main properties of a complete PMT-Block. The system, both hardware and software, and the protocol used for the PMT-Blocks characterization are described in detail in this report. The results obtained in the test of about 10 000 PMT-Blocks needed for the instrumentation of the ATLAS (LHC-CERN) hadronic Tile Calorimeter are also reported

A PMT-Block test bench

Energy Technology Data Exchange (ETDEWEB)

Adragna, P [Dipartimento di Fisica ' E.Fermi' , Universita di Pisa and Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo B. Pontecorvo 3, Pisa 56127 (Italy); Universita degli studi di Siena, via Roma 56, 53100 Siena (Italy); Antonaki, A [Institute of Accelerating Systems and Applications, P.O. Box 17214, Athens 10024 (Greece); National Capodistrian University of Athens, 30 Panepistimiou st., Athens 10679 (Greece)] (and others)

2006-08-01

The front-end electronics of the ATLAS hadronic calorimeter (Tile Cal) is housed in a unit, called PMT-Block. The PMT-Block is a compact instrument comprising a light mixer, a PMT together with its divider and a 3-in-1 card, which provides shaping, amplification and integration for the signals. This instrument needs to be qualified before being assembled on the detector. A PMT-Block test bench has been developed for this purpose. This test bench is a system which allows fast, albeit accurate enough, measurements of the main properties of a complete PMT-Block. The system, both hardware and software, and the protocol used for the PMT-Blocks characterization are described in detail in this report. The results obtained in the test of about 10 000 PMT-Blocks needed for the instrumentation of the ATLAS (LHC-CERN) hadronic Tile Calorimeter are also reported.

Backfilling of deposition tunnels, block alternative

International Nuclear Information System (INIS)

Keto, P.; Roennqvist, P.-E.

2007-03-01

This report presents a preliminary process description of backfilling the deposition tunnels with pre-compacted blocks consisting of a mixture of bentonite and ballast (30:70). The process was modified for the Finnish KBS-3V type repository assuming that the amount of spent fuel canisters disposed of yearly is 40. Backfilling blocks (400 x 300 x 300 mm) are prepared in a block production plant with a hydraulic press with an estimated production capacity of 840 blocks per day. Some of the blocks are modified further to fit the profile of the tunnel roof. Prior to the installation of the blocks, the deposition tunnel floor is levelled with a mixture of bentonite and ballast (15:85). The blocks are placed in the tunnel with a modified reach truck. Centrifugal pellet throwing equipment is used to fill the gap between the blocks and the rock surface with bentonite pellets. Based on a preliminary assessment, the average dry density achieved with block backfill is sufficient to fulfil the criteria set for the backfill in order to ensure long-term safety and radiation protection. However, there are uncertainties concerning saturation, homogenisation, erosion, piping and self-healing of the block backfill that need to be studied further with laboratory and field tests. In addition, development efforts and testing concerning block manufacturing and installation are required to verify the technical feasibility of the concept. (orig.)

Emplacement of small and large buffer blocks

International Nuclear Information System (INIS)

Saari, H.; Nikula, M.; Suikki, M.

2010-05-01

The report describes emplacement of a buffer structure encircling a spent fuel canister to be deposited in a vertical hole. The report deals with installability of various size blocks and with an emplacement gear, as well as evaluates the achieved quality of emplacement and the time needed for installing the buffer. Two block assembly of unequal size were chosen for examination. A first option involved small blocks, the use of which resulted in a buffer structure consisting of small sector blocks 200 mm in height. A second option involved large blocks, resulting in a buffer structure which consists of eight blocks. In these tests, the material chosen for both block options was concrete instead of bentonite. The emplacement test was a three-phase process. A first phase included stacking a two meter high buffer structure with small blocks for ensuring the operation of test equipment and blocks. A second phase included installing buffer structures with both block options to a height matching that of a canister-encircling cylindrical component. A third phase included testing also the installability of blocks to be placed above the canister by using small blocks. In emplacement tests, special attention was paid to the installability of blocks as well as to the time required for emplacement. Lifters for both blocks worked well. Due to the mass to be lifted, the lifter for large blocks had a more heavy-duty frame structure (and other lifting gear). The employed lifters were suspended in the tests on a single steel wire rope. Stacking was managed with both block sizes at adequate precision and stacked-up towers were steady. The stacking of large blocks was considerably faster. Therefore it is probably that the overall handling of the large blocks will be more convenient at a final disposal site. From the standpoint of reliability in lifting, the small blocks were safer to install above the canister. In large blocks, there are strict shape-related requirements which are

Comparative study between ultrasound guided tap block and paravertebral block in upper abdominal surgeries. Randomized controlled trial

Directory of Open Access Journals (Sweden)

Ruqaya M. Elsayed

2017-01-01

Conclusion: We concluded that ultrasound guided transversus abdominis plane block and thoracic paravertebral block were safe and effective anesthetic technique for upper abdominal surgery with longer and potent postoperative analgesia in thoracic paravertebral block than transversus abdominis block.

Myocardial Tbx20 regulates early atrioventricular canal formation and endocardial epithelial-mesenchymal transition via Bmp2.

Science.gov (United States)

Cai, Xiaoqiang; Nomura-Kitabayashi, Aya; Cai, Weibin; Yan, Jianyun; Christoffels, Vincent M; Cai, Chen-Leng

2011-12-15

During early embryogenesis, the formation of the cardiac atrioventricular canal (AVC) facilitates the transition of the heart from a linear tube into a chambered organ. However, the genetic pathways underlying this developmental process are poorly understood. The T-box transcription factor Tbx20 is expressed predominantly in the AVC of early heart tube. It was shown that Tbx20 activates Nmyc1 and suppresses Tbx2 expression to promote proliferation and specification of the atrial and ventricular chambers, yet it is not known if Tbx20 is involved in early AVC development. Here, we report that mice lacking Tbx20 in the AVC myocardium fail to form the AVC constriction, and the endocardial epithelial-mesenchymal transition (EMT) is severely perturbed. Tbx20 maintains expression of a variety of genes, including Bmp2, Tbx3 and Hand1 in the AVC myocardium. Intriguingly, we found Bmp2 downstream genes involved in the EMT initiation are also downregulated. In addition, re-expression of Bmp2 in the AVC myocardium substantially rescues the EMT defects resulting from the lack of Tbx20, suggesting Bmp2 is one of the key downstream targets of Tbx20 in AVC development. Our data support a complex signaling network with Tbx20 suppressing Tbx2 in the AVC myocardium but also indirectly promoting Tbx2 expression through Bmp2. The spatiotemporal expression of Tbx2 in the AVC appears to be balanced between these two opposing signals. Overall, our study provides genetic evidence that Tbx20 has essential roles in regulating AVC development that coordinate early cardiac chamber formation. Copyright © 2011 Elsevier Inc. All rights reserved.

Reflux and Belching After 270 Degree Versus 360 Degree Laparoscopic Posterior Fundoplication

NARCIS (Netherlands)

Broeders, Joris A.; Bredenoord, Albert J.; Hazebroek, Eric J.; Broeders, Ivo A.; Gooszen, Hein G.; Smout, André J.

2012-01-01

Objective: To investigate differences in effects of 270 degrees (270 degrees LPF) and 360 degrees laparoscopic posterior fundoplication (360 degrees LPF) on reflux characteristics and belching. Background: Three hundred sixty degrees LPF greatly reduces the ability of the stomach to vent ingested

Combining a popularity-productivity stochastic block model with a discriminative-content model for general structure detection.

Science.gov (United States)

Chai, Bian-fang; Yu, Jian; Jia, Cai-Yan; Yang, Tian-bao; Jiang, Ya-wen

2013-07-01

Latent community discovery that combines links and contents of a text-associated network has drawn more attention with the advance of social media. Most of the previous studies aim at detecting densely connected communities and are not able to identify general structures, e.g., bipartite structure. Several variants based on the stochastic block model are more flexible for exploring general structures by introducing link probabilities between communities. However, these variants cannot identify the degree distributions of real networks due to a lack of modeling of the differences among nodes, and they are not suitable for discovering communities in text-associated networks because they ignore the contents of nodes. In this paper, we propose a popularity-productivity stochastic block (PPSB) model by introducing two random variables, popularity and productivity, to model the differences among nodes in receiving links and producing links, respectively. This model has the flexibility of existing stochastic block models in discovering general community structures and inherits the richness of previous models that also exploit popularity and productivity in modeling the real scale-free networks with power law degree distributions. To incorporate the contents in text-associated networks, we propose a combined model which combines the PPSB model with a discriminative model that models the community memberships of nodes by their contents. We then develop expectation-maximization (EM) algorithms to infer the parameters in the two models. Experiments on synthetic and real networks have demonstrated that the proposed models can yield better performances than previous models, especially on networks with general structures.

Influence of the heart rate and atrioventricular delays on vortex evolution and blood transport inside the left ventricle

Science.gov (United States)

Hendabadi, Sahar; Martinez-Legazpi, Pablo; Benito, Yolanda; Bermejo, Javier; Del Alamo, Juan Carlos; Shadden, Shawn

2013-11-01

Cardiac resynchronization therapy (CRT) is used to help restore coordinated pumping of the ventricles by overcoming delays in electrical conduction due to cardiac disease. This is accomplished by a specialized cardiac pacemaker that is able to adjust the atrioventricular (AV) delay.A major clinical challenge is to adjust the pacing strategy to best coordinate the blood flow mechanics of ventricular filling and ejection. To this end, we have studied the difference in the vortex formation and its evolution inside the left ventricle (LV) for 4 different AV delays in a cohort of patients with implanted pacemakers. A reconstruction algorithm was used to obtain 2D velocity over the apical long-axis view of the LV from color Doppler and B-mode ultrasound data. To study blood transport, we have identified Lagrangian coherent structures to determine moving boundaries of the blood volumes injected to the LV in diastole and ejected to the aorta in systole. In all cases, we have analyzed the differences in filling and ejection patterns and the blood transport during the E-wave and A-wave formation.Finally we have assessed the influence of the AV delay on 2 indices of stasis, direct flow and residence time.The findings shed insight to the optimization of AV delays in patients undergoing CRT. NIH award 5R21HL108268 and grants PIS09/02603 and RD06/0010 from the Plan Nacional de Investigacion Cientifica, Spain.

