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Sample records for high cardiac output

  1. Cardiac output measurement

    Directory of Open Access Journals (Sweden)

    Andreja Möller Petrun

    2014-02-01

    Full Text Available In recent years, developments in the measuring of cardiac output and other haemodynamic variables are focused on the so-called minimally invasive methods. The aim of these methods is to simplify the management of high-risk and haemodynamically unstable patients. Due to the need of invasive approach and the possibility of serious complications the use of pulmonary artery catheter has decreased. This article describes the methods for measuring cardiac output, which are based on volume measurement (Fick method, indicator dilution method, pulse wave analysis, Doppler effect, and electrical bioimpedance.

  2. Cardiac output during exercise

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  3. High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents.

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    Pianosi, Paolo T; Goodloe, Adele H; Soma, David; Parker, Ken O; Brands, Chad K; Fischer, Philip R

    2014-08-01

    Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise - hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning. We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output () versus oxygen uptake () relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat·min(-1) with head-up tilt. Among 107 POTS patients the distribution of slopes for the , relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min(-1) per L·min(-1), designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min(-1) per L·min(-1). Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups. We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an

  4. Cardiac output monitoring

    Directory of Open Access Journals (Sweden)

    Mathews Lailu

    2008-01-01

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

  5. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

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    Uygar Teomete

    2016-01-01

    Full Text Available Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.

  6. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

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    Teomete, Uygar; Gugol, Rubee Anne; Neville, Holly; Dandin, Ozgur; Young, Ming-Lon

    2016-01-01

    Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics. PMID:26885434

  7. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old.

    Science.gov (United States)

    Teomete, Uygar; Gugol, Rubee Anne; Neville, Holly; Dandin, Ozgur; Young, Ming-Lon

    2016-01-01

    Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.

  8. Scalp congenital hemangioma with associated high-output cardiac failure in a premature infant: Case report and review of literature.

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    Shah, Sumedh S; Snelling, Brian M; Sur, Samir; Ramnath, Alexandra R; Bandstra, Emmalee S; Yavagal, Dileep R

    2017-02-01

    Introduction Scalp congenital hemangiomas (CHs) are rare vascular malformations among infants; they can be associated with an array of complications, including cardiac and cosmetic issues. Here, we report the endovascular treatment of a premature infant with a suspected large right parietal scalp hemangioma and associated high-output cardiac failure. Case description A two-day-old female premature infant (29 weeks gestational age; 1330 g birth weight) was referred by the neonatologists to our department for consultation and potential treatment of a large right parietal CH causing abrupt hypotension and high-output cardiac failure. Doppler ultrasound imaging at bedside revealed areas of arterial-venous shunting from the scalp and the presence of a superior sagittal sinus waveform, consistent with intracranial venous drainage. To alleviate cardiac dysfunction secondary to this lesion, trans-arterial embolization via n-butyl cyanoacrylate (nBCA) glue and deployment of detachable coils was performed via umbilical artery to occlude the right superficial temporal and occipital artery branches supplying the CH. Following treatment, the infant continued to require ventilator management, vasopressor support, and correction of coagulopathy, but by post-operative day two, her condition improved remarkably and the mass size began decreasing. The patient was discharged after a relatively uncomplicated subsequent 2½-month course in the neonatal intensive care unit. Conclusion Endovascular therapy proved effective and safe in treating cardiac failure associated with scalp CH, despite potential complications associated with neuro-interventional surgery in premature infants. Appropriate consideration in this patient population should be given to factors including blood loss, contrast use, radiation exposure, operative time, and possible intra-/post-operative complications.

  9. Mini invasive hemodynamic monitoring: from arterial pressure to cardiac output

    OpenAIRE

    Della Rocca, Giorgio; Cecconi, Maurizio; Costa, Maria Gabriella

    2008-01-01

    To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient's outcome. The interest to lesser and lesser invasive techniques is high. Therefore, the alternative techniques have been recently developed.Cardiac Output can be monitored continuously by different devices that analyze the arterial waveform to track change...

  10. William Harvey, Peter Lauremberg and cardiac output.

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    Teichmann, G

    1992-11-01

    In 1636, the Rostock professor of medicine and the art of poetry, Peter Lauremberg (1585-1639), was one of the earliest to mention circulation which had been discovered by William Harvey and documented in his anatomical manual. In 1628 William Harvey proved the existence of the blood circulation by calculating the "cardiac output in a half an hour (semihora)". The answer to the question why Harvey chose half an hour as the time range can be found in the way of measuring time usual at that period. The sandglasses were turned half-hourly in maritime navigation and the wheel-clocks on shore had only the hour-hand. Improved chronometry was one of the prerequisites for measuring cardiac output. The minute-hand became usual after 1700 and the second-hand later on. Taking into consideration the alterations of cardiac output made the latter one of the most important circulation parameters in diagnostics, prognostication and therapeutics.

  11. Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients

    DEFF Research Database (Denmark)

    Meyhoff, C S; Hesselbjerg, L; Koscielniak-Nielsen, Z

    2007-01-01

    BACKGROUND AND OBJECTIVE: In most studies of cardiac output changes after spinal anaesthesia, the time-resolution is limited. The aim of this study was to demonstrate cardiac output changes with high time-resolution during onset of spinal anaesthesia in elderly patients. METHODS: We investigated 32...... changes in cardiac output during onset of spinal anaesthesia. Initially, cardiac output increased. Subsequently, it was significantly reduced from baseline, although this decrease was of minor clinical importance....

  12. Predictors of low cardiac output in decompensated severe heart failure

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    Marcelo Eidi Ochiai

    2011-01-01

    Full Text Available OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 60 years, and 64.6% were men. Low cardiac output was present in 281 (63% patients on admission. Chagas disease was the cause of heart failure in 92 (20.4% patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015. Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001, lower ejection fraction (RR: 2.414, P<0.001, hyponatremia (RR: 1.618, P = 0.036, and renal dysfunction (RR: 1.916, P = 0.007. Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001. Predictors of mortality were Chagas disease (RR: 2.286, P<0.001, ischemic etiology (RR: 1.449, P = 0.035, and low cardiac output (RR: 1.419, P = 0.047. CONCLUSIONS: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.

  13. Comparison of cardiac output measurement techniques

    DEFF Research Database (Denmark)

    Espersen, K; Jensen, E W; Rosenborg, D;

    1995-01-01

    Simultaneously measured cardiac output obtained by thermodilution (TD), transcutaneous suprasternal ultrasonic Doppler (DOP), CO2-rebreathing (CR) and the direct Fick method (FI) were compared in eleven healthy subjects in a supine position (SU), a sitting position (SI), and during sitting exercise...... at a workload of 50 W (EX). The agreements between the techniques, two by two, were expressed as the bias calculated as the averaged differences between the techniques. Precision was expressed as the standard deviation of the bias. The overall agreement (bias +/- precision) between TD, DOP and CR respectively...... and CR, respectively, and TD were 2.5 +/- 2.2 and 2.6 +/- 1.6 l/min. The overall agreement between DOP and CR was 0.1 +/- 1.6 l/min. In conclusion, TD overestimated cardiac output compared to the other techniques and the poor agreement has to be taken into consideration especially in measures of low...

  14. Videodensitometric Methods for Cardiac Output Measurements

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    Massimo Mischi

    2003-04-01

    Full Text Available Cardiac output is often measured by indicator dilution techniques, usually based on dye or cold saline injections. Developments of more stable ultrasound contrast agents (UCA are leading to new noninvasive indicator dilution methods. However, several problems concerning the interpretation of dilution curves as detected by ultrasound transducers have arisen. This paper presents a method for blood flow measurements based on UCA dilution. Dilution curves are determined by real-time densitometric analysis of the video output of an ultrasound scanner and are automatically fitted by the Local Density Random Walk model. A new fitting algorithm based on multiple linear regression is developed. Calibration, that is, the relation between videodensity and UCA concentration, is modelled by in vitro experimentation. The flow measurement system is validated by in vitro perfusion of SonoVue contrast agent. The results show an accurate dilution curve fit and flow estimation with determination coefficient larger than 0.95 and 0.99, respectively.

  15. Methods and apparatus for determining cardiac output

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    Cohen, Richard J. (Inventor); Mukkamala, Ramakrishna (Inventor); Sherman, Derin A. (Inventor)

    2010-01-01

    The present invention provides methods and apparatus for determining a dynamical property of the systemic or pulmonary arterial tree using long time scale information, i.e., information obtained from measurements over time scales greater than a single cardiac cycle. In one aspect, the invention provides a method and apparatus for monitoring cardiac output (CO) from a single blood pressure signal measurement obtained at any site in the systemic or pulmonary arterial tree or from any related measurement including, for example, fingertip photoplethysmography.According to the method the time constant of the arterial tree, defined to be the product of the total peripheral resistance (TPR) and the nearly constant arterial compliance, is determined by analyzing the long time scale variations (greater than a single cardiac cycle) in any of these blood pressure signals. Then, according to Ohm's law, a value proportional to CO may be determined from the ratio of the blood pressure signal to the estimated time constant. The proportional CO values derived from this method may be calibrated to absolute CO, if desired, with a single, absolute measure of CO (e.g., thermodilution). The present invention may be applied to invasive radial arterial blood pressure or pulmonary arterial blood pressure signals which are routinely measured in intensive care units and surgical suites or to noninvasively measured peripheral arterial blood pressure signals or related noninvasively measured signals in order to facilitate the clinical monitoring of CO as well as TPR.