Mapping Urban Land Use at Street Block Level Using OpenStreetMap, Remote Sensing Data, and Spatial Metrics

Directory of Open Access Journals (Sweden)

Taïs Grippa

2018-06-01

Full Text Available Up-to-date and reliable land-use information is essential for a variety of applications such as planning or monitoring of the urban environment. This research presents a workflow for mapping urban land use at the street block level, with a focus on residential use, using very-high resolution satellite imagery and derived land-cover maps as input. We develop a processing chain for the automated creation of street block polygons from OpenStreetMap and ancillary data. Spatial metrics and other street block features are computed, followed by feature selection that reduces the initial datasets by more than 80%, providing a parsimonious, discriminative, and redundancy-free set of features. A random forest (RF classifier is used for the classification of street blocks, which results in accuracies of 84% and 79% for five and six land-use classes, respectively. We exploit the probabilistic output of RF to identify and relabel blocks that have a high degree of uncertainty. Finally, the thematic precision of the residential blocks is refined according to the proportion of the built-up area. The output data and processing chains are made freely available. The proposed framework is able to process large datasets, given that the cities in the case studies, Dakar and Ouagadougou, cover more than 1000 km2 in total, with a spatial resolution of 0.5 m.

Parasympathetic neurons in the cranial medial ventricular fat pad on the dog heart selectively decrease ventricular contractility.

Science.gov (United States)

Dickerson, L W; Rodak, D J; Fleming, T J; Gatti, P J; Massari, V J; McKenzie, J C; Gillis, R A

1998-05-28

We hypothesized that selective control of ventricular contractility might be mediated by postganglionic parasympathetic neurons in the cranial medial ventricular (CMV) ganglion plexus located in a fat pad at the base of the aorta. Sinus rate, atrioventricular (AV) conduction (ventricular rate during atrial pacing), and left ventricular contractile force (LV dP/dt during right ventricular pacing) were measured in eight chloralose-anesthetized dogs both before and during bilateral cervical vagus stimulation (20-30 V, 0.5 ms pulses, 15-20 Hz). Seven of these dogs were tested under beta-adrenergic blockade (propranolol, 0.8 mg kg(-1) i.v.). Control responses included sinus node bradycardia or arrest during spontaneous rhythm, high grade AV block or complete heart block, and a 30% decrease in contractility from 2118 +/- 186 to 1526 +/- 187 mm Hg s(-1) (P 0.05) decrease in contractility but still elicited the same degree of sinus bradycardia and AV block (N = 8, P < 0.05). Five dogs were re-tested 3 h after trimethaphan fat pad injection, at which time blockade of vagally-induced negative inotropy was partially reversed, as vagal stimulation decreased LV dP/dt by 19%. The same dose of trimethaphan given either locally into other fat pads (PVFP or IVC-ILA) or systemically (i.v.) had no effect on vagally-induced negative inotropy. Thus, parasympathetic ganglia located in the CMV fat pad mediated a decrease in ventricular contractility during vagal stimulation. Blockade of the CMV fat pad had no effect on vagally-mediated slowing of sinus rate or AV conduction.

Ionization of amphiphilic acidic block copolymers.

Science.gov (United States)

Colombani, Olivier; Lejeune, Elise; Charbonneau, Céline; Chassenieux, Christophe; Nicolai, Taco

2012-06-28

The ionization behavior of an amphiphilic diblock copolymer poly(n-butyl acrylate(50%)-stat-acrylic acid(50%))(100)-block-poly(acrylic acid)(100) (P(nBA(50%)-stat-AA(50%))(100)-b-PAA(100), DH50) and of its equivalent triblock copolymer P(nBA(50%)-stat-AA(50%))(100)-b-PAA(200)-b-P(nBA(50%)-stat-AA(50%))(100) (TH50) were studied by potentiometric titration either in pure water or in 0.5 M NaCl. These polymers consist of a hydrophilic acidic block (PAA) connected to a hydrophobic block, P(nBA(50%)-stat-AA(50%))(100), whose hydrophobic character has been mitigated by copolymerization with hydrophilic units. We show that all AA units, even those in the hydrophobic block could be ionized. However, the AA units within the hydrophobic block were less acidic than those in the hydrophilic block, resulting in the preferential ionization of the latter block. The preferential ionization of PAA over that of P(nBA(50%)-stat-AA(50%))(100) was stronger at higher ionic strength. Remarkably, the covalent bonds between the PAA and P(nBA(50%)-stat-AA(50%))(100) blocks in the diblock or the triblock did not affect the ionization of each block, although the self-association of the block copolymers into spherical aggregates modified the environment of the PAA blocks compared to when PAA was molecularly dispersed.

Integral-fuel blocks

International Nuclear Information System (INIS)

Cunningham, C.; Simpkin, S.D.

1975-01-01

A prismatic moderator block is described which has fuel-containing channels and coolant channels disposed parallel to each other and to edge faces of the block. The coolant channels are arranged in rows on an equilateral triangular lattice pattern and the fuel-containing channels are disposed in a regular lattice pattern with one fuel-containing channel between and equidistant from each of the coolant channels in each group of three mutually adjacent coolant channels. The edge faces of the block are parallel to the rows of coolant channels and the channels nearest to each edge face are disposed in two rows parallel thereto, with one of the rows containing only coolant channels and the other row containing only fuel-containing channels. (Official Gazette)

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty.

Science.gov (United States)

Seo, Seung Suk; Kim, Ok Gul; Seo, Jin Hyeok; Kim, Do Hoon; Kim, Youn Gu; Park, Beyoung Yun

2017-09-01

This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps

Powered Explicit Guidance Modifications and Enhancements for Space Launch System Block-1 and Block-1B Vehicles

Science.gov (United States)

Von der Porten, Paul; Ahmad, Naeem; Hawkins, Matt; Fill, Thomas

2018-01-01

NASA is currently building the Space Launch System (SLS) Block-1 launch vehicle for the Exploration Mission 1 (EM-1) test flight. NASA is also currently designing the next evolution of SLS, the Block-1B. The Block-1 and Block-1B vehicles will use the Powered Explicit Guidance (PEG) algorithm (of Space Shuttle heritage) for closed loop guidance. To accommodate vehicle capabilities and design for future evolutions of SLS, modifications were made to PEG for Block-1 to handle multi-phase burns, provide PEG updated propulsion information, and react to a core stage engine out. In addition, due to the relatively low thrust-to-weight ratio of the Exploration Upper Stage (EUS) and EUS carrying out Lunar Vicinity and Earth Escape missions, certain enhancements to the Block-1 PEG algorithm are needed to perform Block-1B missions to account for long burn arcs and target translunar and hyperbolic orbits. This paper describes the design and implementation of modifications to the Block-1 PEG algorithm as compared to Space Shuttle. Furthermore, this paper illustrates challenges posed by the Block-1B vehicle and the required PEG enhancements. These improvements make PEG capable for use on the SLS Block-1B vehicle as part of the Guidance, Navigation, and Control (GN&C) System.

Elucidation of the Structure Formation of Polymer-Conjugated Proteins in Solution and Block Copolymer Templates

Science.gov (United States)

Ferebee, Rachel L.

The broader technical objective of this work is to contribute to the development of enzyme-functionalized nanoporous membranes that can function as autonomous and target selective dynamic separators. The scientific objective of the research performed within this thesis is to elucidate the parameters that control the mixing of proteins in organic host materials and in block copolymers templates in particular. A "biomimetic" membrane system that uses enzymes to selectively neutralize targets and trigger a change in permeability of nanopores lined with a pH-responsive polymer has been fabricated and characterized. Mechanical and functional stability, as well as scalability, have been demonstrated for this system. Additional research has focused on the role of polymeric ligands on the solubility characteristics of the model protein, Bovine Serum Albumin (BSA). For this purpose BSA was conjugated with poly(ethylene glycol) (PEG) ligands of varied degree of polymerization and grafting density. Combined static and dynamic light scattering was used (in conjunction with MALDI-TOF) to determine the second virial coefficient in PBS solutions. At a given mass fraction PEG or average number of grafts, the solubility of BSA-PEG conjugates is found to increase with the degree of polymerization of conjugated PEG. This result informs the synthesis of protein-conjugate systems that are optimized for the fabrication of block copolymer blend materials with maximum protein loading. Blends of BSA-PEG conjugates and block copolymer (BCP) matrices were fabricated to evaluate the dispersion morphology and solubility limits in a model system. Electron microscopy was used to evaluate the changes in lamellar spacing with increased filling fraction of BSA-PEG conjugates.

Building Curriculum during Block Play

Science.gov (United States)

Andrews, Nicole

2015-01-01

Blocks are not just for play! In this article, Nicole Andrews describes observing the interactions of three young boys enthusiastically engaged in the kindergarten block center of their classroom, using blocks in a building project that displayed their ability to use critical thinking skills, physics exploration, and the development of language…

Region 9 Census Block 2010

Science.gov (United States)

Geography:The TIGER Line Files are feature classes and related database files (.) that are an extract of selected geographic and cartographic information from the U.S. Census Bureau's Master Address File / Topologically Integrated Geographic Encoding and Referencing (MAF/TIGER) Database (MTDB). The MTDB represents a seamless national file with no overlaps or gaps between parts, however, each TIGER Line File is designed to stand alone as an independent data set, or they can be combined to cover the entire nation. Census Blocks are statistical areas bounded on all sides by visible features, such as streets, roads, streams, and railroad tracks, and/or by non visible boundaries such as city, town, township, and county limits, and short line-of-sight extensions of streets and roads. Census blocks are relatively small in area; for example, a block in a city bounded by streets. However, census blocks in remote areas are often large and irregular and may even be many square miles in area. A common misunderstanding is that data users think census blocks are used geographically to build all other census geographic areas, rather all other census geographic areas are updated and then used as the primary constraints, along with roads and water features, to delineate the tabulation blocks. As a result, all 2010 Census blocks nest within every other 2010 Census geographic area, so that Census Bureau statistical data can be tabulated at the block level and aggregated up t

Au-coated 3-D nanoporous titania layer prepared using polystyrene-b-poly(2-vinylpyridine) block copolymer nanoparticles.

Science.gov (United States)

Shin, Won-Jeong; Basarir, Fevzihan; Yoon, Tae-Ho; Lee, Jae-Suk

2009-04-09

New nanoporous structures of Au-coated titania layers were prepared by using amphiphilic block copolymer nanoparticles as a template. A 3-D template composed of self-assembled quaternized polystyrene-b-poly(2-vinylpyridine) (Q-PS-b-P2VP) block copolymer nanoparticles below 100 nm was prepared. The core-shell-type nanoparticles were well ordered three-dimensionally using the vertical immersion method on the substrate. The polar solvents were added to the polymer solution to prevent particle merging at 40 degrees C when considering the interaction between polymer nanoparticles and solvents. Furthermore, Au-coated PS-b-P2VP nanoparticles were prepared using thiol-capped Au nanoparticles (3 nm). The 3-D arrays with Au-coated PS-b-P2VP nanoparticles as a template contributed to the preparation of the nanoporous Au-coated titania layer. Therefore, the nanoporous Au-coated titania layer was fabricated by removing PS-b-P2VP block copolymer nanoparticles by oxygen plasma etching.

[Public health competencies and contents in Spanish undergraduate medical degrees].

Science.gov (United States)

Davó-Blanes, M Carmen; Vives-Cases, Carmen; Barrio-Fernández, José Luis; Porta, Miquel; Benavides, Fernando G; de Miguel, Ángel Gil

2016-01-01

To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into undergraduate medical degrees. The 2nd Forum of University Teachers was held at the Rey Juan Carlos University (Madrid, 11-12 December 2014). Twenty-four university professors and lecturers from 19 Spanish universities imparting medical degrees participated in the forum. They were distributed in three working groups during three working sessions. In the first session, they were asked to identify and classify core public health competencies for medical degrees. In the second, they were asked to propose public health contents for the identified competencies. In the third session, the participants organized these contents in thematic blocks. The results were discussed in distinct plenary sessions. The highest number of core competencies was identified in the activities related to the public health functions «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organised into five units: Concept of health, public health and its determinants; Epidemiology and health research; Determinants and health problems; Strategies, interventions and policies; and health systems, clinical and healthcare management. The public health core competencies and contents identified in this Forum may be considered as a starting point to improve and update public health training programmes for future medical professionals. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Various semiclassical limits of torus conformal blocks

Energy Technology Data Exchange (ETDEWEB)

Alkalaev, Konstantin [I.E. Tamm Department of Theoretical Physics, P.N. Lebedev Physical Institute,Leninsky ave. 53, Moscow, 119991 (Russian Federation); Department of General and Applied Physics, Moscow Institute of Physics and Technology,Institutskiy per. 7, Dolgoprudnyi, Moscow region, 141700 (Russian Federation); Geiko, Roman [Mathematics Department, National Research University Higher School of Economics,Usacheva str. 6, Moscow, 119048 (Russian Federation); Rappoport, Vladimir [I.E. Tamm Department of Theoretical Physics, P.N. Lebedev Physical Institute,Leninsky ave. 53, Moscow, 119991 (Russian Federation); Department of Quantum Physics, Institute for Information Transmission Problems,Bolshoy Karetny per. 19, Moscow, 127994 (Russian Federation)

2017-04-12

We study four types of one-point torus blocks arising in the large central charge regime. There are the global block, the light block, the heavy-light block, and the linearized classical block, according to different regimes of conformal dimensions. It is shown that the blocks are not independent being connected to each other by various links. We find that the global, light, and heavy-light blocks correspond to three different contractions of the Virasoro algebra. Also, we formulate the c-recursive representation of the one-point torus blocks which is relevant in the semiclassical approximation.

Common blocks for ASQS(12

Directory of Open Access Journals (Sweden)

Lorenzo Milazzo

1997-05-01

Full Text Available An ASQS(v is a particular Steiner system featuring a set of v vertices and two separate families of blocks, B and G, whose elements have a respective cardinality of 4 and 6. It has the property that any three vertices of X belong either to a B-block or to a G-block. The parameter cb is the number of common blocks in two separate ASQSs, both defined on the same set of vertices X . In this paper it is shown that cb ≤ 29 for any pair of ASQSs(12.

Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

DEFF Research Database (Denmark)

Greve, Anders M; Gerdts, Eva; Boman, Kurt

2011-01-01

Electrocardiograms are routinely obtained in clinical follow-up of patients with asymptomatic aortic stenosis (AS). The association with aortic valve, left ventricular (LV) response to long-term pressure load, and clinical covariates is unclear and the clinical value is thus uncertain. Data from...... clinical examination, electrocardiogram, and echocardiogram in 1,563 patients in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study were used. Electrocardiograms were Minnesota coded for arrhythmias and atrioventricular and intraventricular blocks; LV hypertrophy was assessed by Sokolow...

Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia.

Science.gov (United States)

Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon; Yi, Jae-Woo

2017-09-01

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

49 CFR 236.708 - Block.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Block. 236.708 Section 236.708 Transportation... OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Definitions § 236.708 Block. A length of track of defined limits, the use of which by trains is governed by block signals, cab signals, or both. ...

The influence of cold on the recovery of three neuromuscular blocking agents in man.

Science.gov (United States)

England, A J; Wu, X; Richards, K M; Redai, I; Feldman, S A

1996-03-01

The Arrhenius hypothesis suggests that change in temperature has a less marked effect on the rate of physical processes than on biological reactions. We have investigated the process underlying recovery from neuromuscular block in man by studying the effect of cooling on the rate of recovery from depolarising and non-depolarising block. Vecuronium, rocuronium and decamethonium (C10) neuromuscular block were investigated using the isolated forearm technique on awake human volunteers. In these experiments, one arm was cooled whilst the other was used as control. Moderate hypothermia decreased the rate of recovery from all three agents, but this was significantly less marked with the depolarising drug. The mean Q10 (the anticipated change in rate of a reaction across of 10 degrees C temperature gradient) of the rate of recovery for vecuronium was 3.21, rocuronium 2.86 and decamethonium 1.29. This suggests a different process in the recovery of these two types of drug. According to the Arrhenius hypothesis this would suggest that the recovery from non-depolarising drugs is likely to involve a biochemical mechanism and that recovery from decamethonium is controlled by a physical process.

Ultrasound-Guided Single-Injection Infraclavicular Block Versus Ultrasound-Guided Double-Injection Axillary Block: A Noninferiority Randomized Controlled Trial.

Science.gov (United States)

Boivin, Ariane; Nadeau, Marie-Josée; Dion, Nicolas; Lévesque, Simon; Nicole, Pierre C; Turgeon, Alexis F

2016-01-01

Single-injection ultrasound-guided infraclavicular block is a simple, reliable, and effective technique. A simplified double-injection ultrasound-guided axillary block technique with a high success rate recently has been described. It has the advantage of being performed in a superficial and compressible location, with a potentially improved safety profile. However, its effectiveness in comparison with single-injection infraclavicular block has not been established. We hypothesized that the double-injection ultrasound-guided axillary block would show rates of complete sensory block at 30 minutes noninferior to the single-injection ultrasound-guided infraclavicular block. After approval by our research ethics committee and written informed consent, adults undergoing distal upper arm surgery were randomized to either group I, ultrasound-guided single-injection infraclavicular block, or group A, ultrasound-guided double-injection axillary block. In group I, 30 mL of 1.5% mepivacaine was injected posterior to the axillary artery. In group A, 25 mL of 1.5% mepivacaine was injected posteromedial to the axillary artery, after which 5 mL was injected around the musculocutaneous nerve. Primary outcome was the rate of complete sensory block at 30 minutes. Secondary outcomes were the onset of sensory and motor blocks, surgical success rates, performance times, and incidence of complications. All outcomes were assessed by a blinded investigator. The noninferiority of the double-injection ultrasound-guided axillary block was considered if the limits of the 90% confidence intervals (CIs) were within a 10% margin of the rate of complete sensory block of the infraclavicular block. At 30 minutes, the rate of complete sensory block was 79% in group A (90% CI, 71%-85%) compared with 91% in group I (90% CI, 85%-95%); the upper limit of CI of group A is thus included in the established noninferiority margin of 10%. The rate of complete sensory block was lower in group A (proportion

Block copolymer battery separator

Science.gov (United States)

Wong, David; Balsara, Nitash Pervez

2016-04-26

The invention herein described is the use of a block copolymer/homopolymer blend for creating nanoporous materials for transport applications. Specifically, this is demonstrated by using the block copolymer poly(styrene-block-ethylene-block-styrene) (SES) and blending it with homopolymer polystyrene (PS). After blending the polymers, a film is cast, and the film is submerged in tetrahydrofuran, which removes the PS. This creates a nanoporous polymer film, whereby the holes are lined with PS. Control of morphology of the system is achieved by manipulating the amount of PS added and the relative size of the PS added. The porous nature of these films was demonstrated by measuring the ionic conductivity in a traditional battery electrolyte, 1M LiPF.sub.6 in EC/DEC (1:1 v/v) using AC impedance spectroscopy and comparing these results to commercially available battery separators.

Design and Production of an Articulating Needle Guide for Ultrasound-Guided Needle Block Manufactured With a Three-Dimensional Printer: Technical Communication.

Science.gov (United States)

Bigeleisen, Paul E

2017-05-15

Needle guides may allow the practitioner to align the needle with the probe when ultrasound-guided nerve block is performed. The author's goal was to design and fabricate an inexpensive ($1.90), disposable, needle guide that could articulate over a range from 85 degrees to 0 degrees with a three-dimension printer. Three-dimensional representations of an L50, L25, and C 60 ultrasound probe (Sono Site, Bothell, WA) were created using a laser scanner. Computer-aided design software (Solid Works, Waltham, MA) was used to design a needle bracket and needle guide to attach to these probes. A three-dimensional printer was used to fabricate the needle bracket and guide with acrylonitrile polybutadiene polystyrene. An echogenic needle was held in plane with the needle guide. The author performed a supraclavicular block in a morbidly obese patient. The needle was easily visualized. Similar guides that are commercially available cost as much as $400. A knowledge of computer-aided design is necessary for this work.

Strength and deformability of hollow concrete blocks: correlation of block and cylindrical sample test results

Directory of Open Access Journals (Sweden)

C. S. Barbosa

Full Text Available This paper deals with correlations among mechanical properties of hollow blocks and those of concrete used to make them. Concrete hollow blocks and test samples were moulded with plastic consistency concrete, to assure the same material in all cases, in three diferente levels of strength (nominally 10 N/mm², 20 N/mm² and 30 N/mm². The mechanical properties and structural behaviour in axial compression and tension tests were determined by standard tests in blocks and cylinders. Stress and strain analyses were made based on concrete’s modulus of elasticity obtained in the sample tests as well as on measured strain in the blocks’ face-shells and webs. A peculiar stress-strain analysis, based on the superposition of effects, provided an estimation of the block load capacity based on its deformations. In addition, a tentative method to preview the block deformability from the concrete mechanical properties is described and tested. This analysis is a part of a broader research that aims to support a detailed structural analysis of blocks, prisms and masonry constructions.