  16. Newer methods of cardiac output monitoring

    Institute of Scientific and Technical Information of China (English)

    Yatin; Mehta; Dheeraj; Arora

    2014-01-01

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

  17. Invasive and non-invasive methods for cardiac output measurement

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    Lavdaniti M.

    2008-01-01

    Full Text Available The hemodynamic status monitoring of high-risk surgical patients and critically ill patients inIntensive Care Units is one of the main objectives of their therapeutic management. Cardiac output is one of the mostimportant parameters for cardiac function monitoring, providing an estimate of whole body perfusion oxygen deliveryand allowing for an understanding of the causes of high blood pressure. The purpose of the present review is thedescription of cardiac output measurement methods as presented in the international literature. The articles documentthat there are many methods of monitoring the hemodynamic status of patients, both invasive and non-invasive, themost popular of which is thermodilution. The invasive methods are the Fick method and thermodilution, whereasthe non-invasive methods are oeshophaegeal Doppler, transoesophageal echocardiography, lithium dilution, pulsecontour, partial CO2 rebreathing and thoracic electrical bioimpedance. All of them have their advantages and disadvantages,but thermodilution is the golden standard for critical patients, although it does entail many risks. The idealsystem for cardiac output monitoring would be non-invasive, easy to use, reliable and compatible in patients. A numberof research studies have been carried out in clinical care settings, by nurses as well as other health professionals, for thepurpose of finding a method of measurement that would have the least disadvantages. Nevertheless, the thermodilutiontechnique remains the most common approach in use today.

  18. Modelflow underestimates cardiac output in heat-stressed individuals

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  19. Kredsløbsmonitorering med lithium dilution cardiac output-systemet

    DEFF Research Database (Denmark)

    Christiansen, Christian; Hostrup, Anette; Tønnesen, Else

    2008-01-01

    The lithium dilution cardiac output (LiDCO) system measures cardiac output beat-to-beat with high precision. The system is based on an arterial pulse power analysis which is calibrated every eight hours with a small non-pharmacological dose of lithium. The system is minimally invasive; it requires...

  20. Validation of Fick cardiac output calculated with assumed oxygen consumption : a study of cardiac output during epoprostenol

    NARCIS (Netherlands)

    Bergstra, A; van den Heuvel, A F M; Zijlstra, F; Berger, R M F; Mook, G A; van Veldhuisen, D J

    2004-01-01

    OBJECTIVE: To test the validity of using assumed oxygen consumption for Fick cardiac output during administration of epoprostenol. METHODS: In 24 consecutive patients Fick cardiac output calculated with assumed oxygen consumption according to LaFarge and Miettinen (COLM) and according to Bergstra et

  1. A Case of Femoral Arteriovenous Fistula Causing High-Output Cardiac Failure, Originally Misdiagnosed as Chronic Fatigue Syndrome

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    J. Porter

    2014-01-01

    Full Text Available Percutaneous arterial catheterisation is commonly undertaken for a range of diagnostic and interventional procedures. Iatrogenic femoral arteriovenous fistulas are an uncommon complication of these procedures. Most are asymptomatic and close spontaneously, but can rarely increase in size leading to the development of symptoms. We report a case of an iatrogenic femoral arteriovenous fistula, causing worsening congestive cardiac failure, in a 34-year-old marathon runner. This was originally diagnosed as chronic fatigue syndrome. Following clinical examination, duplex ultrasound, and CT angiography a significant arteriovenous fistula was confirmed. Elective open surgery was performed, leading to a dramatic and rapid improvement in symptoms. Femoral arteriovenous fistulas have the potential to cause significant haemodynamic effects and can present many years after the initial procedure. Conservative, endovascular, and open surgical management strategies are available.

  2. Continuous measurement of cardiac output using stochastic system identification techniques.

    Science.gov (United States)

    Yelderman, Mark

    2004-01-01

    Indicator dilutions techniques offer the most reliable methods of determining clinical cardiac output because of the elastic nature of the cardiac vessels. A catheter-mounted beating filament affords a simple means of supplying "heat" indicator, but is power and temperature limited because of possible patient injury. A stochastic signal processing method using pseudorandom binary infusion of heat offers a process of enhancing the signal to noise sufficiently to facilitate a computation of cardiac output over a reasonable time period (5 min) with a clinically acceptable error.

  3. Kredsløbsmonitorering af kritisk syge patienter med "pulse contour cardiac output"-systemet

    DEFF Research Database (Denmark)

    Afshari, Arash; Perner, Anders; Bonde, Jan

    2006-01-01

    The Pulse Contour Cardiac Output (PiCCO) monitoring system measures cardiac output with high precision and accuracy. The system may replace the pulmonary artery catheter in most critically ill patients because the rate of serious complications may be lower. Whether the use of dynamic or static fl...... fluid monitoring by PiCCO will result in better outcomes should be assessed by studies using clinically relevant end points....

  4. Volume and its relationship to cardiac output and venous return.

    Science.gov (United States)

    Magder, S

    2016-09-10

    Volume infusions are one of the commonest clinical interventions in critically ill patients yet the relationship of volume to cardiac output is not well understood. Blood volume has a stressed and unstressed component but only the stressed component determines flow. It is usually about 30 % of total volume. Stressed volume is relatively constant under steady state conditions. It creates an elastic recoil pressure that is an important factor in the generation of blood flow. The heart creates circulatory flow by lowering the right atrial pressure and allowing the recoil pressure in veins and venules to drain blood back to the heart. The heart then puts the volume back into the systemic circulation so that stroke return equals stroke volume. The heart cannot pump out more volume than comes back. Changes in cardiac output without changes in stressed volume occur because of changes in arterial and venous resistances which redistribute blood volume and change pressure gradients throughout the vasculature. Stressed volume also can be increased by decreasing vascular capacitance, which means recruiting unstressed volume into stressed volume. This is the equivalent of an auto-transfusion. It is worth noting that during exercise in normal young males, cardiac output can increase five-fold with only small changes in stressed blood volume. The mechanical characteristics of the cardiac chambers and the circulation thus ultimately determine the relationship between volume and cardiac output and are the subject of this review.

  5. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    Reliable methods for cardiac output determination are essential for studying the pathophysiology of intradialytic hypotension. Use of the current gold standard, the Transonic monitor, requires an arteriovenous fistula. We wished to verify the accuracy of a method based on finger pulse contour...... analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...

  6. Comparison of cardiac output determined by bioimpedance and bioreactance methods at rest and during exercise.

    Science.gov (United States)

    Jakovljevic, Djordje G; Moore, Sarah; Hallsworth, Kate; Fattakhova, Gulnar; Thoma, Christian; Trenell, Michael I

    2012-04-01

    Bioreactance is a novel non-invasive method for cardiac output measurement that involves the analysis of blood flow-dependent changes in the phase shifts of electrical currents applied across the chest. The present study (1) compared resting and exercise cardiac outputs determined by bioreactance and bioimpedance methods and those estimated from measured oxygen consumption, (2) determined the relationship between cardiac output and oxygen consumption, and (3) assessed the agreement between the bioreactance and bioimpedance methods. Twelve healthy subjects (aged 30 ± 4 years) performed graded cardiopulmonary exercise test on a recumbent cycle ergometer on two occasions, 1 week apart. Cardiac output was monitored at rest, at 30, 50, 70, 90, 150 W and at peak exercise intensity by bioreactance and bioimpedance and expired gases collected. Resting cardiac output was not significantly different between the bioreactance and bioimpedance methods (6.2 ± 1.4 vs. 6.5 ± 1.4 l min(-1), P = 0.42). During exercise cardiac outputs were correlated with oxygen uptake for both bioreactance (r = 0.84, P bioimpedance techniques (r = 0.82, P bioimpedance estimated significantly lower cardiac outputs than both bioreactance and theoretically calculated cardiac output (14.3 ± 2.6 vs. 17.5 ± 5.2 vs. 16.9 ± 4.9 l min(-1), P bioimpedance method reported ~1.5 l min(-1) lower cardiac output than bioreactance with lower and upper limits of agreement of -2.98 to 5.98 l min(-1). Bioimpedance and bioreactance methods provide different cardiac output estimates, particularly at high exercise intensity, and therefore the two methods cannot be used interchangeably. In contrast with bioimpedance, bioreactance cardiac outputs are similar to those estimated from measured oxygen consumption.

  7. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

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    Hann Christopher E

    2010-11-01

    Full Text Available Abstract The application of positive end expiratory pressure (PEEP in mechanically ventilated (MV patients with acute respiratory distress syndrome (ARDS decreases cardiac output (CO. Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

  8. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    Reliable methods for cardiac output determination are essential for studying the pathophysiology of intradialytic hypotension. Use of the current gold standard, the Transonic monitor, requires an arteriovenous fistula. We wished to verify the accuracy of a method based on finger pulse contour...

  9. Cardiac output and vasodilation in the vasovagal response

    DEFF Research Database (Denmark)

    Wieling, Wouter; Jardine, David L.; de Lange, Frederik J

    2016-01-01

    The simple faint is secondary to hypotension and bradycardia resulting in transient loss of consciousness. According to Ohm's law applied to the circulation, BP = SVR × CO, hypotension can result from a decrease in systemic vascular resistance (SVR), cardiac output (CO), or both. It is important ...