Compaction of bentonite blocks. Development of techniques for production of blocks with different shapes and sizes

International Nuclear Information System (INIS)

Johannesson, Lars-Erik; Boergesson, Lennart

1998-09-01

In this report useful techniques for producing both smaller blocks manageable by man (10-15 kg) and larger blocks which need special equipment for handling (weight up to 600 kg) are described. Tests for producing blocks with a weight of approximately 10 kg were carried out at Hoeganaes Bjuf AB in Bjuv. This industry is normally producing refractory bricks and other refractory products. The plant has facilities for handling large volumes of clay. It also has machines suitable for producing uniaxially compacted blocks. Tests performed at the plant show that it is possible to compact blocks with good quality. The best quality was reached with a coarsely ground bentonite at a water ratio of 17 %. The compaction rate was high and performed with lubricated form and stepwise loading. Tests, in order to find a technique for producing larger blocks with a diameter of the same size as a deposition hole (about 1.65 m), were also made. The technique was developed in a smaller scale (250 mm). Ring-shaped blocks with the same outer diameter and with an inner diameter of about 156 mm were also compacted. The compaction was made with vacuum in the form. The outer surface of the form was conical and most of the tests were performed with a lubricated form. Tests were performed with different water ratios of the bentonite. All the blocks had a good quality. In consequence of the good test results a form with a 1000 mm diameter was constructed and a number of compaction tests were performed. The same technique was used as for the smaller blocks. The compaction pressure in most tests was 100 MPa (maximum compaction load 80.000 kN). The tests were performed at HYDROWELD in Ystad in a press with a maximum capacity of 300.000 kN. All tests were performed with MX-80. Most of the blocks had a good quality. A small damage close to the upper surface of all blocks was observed but is considered to be of no importance for the possibility to handle the blocks and is not affecting the properties

Compaction of bentonite blocks. Development of techniques for production of blocks with different shapes and sizes

Energy Technology Data Exchange (ETDEWEB)

Johannesson, Lars-Erik; Boergesson, Lennart [Clay Technology AB, Lund (Sweden)

1998-09-01

In this report useful techniques for producing both smaller blocks manageable by man (10-15 kg) and larger blocks which need special equipment for handling (weight up to 600 kg) are described. Tests for producing blocks with a weight of approximately 10 kg were carried out at Hoeganaes Bjuf AB in Bjuv. This industry is normally producing refractory bricks and other refractory products. The plant has facilities for handling large volumes of clay. It also has machines suitable for producing uniaxially compacted blocks. Tests performed at the plant show that it is possible to compact blocks with good quality. The best quality was reached with a coarsely ground bentonite at a water ratio of 17 %. The compaction rate was high and performed with lubricated form and stepwise loading. Tests, in order to find a technique for producing larger blocks with a diameter of the same size as a deposition hole (about 1.65 m), were also made. The technique was developed in a smaller scale (250 mm). Ring-shaped blocks with the same outer diameter and with an inner diameter of about 156 mm were also compacted. The compaction was made with vacuum in the form. The outer surface of the form was conical and most of the tests were performed with a lubricated form. Tests were performed with different water ratios of the bentonite. All the blocks had a good quality. In consequence of the good test results a form with a 1000 mm diameter was constructed and a number of compaction tests were performed. The same technique was used as for the smaller blocks. The compaction pressure in most tests was 100 MPa (maximum compaction load 80.000 kN). The tests were performed at HYDROWELD in Ystad in a press with a maximum capacity of 300.000 kN. All tests were performed with MX-80. Most of the blocks had a good quality. A small damage close to the upper surface of all blocks was observed but is considered to be of no importance for the possibility to handle the blocks and is not affecting the properties

Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Device: The United Kingdom Experience.

Science.gov (United States)

Rampat, Rajiv; Khawaja, M Zeeshan; Hilling-Smith, Roland; Byrne, Jonathan; MacCarthy, Philip; Blackman, Daniel J; Krishnamurthy, Arvindra; Gunarathne, Ashan; Kovac, Jan; Banning, Adrian; Kharbanda, Raj; Firoozi, Sami; Brecker, Stephen; Redwood, Simon; Bapat, Vinayak; Mullen, Michael; Aggarwal, Suneil; Manoharan, Ganesh; Spence, Mark S; Khogali, Saib; Dooley, Maureen; Cockburn, James; de Belder, Adam; Trivedi, Uday; Hildick-Smith, David

2017-06-26

The authors report the incidence of pacemaker implantation up to hospital discharge and the factors influencing pacing rate following implantation of the LOTUS bioprosthesis (Boston Scientific, Natick, Massachusetts) in the United Kingdom. Transcatheter aortic valve replacement (TAVR) is associated with a significant need for permanent pacemaker implantation. Pacing rates vary according to the device used. The REPRISE II (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System) trial reported a pacing rate of 29% at 30 days after implantation of the LOTUS device. Data were collected retrospectively on 228 patients who had the LOTUS device implanted between March 2013 and February 2015 across 10 centers in the United Kingdom. Twenty-seven patients (12%) had pacemakers implanted pre-procedure and were excluded from the analysis. Patients were aged 81.2 ± 7.7 years; 50.7% were male. The mean pre-procedural QRS duration was 101.7 ± 20.4 ms. More than one-half of the cohort (n = 111, 55%) developed new left bundle branch block (LBBB) following the procedure. Permanent pacemakers were implanted in 64 patients (32%) with a median time to insertion of 3.0 ± 3.4 days. Chief indications for pacing were atrioventricular (AV) block (n = 46, 72%), or LBBB with 1st degree AV block (n = 11, 17%). Amongst those who received a pacemaker following TAVR the pre-procedural electrocardiogram findings included: No conduction disturbance (n = 41, 64%); 1st degree AV block (n = 10, 16%); right bundle branch block (n = 6, 9%) and LBBB (n = 5, 8%). LBBB (but not permanent pacemaker) occurred more frequently in patients who had balloon aortic valvuloplasty before TAVR (odds ratio [OR]: 1.25; p = 0.03). Pre-procedural conduction abnormality (composite of 1st degree AV block, hemiblock, right bundle branch block, LBBB) was independently associated with the need for permanent pacemaker (OR: 2.54; p = 0.048). The absence of

Bullet-Block Science Video Puzzle

Science.gov (United States)

Shakur, Asif

2015-01-01

A science video blog, which has gone viral, shows a wooden block shot by a vertically aimed rifle. The video shows that the block hit dead center goes exactly as high as the one shot off-center. (Fig. 1). The puzzle is that the block shot off-center carries rotational kinetic energy in addition to the gravitational potential energy. This leads a…

Cellient™ automated cell block versus traditional cell block preparation: a comparison of morphologic features and immunohistochemical staining.

Science.gov (United States)

Wagner, David G; Russell, Donna K; Benson, Jenna M; Schneider, Ashley E; Hoda, Rana S; Bonfiglio, Thomas A

2011-10-01

Traditional cell block (TCB) sections serve as an important diagnostic adjunct to cytologic smears but are also used today as a reliable preparation for immunohistochemical (IHC) studies. There are many ways to prepare a cell block and the methods continue to be revised. In this study, we compare the TCB with the Cellient™ automated cell block system. Thirty-five cell blocks were obtained from 16 benign and 19 malignant nongynecologic cytology specimens at a large university teaching hospital and prepared according to TCB and Cellient protocols. Cell block sections from both methods were compared for possible differences in various morphologic features and immunohistochemical staining patterns. In the 16 benign cases, no significant morphologic differences were found between the TCB and Cellient cell block sections. For the 19 malignant cases, some noticeable differences in the nuclear chromatin and cellularity were identified, although statistical significance was not attained. Immunohistochemical or special stains were performed on 89% of the malignant cases (17/19). Inadequate cellularity precluded full evaluation in 23% of Cellient cell block IHC preparations (4/17). Of the malignant cases with adequate cellularity (13/17), the immunohistochemical staining patterns from the different methods were identical in 53% of cases. The traditional and Cellient cell block sections showed similar morphologic and immunohistochemical staining patterns. The only significant difference between the two methods concerned the lower overall cell block cellularity identified during immunohistochemical staining in the Cellient cell block sections. Copyright © 2010 Wiley-Liss, Inc.

Compatibilization of low-density polyethylene/polystyrene blends by segmented EB(PS-block-EB)(n) block copolymers

NARCIS (Netherlands)

Kroeze, E; ten Brinke, G.; Hadziioannou, G

Hydrogenated segmented poly[butadiene-block-(styrene-block-butadiene)(n)] block copolymers, which were developed by use of a polymeric iniferter technique, were tested on their compatibilizing effectiveness for (10/90) LDPE/PS blends. They were found to be effective compatibilizers for this mixture,

Light extraction block with curved surface

Science.gov (United States)

Levermore, Peter; Krall, Emory; Silvernail, Jeffrey; Rajan, Kamala; Brown, Julia J.

2016-03-22

Light extraction blocks, and OLED lighting panels using light extraction blocks, are described, in which the light extraction blocks include various curved shapes that provide improved light extraction properties compared to parallel emissive surface, and a thinner form factor and better light extraction than a hemisphere. Lighting systems described herein may include a light source with an OLED panel. A light extraction block with a three-dimensional light emitting surface may be optically coupled to the light source. The three-dimensional light emitting surface of the block may includes a substantially curved surface, with further characteristics related to the curvature of the surface at given points. A first radius of curvature corresponding to a maximum principal curvature k.sub.1 at a point p on the substantially curved surface may be greater than a maximum height of the light extraction block. A maximum height of the light extraction block may be less than 50% of a maximum width of the light extraction block. Surfaces with cross sections made up of line segments and inflection points may also be fit to approximated curves for calculating the radius of curvature.

Aqueous dispersion polymerization: a new paradigm for in situ block copolymer self-assembly in concentrated solution.

Science.gov (United States)

Sugihara, Shinji; Blanazs, Adam; Armes, Steven P; Ryan, Anthony J; Lewis, Andrew L

2011-10-05

Reversible addition-fragmentation chain transfer polymerization has been utilized to polymerize 2-hydroxypropyl methacrylate (HPMA) using a water-soluble macromolecular chain transfer agent based on poly(2-(methacryloyloxy)ethylphosphorylcholine) (PMPC). A detailed phase diagram has been elucidated for this aqueous dispersion polymerization formulation that reliably predicts the precise block compositions associated with well-defined particle morphologies (i.e., pure phases). Unlike the ad hoc approaches described in the literature, this strategy enables the facile, efficient, and reproducible preparation of diblock copolymer spheres, worms, or vesicles directly in concentrated aqueous solution. Chain extension of the highly hydrated zwitterionic PMPC block with HPMA in water at 70 °C produces a hydrophobic poly(2-hydroxypropyl methacrylate) (PHPMA) block, which drives in situ self-assembly to form well-defined diblock copolymer spheres, worms, or vesicles. The final particle morphology obtained at full monomer conversion is dictated by (i) the target degree of polymerization of the PHPMA block and (ii) the total solids concentration at which the HPMA polymerization is conducted. Moreover, if the targeted diblock copolymer composition corresponds to vesicle phase space at full monomer conversion, the in situ particle morphology evolves from spheres to worms to vesicles during the in situ polymerization of HPMA. In the case of PMPC(25)-PHPMA(400) particles, this systematic approach allows the direct, reproducible, and highly efficient preparation of either block copolymer vesicles at up to 25% solids or well-defined worms at 16-25% solids in aqueous solution.

The Degree Cycle

DEFF Research Database (Denmark)

Wood, Johanna

2016-01-01

, empirical data relevant to the development of the degree adverb function is presented and possible relevant constructions identified. It is argued that the degree adverb function of that possibly occurs later than the historical dictionaries indicate. The degree adverb function of this is challenging...

Contributions of hard and soft blocks in the self-healing of metal-ligand-containing block copolymers

NARCIS (Netherlands)

Bose, Ranjita K.; Enke, Marcel; Grande, Antonio M.; Zechel, Stefan; Schacher, Felix H.; Hager, Martin D.; Garcia, Santiago J.; Schubert, Ulrich S.; van der Zwaag, Sybrand

2017-01-01

The main aim of this work is to study the respective contribution of the hard and soft blocks of a metal-ligand containing block copolymer to the self-healing behavior. To this aim, different block copolymers containing terpyridine were synthesized using reversible addition-fragmentation chain

Robustness, Death of Spiral Wave in the Network of Neurons under Partial Ion Channel Block

International Nuclear Information System (INIS)

Jun, Ma; Long, Huang; Chun-Ni, Wang; Zhong-Sheng, Pu

2013-01-01

The development of spiral wave in a two-dimensional square array due to partial ion channel block (Potassium, Sodium) is investigated, the dynamics of the node is described by Hodgkin—Huxley neuron and these neurons are coupled with nearest neighbor connection. The parameter ratio x Na (and x K ), which defines the ratio of working ion channel number of sodium (potassium) to the total ion channel number of sodium (and potassium), is used to measure the shift conductance induced by channel block. The distribution of statistical variable R in the two-parameter phase space (parameter ratio vs. poisoning area) is extensively calculated to mark the parameter region for transition of spiral wave induced by partial ion channel block, the area with smaller factors of synchronization R is associated the parameter region that spiral wave keeps alive and robust to the channel poisoning. Spiral wave keeps alive when the poisoned area (potassium or sodium) and degree of intoxication are small, distinct transition (death, several spiral waves coexist or multi-arm spiral wave emergence) occurs under moderate ratio x Na (and x K ) when the size of blocked area exceeds certain thresholds. Breakup of spiral wave occurs and multi-arm of spiral waves are observed when the channel noise is considered. (interdisciplinary physics and related areas of science and technology)

Assessment of inter-atrial, inter-ventricular, and atrio-ventricular interactions in tetralogy of Fallot patients after surgical correction. Insights from two-dimensional speckle tracking and three-dimensional echocardiography.

Science.gov (United States)

Abd El Rahman, Mohamed; Raedle-Hurst, Tanja; Rentzsch, Axel; Schäfers, Hans-Joachim; Abdul-Khaliq, Hashim

2015-10-01

We aimed to assess biatrial size and function, interactions on atrial and ventricular levels, and atrio-ventricular coupling in patients after tetralogy of Fallot repair. A total of 34 patients with a mean age of 20.9±9 years, and 35 healthy controls, underwent two-dimensional speckle tracking echocardiography for ventricular and atrial strain measurements and real-time three-dimensional echocardiography to assess ventricular and atrial volumes. When compared with controls, tetralogy of Fallot patients had significantly reduced right atrial peak atrial longitudinal strain (ptetralogy of Fallot group, left ventricular ejection fraction was negatively related to the right ventricular end-systolic volume normalised to body surface area (r=-0.62, ptetralogy of Fallot patients, biatrial dysfunction exists and can be quantified via two-dimensional speckle tracking echocardiography as well as real-time three-dimensional echocardiography. Different forms of interactions on atrial and ventricular levels are evident among such cohorts.

Predictors and Frequency of Conduction Disturbances After Open-Heart Surgery

Directory of Open Access Journals (Sweden)

Zahra Emkanjoo

2008-02-01

Full Text Available Introduction The risk of developing conduction disturbances after coronary bypass grafting (CABG or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2% to 3% of patients, and in 10% of patients undergoing repeat cardiac surgery.We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation.Material and Method We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG (n=128, Mitral valve replacement(MVR(n=18, aortic valve replacement(AVR (n=21, MVR and AVR(n=56, repair of ventricular septal defect (VSD (n=51, repair of tetralogy of Fallot (TOF (n=57,CABG and valvular surgery (n=6, others (n=37.Results Among 374 patients included in our study (mean age 34.46±25.68; 146 males, 192 developed new conduction disorders: symptomatic sinus bradycardia in 8%, atrial fibrillation with slow ventricular response (AF in 4.5%, first-degree atrioventricular block (AVBin 6.4%, second-degree AVB in 0.3%, third-degree AVB in 7%, new right bundle branch block (RBBB in 33%, and new left bundle branch block (LBBB in 2.1%. In 5.6% patients, a permanent pacemaker was implanted, 47.6% of them underwent valvular surgery. In 44.1% of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7% of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2% of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response . After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI occurred in 1.9% of patients. The occurrence conduction disturbance

Contributions of hard and soft blocks in the self-healing of metal-ligand-containing block copolymers

NARCIS (Netherlands)

Bose, R.K.; Enke, Marcel; Grande, A.M.; Zechel, Stefan; Schacher, Felix H.; Hager, Martin D.; Garcia Espallargas, Santiago J.; Schubert, Ulrich S.; van der Zwaag, S.

2017-01-01

The main aim of this work is to study the respective contribution of the hard and soft blocks of a metal-ligand containing block copolymer to the self-healing behavior. To this aim, different block copolymers containing terpyridine were synthesized using reversible addition-fragmentation chain

Comparison of the Cellient(™) automated cell block system and agar cell block method.

Science.gov (United States)

Kruger, A M; Stevens, M W; Kerley, K J; Carter, C D

2014-12-01

To compare the Cellient(TM) automated cell block system with the agar cell block method in terms of quantity and quality of diagnostic material and morphological, histochemical and immunocytochemical features. Cell blocks were prepared from 100 effusion samples using the agar method and Cellient system, and routinely sectioned and stained for haematoxylin and eosin and periodic acid-Schiff with diastase (PASD). A preliminary immunocytochemical study was performed on selected cases (27/100 cases). Sections were evaluated using a three-point grading system to compare a set of morphological parameters. Statistical analysis was performed using Fisher's exact test. Parameters assessing cellularity, presence of single cells and definition of nuclear membrane, nucleoli, chromatin and cytoplasm showed a statistically significant improvement on Cellient cell blocks compared with agar cell blocks (P cell groups, PASD staining or the intensity or clarity of immunocytochemical staining. A discrepant immunocytochemistry (ICC) result was seen in 21% (13/63) of immunostains. The Cellient technique is comparable with the agar method, with statistically significant results achieved for important morphological features. It demonstrates potential as an alternative cell block preparation method which is relevant for the rapid processing of fine needle aspiration samples, malignant effusions and low-cellularity specimens, where optimal cell morphology and architecture are essential. Further investigation is required to optimize immunocytochemical staining using the Cellient method. © 2014 John Wiley & Sons Ltd.

Two injection digital block versus single subcutaneous palmar injection block for finger lacerations.

Science.gov (United States)

Okur, O M; Şener, A; Kavakli, H Ş; Çelik, G K; Doğan, N Ö; Içme, F; Günaydin, G P

2017-12-01

We aimed to compare two digital nerve block techniques in patients due to traumatic digital lacerations. This was a randomized-controlled study designed prospectively in the emergency department of a university-based training and research hospital. Randomization was achieved by sealed envelopes. Half of the patients were randomised to traditional (two-injection) digital nerve block technique while single-injection digital nerve block technique was applied to the other half. Score of pain due to anesthetic infiltration and suturing, onset time of total anesthesia, need for an additional rescue injection were the parameters evaluated with both groups. Epinephrin added lidocaine hydrochloride preparation was used for the anesthetic application. Visual analog scale was used for the evaluation of pain scores. Outcomes were compared by using Mann-Whitney U test and Student t-test. Fifty emergency department patients ≥18 years requiring digital nerve block were enrolled in the study. Mean age of the patients was 33 (min-max: 19-86) and 39 (78 %) were male. No statistically significant difference was found between the two groups in terms of our main parameters; anesthesia pain score, suturing pain score, onset time of total anesthesia and rescue injection need. Single injection volar digital nerve block technique is a suitable alternative for digital anesthesias in emergency departments.

Related Drupal Nodes Block

NARCIS (Netherlands)

Van der Vegt, Wim

2010-01-01

Related Drupal Nodes Block This module exposes a block that uses Latent Semantic Analysis (Lsa) internally to suggest three nodes that are relevant to the node a user is viewing. This module performs three tasks. 1) It periodically indexes a Drupal site and generates a Lsa Term Document Matrix.

Application of multi-block methods in cement production

DEFF Research Database (Denmark)

Svinning, K.; Høskuldsson, Agnar

2008-01-01

distribution and the two last blocks the superficial microstructure analysed by differential thermo gravimetric analysis. The multi-block method is used to identify the role of each part. The score vectors of each block can be analysed separately or together with score vectors of other blocks. Stepwise......Compressive strength at 1 day of Portland cement as a function of the microstructure of cement was statistically modelled by application of multi-block regression method. The observation X-matrix was partitioned into four blocks, the first block representing the mineralogy, the second particle size...... regression is used to find minimum number of variables of each block. The multi-block method proved useful in determining the modelling strength of each data block and finding minimum number of variables within each data block....

Right bundle branch block

DEFF Research Database (Denmark)

Bussink, Barbara E; Holst, Anders Gaarsdal; Jespersen, Lasse

2013-01-01

AimsTo determine the prevalence, predictors of newly acquired, and the prognostic value of right bundle branch block (RBBB) and incomplete RBBB (IRBBB) on a resting 12-lead electrocardiogram in men and women from the general population.Methods and resultsWe followed 18 441 participants included...... in the Copenhagen City Heart Study examined in 1976-2003 free from previous myocardial infarction (MI), chronic heart failure, and left bundle branch block through registry linkage until 2009 for all-cause mortality and cardiovascular outcomes. The prevalence of RBBB/IRBBB was higher in men (1.4%/4.7% in men vs. 0.......5%/2.3% in women, P block was associated with significantly...