  10. Evaluation of noninvasive cardiac output methods during exercise

    Science.gov (United States)

    Moore, Alan D.; Barrows, Linda H.; Rashid, Michael; Siconolfi, Steven F.

    1992-01-01

    Noninvasive techniques to estimate cardiac output (Qc) will be used during future space flight. This retrospective literature survey compared the Qc techniques of carbon dioxide rebreathing (CO2-R), CO2 single breath (CO2-S), Doppler (DOP), impedance (IM), and inert gas (IG: acetylene or nitrous oxide) to direct (DIR) assessments measured at rest and during exercise.

  11. Peripheral vasodilatation determines cardiac output in exercising humans

    DEFF Research Database (Denmark)

    Bada, A A; Svendsen, J H; Secher, N H

    2012-01-01

    conditions, because of a parallel decrease in stroke volume (P exercise. Atrial pacing lowered central venous pressure (P ...In dogs, manipulation of heart rate has no effect on the exercise-induced increase in cardiac output. Whether these findings apply to humans remain uncertain, because of the large differences in cardiovascular anatomy and regulation. To investigate the role of heart rate and peripheral...... vasodilatation in the regulation of cardiac output during steady-state exercise, we measured central and peripheral haemodynamics in 10 healthy male subjects, with and without atrial pacing (100–150 beats min(−1)) during: (i) resting conditions, (ii) one-legged knee extensor exercise (24 W) and (iii) femoral...

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

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

    2014-06-15

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

  13. Validation of transpulmonary thermodilution cardiac output measurement in a pediatric animal model.

    NARCIS (Netherlands)

    Lemson, J.; Boode, W.P. de; Hopman, J.C.W.; Singh, S.K.; Hoeven, J.G. van der

    2008-01-01

    OBJECTIVE: This study was undertaken to validate the transpulmonary thermodilution cardiac output measurement (CO(TPTD)) in a controlled newborn animal model under various hemodynamic conditions with special emphasis on low cardiac output. DESIGN: Prospective, experimental, pediatric animal study. S

  14. [Arterial pressure-based cardiac output monitoring: 1. FloTrac sensor and SVV].

    Science.gov (United States)

    Seo, Katsuhiro

    2009-07-01

    FloTrac is a recently introduced semi-invasive arterial pressure-based cardiac output (APCO) monitoring device. The accuracy of a new device is usually evaluated by Bland-Altman method, which shows graphically the mean value of differences between a new method and the reference method (bias), standard deviation of the differences (precision) and limits of agreement or 2 standard deviations. Critchley et al calculated the percentage errors which are two standard deviations divided by mean cardiac output, and proposed that percentage error should be less than 30% as a reliable new method. Cardiac output was measured by FloTrac (APCO) and pulmonary arterial catheter-based thermodilution method (ICO) during off-pump coronary artery bypass and resection of pheochromocytoma, procedures associated with hemodynamically unstable conditions. As algorithm is renewed in a new version of the device, the accuracy of the device is improved; bias, precision and limits of agreement decreased; correlation coefficient increased, and percentage error was assessed to be around 30%. On the other hand, there was a tendency for increased negative bias as cardiac output increased, implying APCO tends to underestimate ICO in high CO ranges. APCO is less invasive and could rapidly respond to fast changes of hemodynamic state. FloTrac is expected to become a reliable cardiac output monitoring device even under hemodynamically unstable conditions. Further improvement of the algorithm is anticipated.

  15. Cardiac output measurement using a modified carbon dioxide Fick method: a validation study in ventilated lambs.

    NARCIS (Netherlands)

    Boode, W.P. de; Hopman, J.C.W.; Daniels, O.; Hoeven, J.G. van der; Liem, K.D.

    2007-01-01

    Cardiac output can be measured using a modified carbon dioxide Fick (mCO2F) method. A validation study was performed comparing mCO2F method-derived cardiac output (Q(mCO2F)) with invasively measured pulmonary blood flow. In seven randomly bred ventilated newborn lambs, cardiac output was manipulated

  16. Cardiac output measurement in newborn infants using the ultrasonic cardiac output monitor: an assessment of agreement with conventional echocardiography, repeatability and new user experience.

    Science.gov (United States)

    Patel, Neil; Dodsworth, Melissa; Mills, John F

    2011-05-01

    To assess (1) agreement between the ultrasonic cardiac output monitor (USCOM) 1A device for measurement of cardiac output in newborn infants and conventional echocardiography (ECHO), (2) repeatability of USCOM measurements and (3) agreement between novice and expert users of the USCOM. A prospective observational study. The Neonatal Unit at the Royal Children's Hospital, Melbourne, Australia. 56 term and near-term infants, with no evidence of structural or functional cardiovascular disease, or haemodynamic shunts. Agreement between ECHO and USCOM was assessed by paired measurements of ventricular outputs by a single experienced user. Repeatability was assessed using five repeated measurements in 10 infants. Agreement between five novices and one expert user was assessed by paired USCOM measurements over 30 training measurements. Agreement between USCOM and ECHO for left ventricular output (LVO) was (bias, ±limits of agreement, mean % error): 14, ±108 ml/kg/min, 43%, and for right ventricular output (RVO): -59, ±160, ml/kg/min, 57%. Intra-observer repeatability was 6.7% for USCOM LVO and 3.6% for ECHO LVO. After five training measurements, the mean difference between USCOM measures of LVO by novice and expert users was less than 50 ml/kg/min, but with variability. Repeatability of USCOM measures is high in newborn infants. New users can be trained quickly, but with high inter-user variability. Agreement between USCOM and conventional ECHO is broad, and worse for RVO and LVO. Further studies are required to assess the ability of the device to detect clinically significant changes in infant cardiac output.

  17. A computerised dichromatic earpiece densitometer for the measurement of cardiac output.

    Science.gov (United States)

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

    1979-07-01

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

  18. EVALUATION OF CONTINUOUS THERMODILUTION METHOD FOR CARDIAC OUTPUT MEASUREMENT

    Directory of Open Access Journals (Sweden)

    Roman Parežnik

    2001-12-01

    Full Text Available Background. Continuous monitoring of haemodynamic variables is often necessary for detection of rapid changes in critically ill patients. In our patients recently introduced continuous thermodilution technique (CTD for cardiac output measurement was compared to bolus thermodilution technique (BTD which is a »golden standard« method for cardiac output (CO measurement in intensive care medicine.Methods. Ten critically ill patients were included in a retrospective observational study. Using CTD method cardiac output was measured continuously. BTD measurements using the same equipment were performed intermittently. The data obtained by BTD were compared to those obtained by CTD just before the BTD (CTD-before and 2–3 minutes after the BTD (CTD-after. The CO values were divided into three groups: all CO values, CO > 4.5 L/min, CO < 4.5 L/min. The bias (mean difference between values obtained by two methods, standard deviation, 95% confidence limits and relative error were calculated and the linear regression analysis was performed. t-test for pared data was used to compare the biases for CTD-before and CTD-after for an individual group. The p value of less than 0.05 was considered statistically significant.Results. A total of 60 data triplets were obtained. CTD-before ranged from 1.9 L/min to 12.6 L/min, CTD-after from 2.0 to 13.2 L/min and BTD from 1.9 to 12.0 L/min. For all CO values the bias for CTD-before was 0.13 ± 0.52 L/min (95% confidence limits 1.17–0.91 L/min, relative error was 3.52 ± 15.20%, linear regression equation was CTD-before = 0.96 × BTD + 0.01 and Pearson’s correlation coefficient was 0.95. The values for CTD-after were 0.08 ± 0.46 L/min (1.0–0.84 L/min, 2.22 ± 9.05%, CTD-after = 0.98 × BTD + 0.01 and 0.98 respectively. For all CO values there was no statistically significant difference between biases for CTD-before and CTD-after (p = 0,51. There was no statistically significant difference between biases for CTD

  19. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients.

    Science.gov (United States)

    Basile, Carlo; Lomonte, Carlo; Vernaglione, Luigi; Casucci, Francesco; Antonelli, Maurizio; Losurdo, Nicola

    2008-01-01

    Satisfactory haemodialysis (HD) vascular access flow (Qa) is necessary for dialysis adequacy. High Qa is postulated to increase cardiac output (CO) and cause high-output cardiac failure. Aim of the present prospective study was to evaluate the relationship between Qa of arteriovenous fistulas (AVFs) and CO in order to have a closer insight into this scarcely explored aspect of HD pathophysiology. Ninety-six patients bearing an AVF entered the study. All were evaluated a priori for the existence of cardiac failure according to the functional classification of the American College of Cardiology/American Heart Association task force. Qa and CO were measured by means of the ultrasound dilution Transonic Hemodialysis Monitor HD02. The mean Qa of the 65 lower arm AVFs was 0.948+/-0.428 SD l/min, whereas that of the 31 upper arm AVFs was 1.58+/-0.553 l/min. The difference was statistically significant (Ppolynomial regression model best fitted the relationship between Qa and CO. The analysis of the regression equation identified 0.95 and 2.2 l/min as Qa cut-off points. The receiver operating characteristic curve analysis showed that Qa values >or= 2.0 l/min predicted the occurrence of high-output cardiac failure more accurately than two other Qa values (sensitivity 89%, specificity 100%, curve area 0.99) and three Qa/CO ratio values (cardio-pulmonary recirculation-CPR). The better performance among the latter was that of CPR values >or= 20% (sensitivity 100%, specificity 74.7%, curve area 0.92). Our prospective study shows that the relationship between Qa of AVFs and CO is complex and a third-order polynomial regression model best fits this relationship. Furthermore, it is the first study to clearly show the high predictive power for high-output cardiac failure occurrence of Qa cut-off values >or= 2.0 l/min.