Isostatic compression of buffer blocks. Middle scale

International Nuclear Information System (INIS)

Ritola, J.; Pyy, E.

2012-01-01

Manufacturing of buffer components using isostatic compression method has been studied in small scale in 2008 (Laaksonen 2010). These tests included manufacturing of buffer blocks using different bentonite materials and different compression pressures. Isostatic mould technology was also tested, along with different methods to fill the mould, such as vibration and partial vacuum, as well as a stepwise compression of the blocks. The development of manufacturing techniques has continued with small-scale (30 %) blocks (diameter 600 mm) in 2009. This was done in a separate project: Isostatic compression, manufacturing and testing of small scale (D = 600 mm) buffer blocks. The research on the isostatic compression method continued in 2010 in a project aimed to test and examine the isostatic manufacturing process of buffer blocks at 70 % scale (block diameter 1200 to 1300 mm), and the aim was to continue in 2011 with full-scale blocks (diameter 1700 mm). A total of nine bentonite blocks were manufactured at 70 % scale, of which four were ring-shaped and the rest were cylindrical. It is currently not possible to manufacture full-scale blocks, because there is no sufficiently large isostatic press available. However, such a compression unit is expected to be possible to use in the near future. The test results of bentonite blocks, produced with an isostatic pressing method at different presses and at different sizes, suggest that the technical characteristics, for example bulk density and strength values, are somewhat independent of the size of the block, and that the blocks have fairly homogenous characteristics. Water content and compression pressure are the two most important properties determining the characteristics of the compressed blocks. By adjusting these two properties it is fairly easy to produce blocks at a desired density. The commonly used compression pressure in the manufacturing of bentonite blocks is 100 MPa, which compresses bentonite to approximately

Isostatic compression of buffer blocks. Middle scale

Energy Technology Data Exchange (ETDEWEB)

Ritola, J.; Pyy, E. [VTT Technical Research Centre of Finland, Espoo (Finland)

2012-01-15

Manufacturing of buffer components using isostatic compression method has been studied in small scale in 2008 (Laaksonen 2010). These tests included manufacturing of buffer blocks using different bentonite materials and different compression pressures. Isostatic mould technology was also tested, along with different methods to fill the mould, such as vibration and partial vacuum, as well as a stepwise compression of the blocks. The development of manufacturing techniques has continued with small-scale (30 %) blocks (diameter 600 mm) in 2009. This was done in a separate project: Isostatic compression, manufacturing and testing of small scale (D = 600 mm) buffer blocks. The research on the isostatic compression method continued in 2010 in a project aimed to test and examine the isostatic manufacturing process of buffer blocks at 70 % scale (block diameter 1200 to 1300 mm), and the aim was to continue in 2011 with full-scale blocks (diameter 1700 mm). A total of nine bentonite blocks were manufactured at 70 % scale, of which four were ring-shaped and the rest were cylindrical. It is currently not possible to manufacture full-scale blocks, because there is no sufficiently large isostatic press available. However, such a compression unit is expected to be possible to use in the near future. The test results of bentonite blocks, produced with an isostatic pressing method at different presses and at different sizes, suggest that the technical characteristics, for example bulk density and strength values, are somewhat independent of the size of the block, and that the blocks have fairly homogenous characteristics. Water content and compression pressure are the two most important properties determining the characteristics of the compressed blocks. By adjusting these two properties it is fairly easy to produce blocks at a desired density. The commonly used compression pressure in the manufacturing of bentonite blocks is 100 MPa, which compresses bentonite to approximately

Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway

Directory of Open Access Journals (Sweden)

Rakesh Gopinathannair, MD, MA

2013-05-01

Full Text Available A 24-year-old male with Wolff-Parkinson-White syndrome developed systolic cardiomyopathy and severe heart failure following membranous ventricular septal defect repair and tricuspid valve replacement. Following successful catheter ablation of a right anterolateral accessory pathway (AP, complete AV block with junctional escape rhythm was noted. Patient subsequently underwent implantation of a biventricular ICD. Heart failure symptoms significantly improved soon after and left ventricular systolic function normalized 3 months post-procedure. In this case, surgically acquired AV block likely explains development of postoperative cardiomyopathy by facilitating ventricular activation solely via the AP and thereby increasing the degree of ventricular dyssynchrony.

Block of the delayed rectifier current (IK) by the 5-HT3 antagonists ondansetron and granisetron in feline ventricular myocytes.

Science.gov (United States)

de Lorenzi, F G; Bridal, T R; Spinelli, W

1994-01-01

1. We investigated the effects of two 5-HT3 antagonists, ondansetron and granisetron, on the action potential duration (APD) and the delayed rectifier current (IK) of feline isolated ventricular myocytes. Whole-cell current and action potential recordings were performed at 37 degrees C with the patch clamp technique. 2. Ondansetron and granisetron blocked IK with a KD of 1.7 +/- 1.0 and 4.3 +/- 1.7 microM, respectively. At a higher concentration (30 microM), both drugs blocked the inward rectifier (IKl). 3. The block of IK was dependent on channel activation. Both drugs slowed the decay of IK tail currents and produced a crossover with the pre-drug current trace. These results are consistent with block and unblock from the open state of the channel. 4. Granisetron showed an intrinsic voltage-dependence as the block increased with depolarization. The equivalent voltage-dependency of block (delta) was 0.10 +/- 0.04, suggesting that granisetron blocks from the intracellular side at a binding site located 10% across the transmembrane electrical field. 5. Ondansetron (1 microM) and granisetron (3 microM) prolonged APD by about 30% at 0.5 Hz. The prolongation of APD by ondansetron was abolished at faster frequencies (3 Hz) showing reverse rate dependence. 6. In conclusion, the 5-HT3 antagonists, ondansetron and granisetron, are open state blockers of the ventricular delayed rectifier and show a clear class III action. PMID:7834204

Uniaxial backfill block compaction

International Nuclear Information System (INIS)

Koskinen, V.

2012-05-01

The main parts of the project were: to make a literature survey of the previous uniaxial compaction experiments; do uniaxial compaction tests in laboratory scale; and do industrial scale production tests. Object of the project was to sort out the different factors affecting the quality assurance chain of the backfill block uniaxial production and solve a material sticking to mould problem which appeared during manufacturing the blocks of bentonite and cruched rock mixture. The effect of mineralogical and chemical composition on the long term functionality of the backfill was excluded from the project. However, the used smectite-rich clays have been tested for mineralogical consistency. These tests were done in B and Tech OY according their SOPs. The objective of the Laboratory scale tests was to find right material- and compaction parameters for the industrial scale tests. Direct comparison between the laboratory scale tests and industrial scale tests is not possible because the mould geometry and compaction speed has a big influence for the compaction process. For this reason the selected material parameters were also affected by the previous compaction experiments. The industrial scale tests were done in summer of 2010 in southern Sweden. Blocks were done with uniaxial compaction. A 40 tons of the mixture of bentonite and crushed rock blocks and almost 50 tons of Friedland-clay blocks were compacted. (orig.)

Impression block with orientator

International Nuclear Information System (INIS)

Brilin, V I; Ulyanova, O S

2015-01-01

Tool review, namely the impression block, applied to check the shape and size of the top of fish as well as to determine the appropriate tool for fishing operation was realized. For multiple application and obtaining of the impress depth of 3 cm and more, the standard volumetric impression blocks with fix rods are used. However, the registered impress of fish is not oriented in space and the rods during fishing are in the extended position. This leads to rods deformation and sinking due to accidental impacts of impression block over the borehole irregularity and finally results in faulty detection of the top end of fishing object in hole. The impression blocks with copy rods and fixed magnetic needle allow estimating the object configuration and fix the position of magnetic needle determining the position of the top end of object in hole. However, the magnetic needle fixation is realized in staged and the rods are in extended position during fishing operations as well as it is in standard design. The most efficient tool is the impression block with copy rods which directs the examined object in the borehole during readings of magnetic needles data from azimuth plate and averaging of readings. This significantly increases the accuracy of fishing toll direction. The rods during fishing are located in the body and extended only when they reach the top of fishing object

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.

Science.gov (United States)

Bergmann, Lars; Martini, Stefan; Kesselmeier, Miriam; Armbruster, Wolf; Notheisen, Thomas; Adamzik, Michael; Eichholz, Rϋdiger

2016-07-29

Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function. This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block. Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test. The spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported. A different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients. German

49 CFR 236.804 - Signal, block.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Signal, block. 236.804 Section 236.804 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Signal, block. A roadway signal operated either automatically or manually at the entrance to a block. ...

Toward Composable Hardware Agnostic Communications Blocks Lessons Learned

Science.gov (United States)

2016-11-01

block-by-block level or on a multi- block level. In the block-by-block pushback approach, queues between each block are small and blocks processing data...medium access, and physical layers of the waveform has limited our ability to take advantage of technology advances in signal processing , rate...pro- cessing functions, and application processing functions as shown in Figure 1 [1]. Transceiver functions are functions associated with transmitting

Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study.

Science.gov (United States)

Thakkar, Bhavesh; Patel, Nehal; Bohora, Shomu; Bhalodiya, Dharmin; Singh, Tarandeep; Madan, Tarun; Shah, Saurin; Poptani, Vishal; Shukla, Anand

2016-04-01

Background and Objective Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3-18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval. Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no

Micellar aggregates of amylose-block-polystyrene rod-coil block copolymers in water and THF

NARCIS (Netherlands)

Loos, Katja; Böker, Alexander; Zettl, Heiko; Zhang, Mingfu; Krausch, Georg; Müller, Axel H.E.; Boker, A.; Zhang, A.F.

2005-01-01

Amylose-block-polystyrenes with various block copolymer compositions were investigated in water and in THF solution. Fluorescence correlation spectroscopy, dynamic light, scattering (DLS), and asymmetric flow field-flow fractionation with multiangle light scattering detection indicate the presence

A comparison of oblique subcostal transversus abdominis plane block versus thoracic paravertebral block for postoperative analgesia after open cholecystectomy

Directory of Open Access Journals (Sweden)

Ghada Kamhawy

2017-10-01

Full Text Available Background: A major challenge in the postoperative period is pain management which, if not adequately controlled, may contribute to patient discomfort and decreased patient satisfaction, and possibly increased morbidity and mortality. Both Thoracic paravertebral block and oblique subcostal transversus abdominis plane block can be used as analgesic techniques for abdominal surgeries. Our aim in this research was comparison of cumulative 24-h post-operative morphine consumption between ultrasound-guided oblique subcostal transversus abdominis plane block and ultrasound-guided thoracic paravertebral block in patients who underwent an open cholecystectomy under general anesthesia. Patients and methods: This study was performed on 46 patients who underwent open cholecystectomy under general anesthesia. All patients were randomly allocated alternatively to one of two equal groups to either undergo ultrasound-guided unilateral oblique subcostal transversus abdominis plane block Group (I or to undergo ultrasound-guided unilateral thoracic paravertebral block Group (II. Both groups were subjected to a similar analgesic regimen in the immediate post-operative period that involved intravenous patient-controlled morphine analgesia which was used in both groups. Results: The total morphine consumption in the first postoperative 24 h was lower in thoracic paravertebral block Group (II (9.9 mg in thoracic paravertebral block group vs. 15.4 mg in oblique subcostal transversus abdominis plane block Group (I with p < 0.001. The mean time of first request of analgesia in Group (I was 248.7 min compared to 432.1 for Group (II with p < 0.001. Conclusions: Both ultrasound-guided oblique subcostal transversus abdominis plain block and single injection ultrasound guided thoracic paravertebral block are effective analgesic techniques for upper abdominal surgeries and reduces postoperative opioid requirements. However, thoracic paravertebral block is more

Habitat Blocks and Wildlife Corridors

Data.gov (United States)

Vermont Center for Geographic Information — Habitat blocks are areas of contiguous forest and other natural habitats that are unfragmented by roads, development, or agriculture. Vermonts habitat blocks are...

Recursion Relations for Conformal Blocks

CERN Document Server

Penedones, João; Yamazaki, Masahito

2016-09-12

In the context of conformal field theories in general space-time dimension, we find all the possible singularities of the conformal blocks as functions of the scaling dimension $\\Delta$ of the exchanged operator. In particular, we argue, using representation theory of parabolic Verma modules, that in odd spacetime dimension the singularities are only simple poles. We discuss how to use this information to write recursion relations that determine the conformal blocks. We first recover the recursion relation introduced in 1307.6856 for conformal blocks of external scalar operators. We then generalize this recursion relation for the conformal blocks associated to the four point function of three scalar and one vector operator. Finally we specialize to the case in which the vector operator is a conserved current.

Block-Parallel Data Analysis with DIY2

Energy Technology Data Exchange (ETDEWEB)

Morozov, Dmitriy [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Peterka, Tom [Argonne National Lab. (ANL), Argonne, IL (United States)

2017-08-30

DIY2 is a programming model and runtime for block-parallel analytics on distributed-memory machines. Its main abstraction is block-structured data parallelism: data are decomposed into blocks; blocks are assigned to processing elements (processes or threads); computation is described as iterations over these blocks, and communication between blocks is defined by reusable patterns. By expressing computation in this general form, the DIY2 runtime is free to optimize the movement of blocks between slow and fast memories (disk and flash vs. DRAM) and to concurrently execute blocks residing in memory with multiple threads. This enables the same program to execute in-core, out-of-core, serial, parallel, single-threaded, multithreaded, or combinations thereof. This paper describes the implementation of the main features of the DIY2 programming model and optimizations to improve performance. DIY2 is evaluated on benchmark test cases to establish baseline performance for several common patterns and on larger complete analysis codes running on large-scale HPC machines.

Assessment of exit block following pulmonary vein isolation: far-field capture masquerading as entrance without exit block.

Science.gov (United States)

Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Naperkowski, Angela; Oren, Jess; Storm, Randle; Ellenbogen, Kenneth A

2012-10-01

Complete electrical isolation of pulmonary veins (PVs) remains the cornerstone of ablation therapy for atrial fibrillation. Entrance block without exit block has been reported to occur in 40% of the patients. Far-field capture (FFC) can occur during pacing from the superior PVs to assess exit block, and this may appear as persistent conduction from PV to left atrium (LA). To facilitate accurate assessment of exit block. Twenty consecutive patients with symptomatic atrial fibrillation referred for ablation were included in the study. Once PV isolation (entrance block) was confirmed, pacing from all the bipoles on the Lasso catheter was used to assess exit block by using a pacing stimulus of 10 mA at 2 ms. Evidence for PV capture without conduction to LA was necessary to prove exit block. If conduction to LA was noticed, pacing output was decreased until there was PV capture without conduction to LA or no PV capture was noted to assess for far-field capture in both the upper PVs. All 20 patients underwent successful isolation (entrance block) of all 76 (4 left common PV) veins: mean age 58 ± 9 years; paroxysmal atrial fibrillation 40%; hypertension 70%, diabetes mellitus 30%, coronary artery disease 15%; left ventricular ejection fraction 55% ± 10%; LA size 42 ± 11 mm. Despite entrance block, exit block was absent in only 16% of the PVs, suggesting persistent PV to LA conduction. FFC of LA appendage was noted in 38% of the left superior PVs. FFC of the superior vena cava was noted in 30% of the right superior PVs. The mean pacing threshold for FFC was 7 ± 4 mA. Decreasing pacing output until only PV capture (loss of FFC) is noted was essential to confirm true exit block. FFC of LA appendage or superior vena cava can masquerade as persistent PV to LA conduction. A careful assessment for PV capture at decreasing pacing output is essential to exclude FFC. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Degree distribution in discrete case

International Nuclear Information System (INIS)

Wang, Li-Na; Chen, Bin; Yan, Zai-Zai

2011-01-01

Vertex degree of many network models and real-life networks is limited to non-negative integer. By means of measure and integral, the relation of the degree distribution and the cumulative degree distribution in discrete case is analyzed. The degree distribution, obtained by the differential of its cumulative, is only suitable for continuous case or discrete case with constant degree change. When degree change is not a constant but proportional to degree itself, power-law degree distribution and its cumulative have the same exponent and the mean value is finite for power-law exponent greater than 1. -- Highlights: → Degree change is the crux for using the cumulative degree distribution method. → It suits for discrete case with constant degree change. → If degree change is proportional to degree, power-law degree distribution and its cumulative have the same exponent. → In addition, the mean value is finite for power-law exponent greater than 1.

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial.

Science.gov (United States)

Blanco, Rafael; Ansari, Tarek; Riad, Waleed; Shetty, Nanda

Effective postoperative analgesia after cesarean delivery enhances early recovery, ambulation, and breastfeeding. In a previous study, we established the effectiveness of the quadratus lumborum block in providing pain relief after cesarean delivery compared with patient-controlled analgesia (morphine). In the current study, we hypothesized that this method would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after cesarean delivery. Between April 2015 and August 2015, we randomized 76 patients scheduled for elective cesarean delivery under spinal anesthesia to receive the quadratus lumborum block or the transversus abdominis plane block for postoperative pain relief. This trial was registered prospectively (NCT 02489851) [corrected]. Patients in the quadratus lumborum block group used significantly less morphine than the transversus abdominis plane block group (P consumption and demands than transversus abdominis plane blocks after cesarean section. This effect was observed up to 48 hours postoperatively.

[THE TECHNOLOGY "CELL BLOCK" IN CYTOLOGICAL PRACTICE].

Science.gov (United States)

Volchenko, N N; Borisova, O V; Baranova, I B

2015-08-01

The article presents summary information concerning application of "cell block" technology in cytological practice. The possibilities of implementation of various modern techniques (immune cytochemnical analysis. FISH, CISH, polymerase chain reaction) with application of "cell block" method are demonstrated. The original results of study of "cell block" technology made with gelatin, AgarCyto and Shadon Cyoblock set are presented. The diagnostic effectiveness of "cell block" technology and common cytological smear and also immune cytochemical analysis on samples of "cell block" technology and fluid cytology were compared. Actually application of "cell block" technology is necessary for ensuring preservation of cell elements for subsequent immune cytochemical and molecular genetic analysis.

21 CFR 520.1448a - Monensin blocks.

Science.gov (United States)

2010-04-01

...) Limitations. Block to be fed free choice to pasture cattle (slaughter, stocker, feeder, and dairy and beef.... Blocks to be fed free choice to pasture cattle (slaughter, stocker, feeder, and dairy and beef.... Blocks to be fed free choice to pasture cattle (slaughter, stocker, and feeder). Provide at least 1 block...

Approximating the imbibition and absorption behavior of a distribution of matrix blocks by an equivalent spherical block

International Nuclear Information System (INIS)

Zimmerman, R.W.; Bodvarsson, G.S.

1994-03-01

A theoretical study is presented of the effect of matrix block shape and matrix block size distribution on liquid imbibition and solute absorption in a fractured rock mass. It is shown that the behavior of an individual irregularly-shaped matrix block can be modeled with reasonable accuracy by using the results for a spherical matrix block, if one uses an effective radius a = 3V/A, where V is the volume of the block and A is its surface area. In the early-time regime of matrix imbibition, it is shown that a collection of blocks of different sizes can be modeled by a single equivalent block, with an equivalent radius of -1 > -1 , where the average is taken on a volumetrically-weighted basis. In an intermediate time regime, it is shown for the case where the radii are normally distributed that the equivalent radius is reasonably well approximated by the mean radius . In the long-time limit, where no equivalent radius can be rigorously defined, an asymptotic expression is derived for the cumulative diffusion as a function of the mean and the standard deviation of the radius distribution function

Application of interconnected porous hydroxyapatite ceramic block for onlay block bone grafting in implant treatment: A case report.

Science.gov (United States)

Ohta, Kouji; Tada, Misato; Ninomiya, Yoshiaki; Kato, Hiroki; Ishida, Fumi; Abekura, Hitoshi; Tsuga, Kazuhiro; Takechi, Masaaki

2017-12-01

Autogenous block bone grafting as treatment for alveolar ridge atrophy has various disadvantages, including a limited availability of sufficiently sized and shaped grafts, donor site morbidity and resorption of the grafted bone. As a result, interconnected porous hydroxyapatite ceramic (IP-CHA) materials with high porosity have been developed and used successfully in orthopedic cases. To the best of the author's knowledge, this is the first report of clinical application of an IP-CHA block for onlay grafting for implant treatment in a patient with horizontal alveolar atrophy. The present study performed onlay block grafting using an IP-CHA block to restore bone volume for implant placement in the alveolar ridge area without collecting autogenous bone. Dental X-ray findings revealed that the border of the IP-CHA block became increasingly vague over the 3-year period, whereas CT scanning revealed that the gap between the block and bone had a smooth transition, indicating that IP-CHA improved the process of integration with host bone. In follow-up examinations over a period of 5 years, the implants and superstructures had no problems. An IP-CHA block may be useful as a substitute for onlay block bone grafting in implant treatment.

Crustal block motion model and interplate coupling along Ecuador-Colombia trench based on GNSS observation network

Science.gov (United States)

Ito, T.; Mora-Páez, H.; Peláez-Gaviria, J. R.; Kimura, H.; Sagiya, T.