  20. Metabolic regulation of cardiac output during inhalation anaesthesia in dogs.

    Science.gov (United States)

    Scheeren, T W; Schwarte, L A; Arndt, J O

    1999-04-01

    The metabolic regulation of tissue blood flow manifests itself in a linear relation between blood flow and oxygen consumption, the latter being the independent variable. It is unknown, however, if this fundamental physiological principle operates also during inhalation anaesthesia known to be associated with decreases in both cardiac output (Q) and oxygen consumption (VO2). Seven dogs (23-32 kg) with chronically implanted flow probes around the pulmonary artery were repeatedly anaesthetized with halothane, enflurane, isoflurane, sevoflurane, and desflurane at increasing minimum alveolar concentrations (1-3 MAC). Cardiac output (ultrasound transit-time flowmeter) and VO2 (indirect calorimetry) were measured continuously. We also imposed selective changes in Q, and thus of O2 supply, to see if and to what extent this would alter VO2 during anaesthesia (1.5 MAC). In awake dogs under basal metabolic conditions, VO2 was 4.6 +/- 0.1 ml.kg-1.min-1 and Q 105 +/- 3 ml.kg-1.min-1 (mean +/- SEM). During inhalation anaesthesia, VO2 and Q decreased by approximately 30% and 60%, respectively. The concentration-effect relations of both variables did not differ between anaesthetics, yielding a uniform Q/VO2 relation, which was nearly linear in the range (0-2 MAC) with an average slope of 39 +/- 1 (range 30-55). Above 2 MAC, Q decreased more for a given change in VO2, and O2 extraction increased by 50%, indicating compromised oxygen delivery (DO2). Imposed changes in Q, both in awake and anaesthetized dogs, yielded Q/VO2 relations which were notably steeper (slopes 114 to 187) than those observed during inhalation anaesthesia. More important, imposed increases in Q and thus DO2 during anaesthesia (1.5 MAC) to rates comparable to that in the awake state produced a much less than proportional increase in VO2 without restoring it to baseline. Inhalation anaesthesia is characterized by a uniform Q/VO2 relation with an almost linear course at an anaesthetic concentration up to 2 MAC

  1. The decrease of cardiac chamber volumes and output during positive-pressure ventilation

    DEFF Research Database (Denmark)

    Kristensen, Kasper Kyhl; Ahtarovski, Kiril Aleksov; Iversen, Kasper

    2013-01-01

    the effect of PPV on the central circulation by studying cardiac chamber volumes with cardiac magnetic resonance imaging (CMR). We hypothesized that PPV lowers cardiac output (CO) mainly via the Frank-Starling relationship. In 18 healthy volunteers, cardiac chamber volumes and flow in aorta and the pulmonary...

  2. High-output heart failure in a newborn.

    Science.gov (United States)

    Mascarenhas, Maria Inês; Moniz, Marta; Ferreira, Sofia; Goulão, Augusto; Barroso, Rosalina

    2012-07-10

    High-output cardiac failure is rare in newborns. Emergent diagnosis and management of this pathology is crucial. We report the case of a child, currently 12-months old; obstetric background is non-contributory. Clinic observation on D1 was normal except for the presence of a systolic cardiac murmur; cardiological evaluation revealed mild ventricular dysfunction of the right ventricle. On the third day of life, she developed cardiac failure with gallop rhythm, hepatomegaly and a murmur in the anterior fontanel; an echocardiogram confirmed clinic aggravation with biventricular dysfunction and right cavities and superior vena cava dilatation. The cranial MRI confirmed the presence of a pial arteriovenous malformation (AVM) involving the anterior and middle cerebral arteries with an associated fronto-parietal ischaemic lesion. The infant underwent embolisations of AVM with successful flow reduction and cardiac failure improvement. The multidisciplinary follow-up showed no cardiac dysfunction or permanent lesions but confirmed a severe psycho-motor delay and left hemiparesia.

  3. Reference Values for Peak Exercise Cardiac Output in Healthy Individuals.

    Science.gov (United States)

    Agostoni, Piergiuseppe; Vignati, Carlo; Gentile, Piero; Boiti, Costanza; Farina, Stefania; Salvioni, Elisabetta; Mapelli, Massimo; Magrì, Damiano; Paolillo, Stefania; Corrieri, Nicoletta; Sinagra, Gianfranco; Cattadori, Gaia

    2017-06-01

    Cardiac output (Q˙) is a key parameter in the assessment of cardiac function, its measurement being crucial for the diagnosis, treatment, and prognostic evaluation of all heart diseases. Until recently, Q˙ determination at peak exercise has been possible through invasive methods, so that normal values were obtained in studies based on small populations. Nowadays, peak Q˙ can be measured noninvasively by means of the inert gas rebreathing (IGR) technique. The present study was undertaken to provide reference values for peak Q˙ in the normal general population and to obtain a formula able to estimate peak exercise Q˙ from measured peak oxygen uptake (V˙o2). We studied 500 normal subjects (age, 44.9 ± 1.5 years; range, 18-77 years; 260 men, 240 women) who underwent a maximal cardiopulmonary exercise test with peak Q˙ measurement by IGR. In the overall study sample, peak Q˙ was 13.2 ± 3.5 L/min (men, 15.3 ± 3.3 L/min; women, 11.0 ± 2.0 L/min; P exercise was (4.4 × peak V˙o2) + 4.3 in the overall study cohort, (4.3 × peak V˙o2) + 4.5 in men, and (4.9 × peak V˙o2) + 3.6 in women. The simultaneous measurement of Q˙ and V˙o2 at peak exercise in a large sample of healthy subjects provided an equation to predict peak Q˙ from peak V˙o2 values. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  4. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography.

    LENUS (Irish Health Repository)

    Weisz, Dany E

    2012-01-01

    Non-invasive cardiac output monitoring is a potentially useful clinical tool in the neonatal setting. Our aim was to evaluate a new method of non-invasive continuous cardiac output (CO) measurement (NICOM™) based on the principle of bioreactance in neonates.

  5. ASSUMED OXYGEN-CONSUMPTION BASED ON CALCULATION FROM DYE DILUTION CARDIAC-OUTPUT - AN IMPROVED FORMULA

    NARCIS (Netherlands)

    BERGSTRA, A; VANDIJK, RB; HILLEGE, HL; LIE, KI; MOOK, GA

    1995-01-01

    This study was performed because of observed differences between dye dilution cardiac output and the Fick cardiac output, calculated from estimated oxygen consumption according to LaFarge and Miettinen, and to find a better formula for assumed oxygen consumption. In 250 patients who underwent left a

  6. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Hansen, K L; Ostergaard, M

    2012-01-01

    cardiac output (CO) during steady state and with induced haemodynamic changes in patients scheduled for elective cardiac surgery. METHODS: Twenty-five patients were enrolled. After induction of anaesthesia, endotracheal intubation using a dedicated ECOM tube, and insertion of the pulmonary artery catheter......BACKGROUND: Minimally invasive monitoring systems of central haemodynamics are gaining increasing popularity. The present study investigated the precision of the endotracheal cardiac output monitor (ECOM) system and its agreement with pulmonary artery catheter thermodilution (PAC TD) for measuring...

  7. Validation of a continuous, arterial pressure-based cardiac output measurement: a multicenter, prospective clinical trial.

    Science.gov (United States)

    McGee, William T; Horswell, Jeffrey L; Calderon, Joachim; Janvier, Gerard; Van Severen, Tom; Van den Berghe, Greet; Kozikowski, Lori

    2007-01-01

    The present study compared measurements of cardiac output by an arterial pressure-based cardiac output (APCO) analysis method with measurement by intermittent thermodilution cardiac output (ICO) via pulmonary artery catheter in a clinical setting. The multicenter, prospective clinical investigation enrolled patients with a clinical indication for cardiac output monitoring requiring pulmonary artery and radial artery catheters at two hospitals in the United States, one hospital in France, and one hospital in Belgium. In 84 patients (69 surgical patients), the cardiac output was measured by analysis of the arterial pulse using APCO and was measured via pulmonary artery catheter by ICO; to establish a reference comparison, the cardiac output was measured by continuous cardiac output (CCO). Data were collected continuously by the APCO and CCO technologies, and at least every 4 hours by ICO. No clinical interventions were made as part of the study. For APCO compared with ICO, the bias was 0.20 l/min, the precision was +/- 1.28 l/min, and the limits of agreement were -2.36 l/m to 2.75 l/m. For CCO compared with ICO, the bias was 0.66 l/min, the precision was +/- 1.05 l/min, and the limits of agreement were -1.43 l/m to 2.76 l/m. The ability of APCO and CCO to assess changes in cardiac output was compared with that of ICO. In 96% of comparisons, APCO tracked the change in cardiac output in the same direction as ICO. The magnitude of change was comparable 59% of the time. For CCO, 95% of comparisons were in the same direction, with 58% of those changes being of similar magnitude. In critically ill patients in the intensive care unit, continuous measurement of cardiac output using either APCO or CCO is comparable with ICO. Further study in more homogeneous populations may refine specific situations where APCO reliability is strongest.