2017-12-01

interplate coupling along the plate interface and rigid block motion. We can evaluate to contribution of elastic deformation and rigid motion. In result, weak plate coupling was found northern part of 3 degree in latitude. Almost crustal deformation are explained by rigid block motion.

Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries

Directory of Open Access Journals (Sweden)

Wafaa Mohamed Alsadek

2015-04-01

Conclusion: TAP block and caudal block under ultrasound guidance proved to be safe with no recorded complications either intra or postoperatively. Patient and parent satisfaction was markedly observed in case of TAP block.

Influence of 1,2-PB matrix cross-linking on structure and properties of selectively etched 1,2-PB-b-PDMS block copolymers

DEFF Research Database (Denmark)

Guo, Fengxiao; Andreasen, Jens Wenzel; Vigild, Martin Etchells

2007-01-01

of the cross-linked samples in toluene was converted into a degree of cross-linking following the Flory scheme; a simple relation between the Flory cross-linking degree and the fraction of consumed double bonds during the cross-linking reaction followed. The structure of the block copolymer at different stages...... of preparation was characterized by small-angle X-ray scattering (SAXS). In addition, scanning electron microscopy (SEM) gave direct images of the nanoporous polymer structure. Nanocavities are accessible to methanol, and observations of methanol uptake were combined with structural information from SAXS...

Transversus abdominis plane block vs. wound infiltration in Caesarean section: a randomised controlled trial.

Science.gov (United States)

Telnes, A; Skogvoll, E; Lonnée, H

2015-04-01

Multiple studies suggest that transversus abdominis plane (TAP) block (without intrathecal morphine) after Caesarean section (CS) reduces post-operative morphine consumption. In our study, we wanted to compare the analgesic effect of TAP block with infiltration of the wound after CS. We included 60 pregnant women scheduled for elective CS under spinal anaesthesia in a randomised, single-centre, double-blind study. Thirty patients received ultrasound-guided TAP block using 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml bilaterally and 20 ml normal saline as wound infiltration (TAP group). The other 30 patients (the control group) received normal saline 20 ml bilaterally in the TAP, and 20 ml bupivacaine 0.25% with adrenaline 5 μg/ml as wound infiltration. The main outcome was cumulative morphine consumption at 48 h after surgery. In addition, continuous morphine consumption, pain scores and side effects were registered. Fifty-seven patients completed the study. Cumulative morphine consumption at 48 h (mean±standard deviation) was 41±34 mg in the TAP group and 38±27 mg in the control group (P=0.7); a difference of 3 mg (95% confidence interval -13 to 19 mg). Morphine consumption at any time up to 48 h was virtually identical in both groups. Side effects were similar, except for a higher degree of sedation in the TAP group (P=0.04). Compared with wound infiltration with local anaesthetics, TAP block did not reduce cumulative morphine consumption following CS. The TAP block was associated with more pronounced sedation. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Naming Block Structures: A Multimodal Approach

Science.gov (United States)

Cohen, Lynn; Uhry, Joanna

2011-01-01

This study describes symbolic representation in block play in a culturally diverse suburban preschool classroom. Block play is "multimodal" and can allow children to experiment with materials to represent the world in many forms of literacy. Combined qualitative and quantitative data from seventy-seven block structures were collected and analyzed.…

21 CFR 882.5070 - Bite block.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bite block. 882.5070 Section 882.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5070 Bite block. (a) Identification. A bite block...

Using Interference to Block RFID Tags

DEFF Research Database (Denmark)

Krigslund, Rasmus; Popovski, Petar; Pedersen, Gert Frølund

We propose a novel method to block RFID tags from responding, using intentional interference. We focus on the experimental evaluation, where we impose interference on the download and uplink, respectively. The results are positive, where modulated CCI shows most effective to block a tag.......We propose a novel method to block RFID tags from responding, using intentional interference. We focus on the experimental evaluation, where we impose interference on the download and uplink, respectively. The results are positive, where modulated CCI shows most effective to block a tag....

Posicionamento ectópico de eletrodo de marcapasso Posicionamiento ectópico de electrodo de marcapaso Ectopic positioning of pacemaker electrode

Directory of Open Access Journals (Sweden)

Gildo Mota

2010-05-01

Full Text Available Apresentamos o caso de um paciente portador da forma cardíaca da doença de Chagas com disfunção ventricular esquerda e bloqueio atrioventricular de 2º grau Mobitz II, associados a vários episódios de síncope. Foi submetido a implante de marcapasso artificial definitivo dupla câmara. Após um ano do implante foi diagnosticado deslocamento de eletrodo atrial, sendo submetido a reimplante de eletrodo atrial. Após dois anos do primeiro procedimento cirúrgico, apresentava dispneia aos grandes esforços. Durante a avaliação, foi solicitado ecocardiograma, que detectou a presença de corpo estranho de características metálicas em câmaras cardíacas esquerdas, consistente com eletrodo de marcapasso ectópico.Referimos el caso de un paciente portador de la forma cardíaca de la enfermedad de Chagas con disfunción ventricular izquierda y bloqueo atrioventricular de 2° grado Mobitz II, asociados a varios episodios de síncope. Fue sometido a implante de marcapaso artificial definitivo doble cámara. Tras un año del implante se diagnosticó desplazamiento de electrodo atrial, con la sumisión del paciente a reimplante de electrodo atrial. Tras dos años del primer procedimiento quirúrgico, presentaba disnea a los grandes esfuerzos. Durante la evaluación, se solicitó ecocardiograma, que detectó presencia de cuerpo extraño de características metálicas en cámaras cardíacas izquierdas, de acuerdo con electrodo de marcapaso ectópico.The present case reports on a patient presenting the cardiac form of Chagas disease, with left ventricular dysfunction and second-degree atrioventricular block Mobitz type II, associated with several syncope episodes. The patient underwent a double-chamber definitive artificial pacemaker implant. One year after the implant, the displacement of the atrial electrode was diagnosed and the patient was submitted to re-implantation of the atrial electrode. Two years after the first surgical procedure, the

Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation.

Science.gov (United States)

Hetta, Diab Fuad; Rezk, Khalid Mohammed

2016-11-01

The aim of this study was to evaluate the analgesic efficacy and safety of pectoralis-serratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain. A prospective randomized controlled study. Tertiary center, university hospital. Sixty-four adult women, American Society of Anesthesiologists physical status classes I, II, and III, scheduled for unilateral modified radical mastectomy with axillary evacuation. Patients were randomized to receive either pectoralis-serratus interfascial plane block, PS group (n=32), or thoracic paravertebral block, PV group (n=32). Twenty-four-hour morphine consumption and the time to rescue analgesic were recorded. The pain intensity evaluated by visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24hours postoperatively was also recorded. The median (interquartile range) postoperative 24-hour morphine consumption was significantly increased in PS group in comparison to PV group (PS vs PV), 20 mg (16-23 mg) vs 12 mg (10-14 mg) (Pplane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block. Copyright © 2016 Elsevier Inc. All rights reserved.

Ground reaction curve based upon block theory

International Nuclear Information System (INIS)

Yow, J.L. Jr.; Goodman, R.E.

1985-09-01

Discontinuities in a rock mass can intersect an excavation surface to form discrete blocks (keyblocks) which can be unstable. Once a potentially unstable block is identified, the forces affecting it can be calculated to assess its stability. The normal and shear stresses on each block face before displacement are calculated using elastic theory and are modified in a nonlinear way by discontinuity deformations as the keyblock displaces. The stresses are summed into resultant forces to evaluate block stability. Since the resultant forces change with displacement, successive increments of block movement are examined to see whether the block ultimately becomes stable or fails. Two-dimensional (2D) and three-dimensional (3D) analytic models for the stability of simple pyramidal keyblocks were evaluated. Calculated stability is greater for 3D analyses than for 2D analyses. Calculated keyblock stability increases with larger in situ stress magnitudes, larger lateral stress ratios, and larger shear strengths. Discontinuity stiffness controls blocks displacement more strongly than it does stability itself. Large keyblocks are less stable than small ones, and stability increases as blocks become more slender

Anatomical and neurohistological observations on the heart of the rose ringed parakeet, Psittacula krameri.

Science.gov (United States)

Qayyum, M A; Shaad, F U

1976-01-01

Anatomy, histology and innervation of the heart of the rose ringed parakeet, Psittacula krameri have been studied in the present investigation. The sinuatrial node is found to be well-developed. It is located towards the right side of the cephalic end of the interatrial septum and composed of a few nucleated cells and a large fibrous mass. The atrioventricular node is poorly defined, present at the caudal end of the interatrial septum. The node is somewhat triangular in shape and is composed of elongated and multinucleated specialized fibres. The node is not covered by any connective tissue sheath. The poor development of the atrio ventricular node and the absence of any sheath around it may be correlated with the fast rate of the heart beat. The atrioventricular bundle is observed at the cephalic end of the interventricular septum. A branch from the right limb of the atrioventricular bundle is noted to pass directly into the right atrioventricular valve. The heart is richly innervated. Ganglion cells along with nerve fibres have been observed at the sulcus terminalis and the atrioventricular junction. A direct nervous connection could be observed between the sinuatrial and atrioventricular nodes. It is argued that the impulse which originates in the sinuatrial node would reach the atrioventricular node through the unspecialized muscle fibres and nerve fibres of the interatrial septum. Nerve cells could not be traced in the substance of the sinuatrial node, atrioventricular node and atrioventricular bundle.

Strength and deformability of hollow concrete blocks: correlation of block and cylindrical sample test results

OpenAIRE

Barbosa, C. S.; Hanai, J.B.

2009-01-01

This paper deals with correlations among mechanical properties of hollow blocks and those of concrete used to make them. Concrete hollow blocks and test samples were moulded with plastic consistency concrete, to assure the same material in all cases, in three diferente levels of strength (nominally 10 N/mm², 20 N/mm² and 30 N/mm²). The mechanical properties and structural behaviour in axial compression and tension tests were determined by standard tests in blocks and cylinders. Stress and str...

Encoders for block-circulant LDPC codes

Science.gov (United States)

Divsalar, Dariush (Inventor); Abbasfar, Aliazam (Inventor); Jones, Christopher R. (Inventor); Dolinar, Samuel J. (Inventor); Thorpe, Jeremy C. (Inventor); Andrews, Kenneth S. (Inventor); Yao, Kung (Inventor)

2009-01-01

Methods and apparatus to encode message input symbols in accordance with an accumulate-repeat-accumulate code with repetition three or four are disclosed. Block circulant matrices are used. A first method and apparatus make use of the block-circulant structure of the parity check matrix. A second method and apparatus use block-circulant generator matrices.