  8. Assessment of cardiac output changes using a modified FloTrac/Vigileo algorithm in cardiac surgery patients.

    Science.gov (United States)

    Senn, Alban; Button, Danny; Zollinger, Andreas; Hofer, Christoph K

    2009-01-01

    The FloTrac/Vigileo (Edwards Lifesciences, Irvine, CA, USA) allows pulse pressure-derived cardiac output measurement without external calibration. Software modifications were performed in order to eliminate initially observed deficits. The aim of this study was to assess changes in cardiac output determined by the FloTrac/Vigileo system (FCO) with an initially released (FCOA) and a modified (FCOB) software version, as well as changes in cardiac output from the PiCCOplus system (PCO; Pulsion Medical Systems, Munich, Germany). Both devices were compared with cardiac output measured by intermittent thermodilution (ICO). Cardiac output measurements were performed in patients after elective cardiac surgery. Two sets of data (A and B) were obtained using FCOA and FCOB in 50 patients. After calibration of the PiCCOplus system, triplicate FCO and PCO values were recorded and ICO was determined in the supine position and cardiac output changes due to body positioning were recorded 15 minutes later (30 degrees head-up, 30 degrees head-down, supine). Student's t test, analysis of variance and Bland-Altman analysis were calculated. Significant changes of FCO, PCO and ICO induced by body positioning were observed in both data sets. For set A, DeltaFCOA was significantly larger than DeltaICO induced by positioning the head down. For set B, there were no significant differences between DeltaFCOB and DeltaICO. For set A, increased limits of agreement were found for FCOA-ICO when compared with PCO-ICO. For set B, mean bias and limits of agreement were comparable for FCOB-ICO and PCO-ICO. The modification of the FloTrac/Vigileo system resulted in an improved performance in order to reliably assess cardiac output and track the related changes in patients after cardiac surgery.

  9. The influence of hemoglobin concentration on exercise cardiac output.

    Science.gov (United States)

    Freedson, P S

    1981-05-01

    Two experiments were performed to study the cardiac output (Q) vs. hemoglobin concentration (Hb) relationship during constant load submaximum eexercise. The first experiment examined the relationship between submaximum exercise Q and Hb in 28 females. A correlation of r = -0.83 (P less than 0.05) was observed between Q and Hb during xercise at 88 W (mean Q = 11.04 l . min-1) and 118 W (mean Q = 13.10 l . min-1) (mean steady rate VO2 = 1.40 l . min-1 and 1.79 l . min-1, respectively). By removing the influence of stroke volume (SV) from Q (part correlation analyses), the relationship between Q and Hb is compromised (r = -0.29, P greater than 0.05, 88 W and r = -0.33, P greater than 0.05, 118 W). The second experiment compared the VO2 max and submaximum exercise (118 W) Q responses in six males before and after blood donation. Experimentally reducing Hb 18.6% (P less than 0.05) caused a 6.2% decrease (P less than 0.05) in VO2 max. Additionally, submaximum exercise Q increased 12% (P less than 0.05) 6 days following hemodilution., The Q remained elevated 11 days (10% higher, P less than 0.05) and 16 days (9% higher, P less than 0.05) post-blood donation and progressively returned to pre-donation levels by 21 days post-withdrawal. The higher Q's during submaximum exercise were ascribed primarily to an 8% (P less than 0.05) higher SV in comparison to pre-donation levels. collectively, the data from the two experiments indicate that individual differences in submaximum exercise Q are due, in part, to individual differences in Hb concentration. Furthermore, it is suggested that the stimulus for the SV-induced Q vs. Hb association is related to maintaining maximal myocardial efficiency.

  10. The value of arterial pressure waveform cardiac output measurements in the radial and femoral artery in major cardiac surgery patients

    NARCIS (Netherlands)

    van Drumpt, A.; J. van Bommel (Jasper); S.E. Hoeks (Sanne); F. Grüne (Frank); T. Wolvetang (Timothy); J.A. Bekkers (Jos); M. Horst, ter (Maarten)

    2017-01-01

    textabstractBackground: A relatively new uncalibrated arterial pressure waveform cardiac output (CO) measurement technique is the Pulsioflex-ProAQT® system. Aim of this study was to validate this system in cardiac surgery patients with a specific focus on the evaluation of a difference in the radial

  11. Measurement of cardiac output in adult and newborn animals by ascorbic acid dilution.

    Science.gov (United States)

    Smallwood, J K; Haselby, K A; Paradise, R R

    1984-05-01

    We have developed an ascorbic acid-dilution method for measuring cardiac output which requires minimal blood withdrawal. Ascorbate is injected into a central venous catheter. The indicator-dilution curve is obtained by drawing blood from an arterial catheter through an amperometric cell at 0.96 ml/min for 35 s. The current is measured by a picoammeter . A calibration curve is obtained in 15 s prior to each indicator-dilution curve. An on-line digital computer measures the curve areas and calculates the cardiac output. Cardiac outputs of heparinized dogs anesthetized with pentobarbital and halothane measured by this method (AA) compared closely to cardiac outputs measured by the dye-dilution method (CG) (AA = 0.96 CG + 20 ml/min, r = 0.98). Both the cardiac output and the arterial blood pressure remained stable during replicate measurements of the cardiac output of 1-day-old piglets. This system allows cardiac output determinations of neonatal subjects without excessive blood removal and, with further development, should be practical in human neonates.

  12. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure.

    Science.gov (United States)

    Jakovljevic, Djordje G; Seferovic, Petar M; Nunan, David; Donovan, Gay; Trenell, Michael I; Grocott-Mason, Richard; Brodie, David A

    2012-02-01

    Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

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

    NARCIS (Netherlands)

    Wilde, Robert Bernard Pieter de

    2009-01-01

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

  14. Effect of heat stress on cardiac output and systemic vascular conductance during simulated hemorrhage to presyncope in young men

    DEFF Research Database (Denmark)

    Ganio, Matthew S; Overgaard, Morten; Seifert, Thomas;

    2012-01-01

    During moderate actual or simulated hemorrhage, as cardiac output decreases, reductions in systemic vascular conductance (SVC) maintain mean arterial pressure (MAP). Heat stress, however, compromises the control of MAP during simulated hemorrhage, and it remains unknown whether this response is due...... to a persistently high SVC and/or a low cardiac output. This study tested the hypothesis that an inadequate decrease in SVC is the primary contributing mechanism by which heat stress compromises blood pressure control during simulated hemorrhage. Simulated hemorrhage was imposed via lower body negative pressure...... (LBNP) to presyncope in 11 passively heat-stressed subjects (increase core temperature: 1.2 ± 0.2°C; means ± SD). Cardiac output was measured via thermodilution, and SVC was calculated while subjects were normothermic, heat stressed, and throughout subsequent LBNP. MAP was not changed by heat stress...

  15. Optimisation of atrioventricular delay during exercise improves cardiac output in patients stabilised with cardiac resynchronisation therapy.

    Science.gov (United States)

    Sun, Jing Ping; Lee, Alex Pui-Wai; Grimm, Richard A; Hung, Ming-Jui; Yang, Xing Sheng; Delurgio, David; Leon, Angel R; Merlino, John D; Yu, Cheuk-Man

    2012-01-01

    Atrioventricular (AV) delay in cardiac resynchronisation therapy (CRT) recipients are typically optimised at rest. However, there are limited data on the impact of exercise-induced changes in heart rate on the optimal AV delay and left ventricular function. The authors serially programmed AV delays in 41 CRT patients with intrinsic sinus rhythm at rest and during two stages of supine bicycle exercise with heart rates at 20 bpm (stage I) and 40 bpm (stage II) above baseline. The optimal AV delay during exercise was determined by the iterative method to maximise cardiac output using Doppler echocardiography. Results were compared to physiological change in PR intervals in 56 normal controls during treadmill exercise. The optimal AV delay was progressively shortened (pexercise level (baseline: 123±26 ms vs. stage I: 102±24 ms vs stage II: 70±22 ms, pexercise. A linear inverse relationship existed between optimal AV delays and heart rates in CRT patients (AV delay=241-1.61×heart rate, R2=0.639, pheart rate during exercise, which suggests the need for programming of rate-adaptive AV delay in CRT recipients.

  16. Improvements in determination of cardiac output with a Swan-Ganz catheter.

    Science.gov (United States)

    Sakagami, M; Kuwana, K; Nakanishi, H; Sakai, K

    1990-01-01

    The time constant for heat transfer may affect exact determination of cardiac output with Swan-Ganz catheters. Commercially available Swan-Ganz catheters are provided with thermistors with varying time constants. Current monitoring of cardiac output is not corrected for these time constants, so the conventional method of determining cardiac output using the equation of Stewart-Hamilton produces marked errors. The authors propose a new method of determining cardiac output with Swan-Ganz catheters with varying time constants from thermal dilution curve data based on Newton's cooling law. Values for blood flow rate determined by the new method using a completely stirred tank of original design, mimicking the natural heart and using bovine blood, are almost the same as values observed at varying saline infusion volumes, saline temperatures, and saline infusion times.

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

    Directory of Open Access Journals (Sweden)

    Véronique L. Billat

    2012-01-01

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

  18. Influence of lung injury on cardiac output measurement using transpulmonary ultrasound dilution: a validation study in neonatal lambs

    NARCIS (Netherlands)

    Vrancken, S.L.A.G.; Boode, W.P. de; Hopman, J.C.W.; Looijen-Salamon, M.G.; Liem, K.D.; Heijst, A.F. van

    2012-01-01

    BACKGROUND: /st> Transpulmonary ultrasound dilution (TPUD) is a promising method for cardiac output (CO) measurement in severely ill neonates. The incidence of lung injury in this population is high, which might influence CO measurement using TPUD because of altered lung perfusion. We evaluated t

  19. Coupling output of multichannel high power microwaves

    Science.gov (United States)

    Li, Guolin; Shu, Ting; Yuan, Chengwei; Zhang, Jun; Yang, Jianhua; Jin, Zhenxing; Yin, Yi; Wu, Dapeng; Zhu, Jun; Ren, Heming; Yang, Jie

    2010-12-01

    The coupling output of multichannel high power microwaves is a promising technique for the development of high power microwave technologies, as it can enhance the output capacities of presently studied devices. According to the investigations on the spatial filtering method and waveguide filtering method, the hybrid filtering method is proposed for the coupling output of multichannel high power microwaves. As an example, a specific structure is designed for the coupling output of S/X/X band three-channel high power microwaves and investigated with the hybrid filtering method. In the experiments, a pulse of 4 GW X band beat waves and a pulse of 1.8 GW S band microwave are obtained.

  20. Volume loading augments cutaneous vasodilatation and cardiac output of heat stressed older adults.

    Science.gov (United States)

    Gagnon, Daniel; Romero, Steven A; Ngo, Hai; Sarma, Satyam; Cornwell, William K; Poh, Paula Y S; Stoller, Douglas; Levine, Benjamin D; Crandall, Craig G

    2017-08-21

    Age-related changes in cutaneous microvascular and cardiac functions limit the extent of cutaneous vasodilatation and the increase in cardiac output that healthy older adults can achieve during passive heat stress. However, it is unclear if these age-related changes in microvascular and cardiac functions maximally restrain the levels of cutaneous vasodilatation and cardiac output that healthy older adults can achieve during heat stress. We observed that rapid volume loading, performed during passive heat stress, augments both cutaneous vasodilatation and cardiac output in healthy older humans. These findings demonstrate that the microcirculation of healthy aged skin can further dilate during passive heat exposure, despite peripheral limitations to vasodilatation. Furthermore, healthy older humans can augment cardiac output when cardiac pre-load is increased during heat stress. Primary ageing markedly attenuates cutaneous vasodilatation and the increase in cardiac output during passive heating. However, it remains unclear if these responses are maximally restrained by age-related changes in cutaneous microvascular and cardiac functions. We hypothesized that rapid volume loading performed during heat stress would increase cardiac output in older adults without parallel increases in cutaneous vasodilatation. Twelve young (Y: 26 ± 5 years) and ten older (O: 69 ± 3 years) healthy adults were passively heated until core temperature increased by 1.5°C. Cardiac output (thermodilution), forearm vascular conductance (FVC, venous occlusion plethysmography) and cutaneous vascular conductance (CVC, laser-Doppler) were measured before and after rapid infusion of warmed saline (15 mL kg(-1) , ∼7 min). While heat stressed, but prior to saline infusion, cardiac output (O: 6.8 ± 0.4 vs. Y: 9.4 ± 0.6 L min(-1) ), FVC (O: 0.08 ± 0.01 vs. Y: 0.17 ± 0.02 mL (100 mL min(-1)  mmHg(-1) )(-1) ), and CVC (O: 1.29 ± 0.34 vs. Y: 1.93 ± 0.30

  1. Risk factors for decreased cardiac output after coronary artery bypass grafting: a prospective cohort study.

    Science.gov (United States)

    Dos Santos, Eduarda Ribeiro; Lopes, Camila Takao; Maria, Vera Lucia Regina; de Barros, Alba Lucia Bottura Leite

    2017-04-01

    No previous study has investigated the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after coronary artery bypass grafting (CABG). This study aimed to identify the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after CABG. This was a prospective cohort study performed at a cardiac university hospital in São Paulo, Brazil and 257 adult patients undergoing CABG were included. Potential risk factors for low cardiac output in the immediate post-operative period were investigated using the patients' medical records. Univariate analysis and logistic regression were used to identify the predictive risk factors of decreased cardiac output. The area under the receiver operating characteristic curve was calculated as a measure of accuracy. The variables that could not be analysed through logistic regression were analysed through Fisher's exact test. One hundred and ninety-five patients had low cardiac output in the immediate post-operative period. The predictive risk factors included age ⩾60 years, decreased left ventricle ejection fraction, not using the radial artery graft, positive fluid balance and post-operative arrhythmia that differed from the pre-operative arrhythmia. This model predicted the outcome with a sensitivity of 62.9%, a specificity of 87.2% and an accuracy of 81.5%. The variables analysed through Fisher's exact test included heart failure, re-exploration and bleeding-related re-exploration. The predictive risk factors for the nursing diagnosis of risk for decreased cardiac output after CABG were found. These results can be used to direct nurses in patient monitoring, staff training and nursing team staffing.

  2. Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    García-Bengochea Jose B

    2012-10-01

    Full Text Available Abstract Background To evaluate, with different pacing modes, acute changes in left ventricular systolic function, obtained by continuous cardiac output thermodilution in various subsets of patients undergoing cardiopulmonary bypass surgery. Increments of mean arterial pressure and cardiac output were considered the end point. Methods Fifty cases electively submitted to cardiac surgery were analyzed. Isolated valve surgery 62%, coronary revascularization 30% and 8% mixed disease. Left ventricular ejection fraction was preserved in 50%,36% had moderate depression,(EF 36%-50% whereas 14% had severe depression (EF  Results Right atrium-right ventricular pacing, decreased significantly mean arterial pressure and cardiac output (2.3% in the overall population and in the subgroups studied. Right atrium-left ventricle, increased mean arterial pressure and cardiac output in 79% of patients and yielded cardiac output increments of 7.5% (0.40 l/m in the low ejection fraction subgroup and 7.3% (0.43 l/m in the left bundle branch block subset. In atrial fibrillation patients, left ventricular and biventricular pacing produced a significant increase in cardiac output 8.5% (0.39 l/min and 11.6% (0.53 l/min respectively. The dP/dt max increased significantly with both modes (p = 0.021,p = 0.028. Conclusion Right atrial-right ventricular pacing generated adverse hemodynamic effects. Right atrium-left ventricular pacing produced significant CO improvement particularly in cases with depressed ventricular function and left bundle branch block. The greatest increments were observed with left ventricular or biventricular pacing in atrial fibrillation with depressed ejection fraction.

  3. Evaluation of transpulmonary thermodilution as a method to measure cardiac output in anesthetized cats.

    Science.gov (United States)

    Beaulieu, Kim E; Kerr, Carolyn L; McDonell, Wayne N

    2009-01-01

    The objectives of this study were to evaluate the use of a transpulmonary thermodilution (Trans) technique for the measurement of cardiac output, and to determine the agreement between Trans and conventional thermodilution (TD) in anesthetized cats. Using each technique, cardiac output was measured in 5 mature cats (weights 2.4 to 5.6 kg) anesthetized with isoflurane. To induce different levels of cardiac output in each cat, anesthesia was maintained at > 1.5x end-tidal minimum alveolar concentration (MAC) of isoflurane, and at 1.3x end-tidal isoflurane MAC with and without administration of dobutamine. At least 2 comparisons between TD and Trans values were made at each cardiac output rate. Thirty-two of the 42 recorded comparisons were analyzed. Linear regression analysis (TD vs Trans) yielded an r(2) value of 0.83. The mean bias (TD-Trans) was -3.7 mL/kg/min with limits of agreement of -35.9 to 28.5 mL/kg/min. The concordance coefficient was 0.91. The Trans method showed good relationship and good agreement with TD in anesthetized cats. The Trans method is a relatively noninvasive, practical, and safe method to measure cardiac output in anesthetized cats.

  4. Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy

    NARCIS (Netherlands)

    Hofhuizen, C.M.; Lansdorp, B.; Hoeven, J.G. van der; Scheffer, G.J.; Lemson, J.

    2014-01-01

    INTRODUCTION: Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABPNI) and cardiac output (CONI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABPNI and CONI as well as the adequacy of detecting

  5. Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy

    NARCIS (Netherlands)

    Hofhuizen, Charlotte; Lansdorp, Benno; van der Hoeven, Johannes G.; Scheffer, Gert-Jan; Lemson, Joris

    2014-01-01

    Introduction Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABPNI) and cardiac output (CONI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABPNI and CONI as well as the adequacy of detecting

  6. Application of bioreactance for cardiac output assessment during exercise in healthy individuals.

    Science.gov (United States)

    Elliott, Adrian; Hull, James H; Nunan, David; Jakovljevic, Djordje G; Brodie, David; Ansley, Lesley

    2010-07-01

    In patients with cardiac failure, bioreactance-based cardiac output (CO) monitoring provides a valid non-invasive method for assessing cardiac performance during exercise. The purpose of this study was to evaluate the efficacy of this technique during strenuous exercise in healthy, trained individuals. Fourteen recreational cyclists, mean (SD) age of 34 (8) years and relative peak oxygen uptake of (VO(2)) 56 (6) ml kg(-1) min(-1), underwent incremental maximal exercise testing, whilst CO was recorded continuously using a novel bioreactance-based device (CO(bio)). The CO(bio) was evaluated against relationship with VO(2), theoretical calculation of arterial-venous oxygen difference (C(a - v) O(2)) and level of agreement with an inert gas rebreathing method (CO(rb)) using a Bland-Altman plot. Bioreactance-based CO measurement was practical and straightforward in application, although there was intermittent loss of electrocardiograph signal at high-intensity exercise. At rest and during exercise, CO(bio) was strongly correlated with VO(2) (r = 0.84; P < 0.001), however, there was evidence of systematic bias with CO(bio) providing lower values than CO(rb); mean bias (limits of agreement) -19% (14.6 to -53%). Likewise, calculated (C(a - v) O(2)) was greater when determined using CO(bio) than CO(rb) (P < 0.001), although both devices provided values in excess of those reported in invasive studies. Bioreactance-based determination of CO provides a pragmatic approach to the continuous assessment of cardiac performance during strenuous exercise in trained individuals. Our findings, however, suggest that further work is needed to refine the key measurement determinants of CO using this device to improve measurement accuracy in this setting.

  7. Impedance cardiography for estimating cardiac output during submaximal and maximal work.

    Science.gov (United States)

    Kobayashi, Y; Andoh, Y; Fujinami, T; Nakayama, K; Takada, K; Takeuchi, T; Okamoto, M

    1978-09-01

    Impedance cardiography was used to estimate cardiac output in 10 men during rest and within 5 s after exercise on a bicycle ergometer, including work up to and including maximal aerobic capacity. An indwelling venous catheter permitted simultaneous sampling of venous blood for observing changes in hematocrit associated with each exercise level. Cardiac output, calculated from a standard equation which assumes a constant value of 150 omega.cm for the electrical resistivity of blood, was compared with corresponding calculations in which blood resistivity was individually determined as a function of hematocrit. It is concluded that many of the discrepancies in the literature related to values for cardiac output obtained during exercise by the impedance method may be inherent in calculations that do not consider the changing electrical resistivity of the blood with a changing hematocrit.

  8. Continuous cardiac output measurement - Aspects of Doppler frequency analysis

    Science.gov (United States)

    Mackay, R. S.; Hechtman, H. B.

    1975-01-01

    From the suprasternal notch blood flow velocity in the aorta can be measured non-invasively by a Doppler probe. Integration over systole after frequency analysis gives a measure of stroke volume if a separate diameter observation is incorporated. Frequency analysis by a zero crossing counter or by a set of parallel phaselock loops was less effective than a set of bandpass filters. Observations on dogs, baboons and humans before and after exercise or surgery suggest the indications to be useful. Application to judging heart failure by the effect of introducing a volume load is indicated. Changes in output also are measured in freely moving subjects.

  9. Pacing to treat low cardiac output syndrome following elective aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Ishaq

    2012-01-01

    Full Text Available We report a case of low cardiac output syndrome caused by dynamic left ventricular (LV outflow obstruction after aortic valve replacement (AVR. This recognized phenomenon probably occurs more frequently than appreciated, and the author suggests that this should be considered when managing patients with severe hemodynamic instability after AVR. In addition, we also focus on the fact that invasive pacemaker systems have significant effects on cardiac output augmentation postoperatively and in long-term management of patients with LV outflow tract (LVOT obstruction following AVR. The possible mechanisms and subsequent treatments are discussed.

  10. Comparison of an advanced minimally invasive cardiac output monitoring with a continuous invasive cardiac output monitoring during lung transplantation.

    Science.gov (United States)

    Tomasi, Roland; Prueckner, Stephan; Czerner, Stephan; Schramm, Renè; Preissler, Gerhard; Zwißler, Bernhard; von Dossow-Hanfstingl, Vera

    2016-08-01

    The aim of this study was to compare a continuous non-calibrated left heart cardiac index (CI) measurement by arterial waveform analysis (FloTrac(®)/Vigileo(®)) with a continuous calibrated right heart CI measurement by pulmonary artery thermodilution (CCOmbo-PAC(®)/Vigilance II(®)) for hemodynamic monitoring during lung transplantation. CI was measured simultaneously by both techniques in 13 consecutive lung transplants (n = 4 single-lung transplants, n = 9 sequential double-lung transplants) at distinct time points perioperatively. Linear regression analysis and Bland-Altman analysis with percentage error calculation were used for statistical comparison of CI measurements by both techniques. In this study the FloTrac(®) system underestimated the CI in comparison with the continuous pulmonary arterial thermodilution (p waveform and continuous pulmonary artery thermodilution are, therefore, not interchangeable during these complex operations.

  11. Assessment of cardiac output with transpulmonary thermodilution during exercise in humans

    DEFF Research Database (Denmark)

    Calbet, José A L; Boushel, Robert

    2015-01-01

    The accuracy and reproducibility of transpulmonary thermodilution (TPTd) to assess cardiac output (Q̇) in exercising men was determined using indocyanine green (ICG) dilution as a reference method. TPTd has been utilized for the assessment of Q̇ and preload indexes of global end-diastolic volume...

  12. A model to calculate cardiac output in hemodialysis patients by thermodilution

    Directory of Open Access Journals (Sweden)

    Alayoud Ahmed

    2012-06-01

    Full Text Available Abstract The Blood Temperature Monitor module (BTM is used to measure recirculation by thermodilution in dialysis. Numerous studies have confirmed its interest in the measuring of the vascular access flow. In this letter we describe a model to calculate cardiac output in dialysis by the BTM.

  13. Effect of Hemorrhage on Cardiac Output, PVP, Alodosterone and Diuresis during Immersion in Men

    Science.gov (United States)

    Simanonok, K.; Greenleaf, John E.; Bernauer, E. M.; Wade, C. E.; Keil, L. C.

    1990-01-01

    The purpose of this study was to test the hypothesis that a reduction in blood volume would attenuate or eliminate immersion-induced increases in cardiac output (Q (sup dot) sub co)) and urine excretion, and to investigate accompanying vasoactive and fluid-electrolyte hormonal responses.

  14. IMPROVING AGREEMENT BETWEEN THORACIC BIOIMPEDANCE AND DYE DILUTION CARDIAC-OUTPUT ESTIMATION IN CHILDREN

    NARCIS (Netherlands)

    OCONNELL, AJ; TIBBALLS, J; COULTHARD, M

    1991-01-01

    The measurement of thoracic electrical bioimpedance (TEB) offers a continuous, non-invasive method for monitoring cardiac output (CO). For clinical use, agreement with a current standard should be demonstrated. We describe a modification to the manufacturer's suggested data entry into the NCCOM3-R6

  15. Use of thermodilution cardiac output overestimates diagnoses of exercise-induced pulmonary hypertension.

    Science.gov (United States)

    Hsu, Steven; Brusca, Samuel B; Rhodes, Parker S; Kolb, Todd M; Mathai, Stephen C; Tedford, Ryan J

    2017-03-01

    Two new definitions of exercise-induced pulmonary hypertension (EIPH) have emerged. Both rely on measuring cardiac output (CO), yet this remains unstandardized. In our cohort of patients undergoing invasive cardiopulmonary exercise testing, we found that using thermodilution CO rather than direct Fick CO led to a significant excess of EIPH diagnoses.

  16. Cardiac output measurement by bioimpedance and noninvasive pulse contour analysis compared with the continuous pulmonary artery thermodilution technique

    NARCIS (Netherlands)

    Maass, Saskia W. M. C.; Roekaerts, Paul M. H. J.; Lance, Marcus D.

    2014-01-01

    Objective: The aim of the present study was to compare 2 noninvasive cardiac output measurement methods with the continuous cardiac output thermodilution (CCO-TD) method. Design: A single-center prospective design. Setting: A university hospital. Participants: Fifty-three consecutive patients schedu

  17. Cardiac troponins and high-sensitivity cardiac troponin assays.

    Science.gov (United States)

    Conrad, Michael J; Jarolim, Petr

    2014-03-01

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

  18. Bioreactance is a reliable method for estimating cardiac output at rest and during exercise.

    Science.gov (United States)

    Jones, T W; Houghton, D; Cassidy, S; MacGowan, G A; Trenell, M I; Jakovljevic, D G

    2015-09-01

    Bioreactance is a novel noninvasive method for cardiac output measurement that involves analysis of blood flow-dependent changes in phase shifts of electrical currents applied across the thorax. The present study evaluated the test-retest reliability of bioreactance for assessing haemodynamic variables at rest and during exercise. 22 healthy subjects (26 (4) yrs) performed an incremental cycle ergometer exercise protocol relative to their individual power output at maximal O2 consumption (Wmax) on two separate occasions (trials 1 and 2). Participants cycled for five 3 min stages at 20, 40, 60, 80 and 90% Wmax. Haemodynamic and cardiorespiratory variables were assessed at rest and continuously during the exercise protocol. Cardiac output was not significantly different between trials at rest (P=0.948), or between trials at any stage of the exercise protocol (all P>0.30). There was a strong relationship between cardiac output estimates between the trials (ICC=0.95, Prest (P=0.989) or during exercise (all P>0.15), and strong relationships between trials were found (ICC=0.83, Prest and during different stages of graded exercise testing including maximal exertion. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    Science.gov (United States)

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

    2014-02-01

    The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.

  20. Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure.

    Science.gov (United States)

    Yildiz, Omer; Aslan, Gamze; Demirozu, Zumrut T; Yenigun, Cemal Deniz; Yazicioglu, Nuran

    2017-09-15

    If the heart is represented by a hydraulic pump, cardiac power represents the hydraulic function of the heart. Cardiac pump function is frequently determined through left ventricular ejection fraction using imaging. This study aims to validate resting cardiac power output (CPO) as a predictive biomarker in patients with advanced heart failure (HF). One hundred and seventy-two patients with HF severe enough to warrant cardiac transplantation were retrospectively reviewed at a single tertiary care institution between September 2010 and July 2013. Patients were initially evaluated with simultaneous right-sided and left-sided cardiac catheter-based hemodynamic measurements, followed by longitudinal follow-up (median of 52 months) for adverse events (cardiac mortality, cardiac transplantation, or ventricular assist device placement). Median resting CPO was 0.54 W (long rank chi-square = 33.6; p < 0.0001). Decreased resting CPO (<0.54 W) predicted increased risk for adverse outcomes. Fifty cardiac deaths, 10 cardiac transplants, and 12 ventricular assist device placements were documented. The prognostic relevance of resting CPO remained significant after adjustment for age, gender, left ventricular ejection fraction, mean arterial pressure, pulmonary vascular resistance, right atrial pressure, and estimated glomerular filtration rate (HR, 3.53; 95% confidence interval, 1.66 to 6.77; p = 0.0007). In conclusion, lower resting CPO supplies independent prediction of adverse outcomes. Thus, it could be effectively used for risk stratification in patients with advanced HF. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

    Krag, A; Bendtsen, F; Henriksen, J H;

    2010-01-01

    OBJECTIVES: Recent studies suggest that cardiac dysfunction precedes development of the hepatorenal syndrome. In this follow-up study, we aimed to investigate the relation between cardiac and renal function in patients with cirrhosis and ascites and the impact of cardiac systolic function...... on survival. Patients and DESIGN: Twenty-four patients with cirrhosis and ascites were included. Cardiac function was investigated by gated myocardial perfusion imaging (MPI) for assessment of cardiac index (CI) and cardiac volumes. The renal function was assessed by determination of glomerular filtration...... (130 (SD 46) vs 78 (SD 29) mumol/l, pdeveloped hepatorenal syndrome type 1 within 3 months was higher in the group with low CI than in the high CI group (43% vs 5%, p = 0.04). Patients with the lowest CI (N = 8) had significantly poorer survival at 3, 9, and 12 months...

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

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Ersgård, David;

    2010-01-01

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

  3. Continuous measurement of cardiac output with the use of stochastic system identification techniques.

    Science.gov (United States)

    Yelderman, M

    1990-10-01

    The limitations of developing a technique to measure cardiac output continuously are given. Logical explanations are provided for the economic, technical, and physiologic benefits of a stochastic system identification technique for measuring cardiac output. Heat is supplied by a catheter-mounted filament driven according to a pseudorandom binary sequence. Volumetric fluid flow is derived by a cross-correlation algorithm written in the C language. In vitro validation is performed with water in a flow bench. The computed flow (y) compared with the in-line-measured flow (x) yields the linear regression y = 1.024x - 0.157 (r = 0.99). The average coefficient of variation is less than 2% over a volumetric fluid flow range of 2 to 10 L/min.

  4. [Ethrane in anaesthesia for children--measurement of cardiac output by impedance-cardiography (author's transl)].

    Science.gov (United States)

    Ottermann, U; Prister, Z

    1976-12-01

    Ethrane permits a very smooth and quick introduction of anaesthesia per inhalationem without signs of any excitation due to its physical properties. Because of its low analgesic property it was necessary to administer nitrous oxide. After the interruption of Tthrane--administration our patients awoke without any nausea or vomiting. In our study we measured stroke-volume and cardiac output during and after Ethrane anaesthesia using the IFM-Minnesota Impedance Cardiograph 304 A. In the first ten minutes of anaesthesia we found a 23 per cent-decrease of strokevolume, a 19 per cent cardiac output-decrease whereas the heartrate rose slightly. Any further significant changes of these parameters up to the end of anaesthesia were not detectable. Already two minutes after the end of Ethrane-administration all parameters had reached their initial values.

  5. Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity.

    Science.gov (United States)

    Obata, Yurie; Mizogami, Maki; Nyhan, Daniel; Berkowitz, Dan E; Steppan, Jochen; Barodka, Viachaslau

    2017-01-01

    Transesophageal echocardiography (TEE) is increasingly replacing thermodilution pulmonary artery catheters to assess hemodynamics in patients at high risk for cardiovascular morbidity. However, one of the drawbacks of TEE compared to pulmonary artery catheters is the inability to measure real time stroke volume (SV) and cardiac output (CO) continuously. The aim of the present proof of concept study was to validate a novel method of SV estimation, based on pulse wave velocity (PWV) in patients undergoing cardiac surgery. This is a retrospective observational study. We measured pulse transit time by superimposing the radial arterial waveform onto the continuous wave Doppler waveform of the left ventricular outflow tract, and calculated SV (SVPWV) using the transformed Bramwell-Hill equation. The SV measured by TEE (SVTEE) was used as a reference. A total of 190 paired SV were measured from 28 patients. A strong correlation was observed between SVPWV and SVTEE with the coefficient of determination (R2) of 0.71. A mean difference between the two (bias) was 3.70 ml with the limits of agreement ranging from -20.33 to 27.73 ml and a percentage error of 27.4% based on a Bland-Altman analysis. The concordance rate of two methods was 85.0% based on a four-quadrant plot. The angular concordance rate was 85.9% with radial limits of agreement (the radial sector that contained 95% of the data points) of ± 41.5 degrees based on a polar plot. PWV based SV estimation yields reasonable agreement with SV measured by TEE. Further studies are required to assess its utility in different clinical situations.

  6. Levosimendan in a neonate with severe coarctation of aorta and low cardiac output syndrome

    Directory of Open Access Journals (Sweden)

    Yann Olivier Boegli

    2013-01-01

    Full Text Available We report successful use of levosimendan after failed balloon angioplasty in a critically ill neonate with coarctation of aorta (CoA and severe low cardiac output syndrome (LCOS. Treatment with levosimendan improved left heart function, and decreased lactate and brain natriuretic peptide levels. To our knowledge, this is the first report on the safe and successful use of levosimendan in the management of LCOS due to severe CoA in a neonate awaiting surgical repair.

  7. Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective measurement in children with shock.

    Science.gov (United States)

    Razavi, Asma; Newth, Christopher J L; Khemani, Robinder G; Beltramo, Fernando; Ross, Patrick A

    2017-06-01

    To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (resistance, categorizing them as high, normal, or low. An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) with USCOM categorized as high, normal, or low. Overall agreement between physician and USCOM for CI (48.5% [κ = 0.18]) and SVRI (45.9% [κ = 0.16]) was poor. Interobserver agreement was also poor for CI (58.7% [κ = 0.33]) and SVRI (52.3% [κ = 0.28]). Comparing theoretical physician interventions to "acceptable" or "unacceptable" clinical interventions, based on USCOM measurement, 56 (21%) physician interventions were found to be "unacceptable." There is poor agreement between physician-assessed CI and SVRI and USCOM, with significant interobserver variability among physicians. Objective measurement of CI and SVRI may reduce variability and improve diagnostic accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Multisite Tissue Oxygenation Monitoring Indicates Organ-Specific Flow Distribution and Oxygen Delivery Related to Low Cardiac Output in Preterm Infants With Clinical Sepsis

    NARCIS (Netherlands)

    van der Laan, Michelle E.; Roofthooft, Marcus T. R.; Fries, Marian W. A.; Schat, Trijntje E.; Bos, Arend F.; Berger, Rolf M. F.; Kooi, Elisabeth M. W.

    Objectives: Cardiac output may be compromised in preterm infants with sepsis. Whether low cardiac output is associated with low tissue oxygen supply in these patients is unclear. The aim of the current study was to assess the association between cardiac output, assessed by echocardiography, and

  9. Multisite Tissue Oxygenation Monitoring Indicates Organ-Specific Flow Distribution and Oxygen Delivery Related to Low Cardiac Output in Preterm Infants With Clinical Sepsis

    NARCIS (Netherlands)

    van der Laan, Michelle E.; Roofthooft, Marcus T. R.; Fries, Marian W. A.; Schat, Trijntje E.; Bos, Arend F.; Berger, Rolf M. F.; Kooi, Elisabeth M. W.

    2016-01-01

    Objectives: Cardiac output may be compromised in preterm infants with sepsis. Whether low cardiac output is associated with low tissue oxygen supply in these patients is unclear. The aim of the current study was to assess the association between cardiac output, assessed by echocardiography, and tiss

  10. Output beam analysis of high power COIL

    Institute of Scientific and Technical Information of China (English)

    Deli Yu(于德利); Fengting Sang(桑凤亭); Yuqi Jin(金玉奇); Yizhu Sun(孙以珠)

    2003-01-01

    As the output power of a chemical oxygen iodine laser (COIL) increases, the output laser beam instabilityappears as the far-field beam spot drift and deformation for the large Fresnel number unstable resonator.In order to interpret this phenomenon, an output beam mode simulation code was developed with the fastFourier transform method. The calculation results show that the presence of the nonuniform gain in COILproduces a skewed output intensity distribution, which causes the mirror tilt and bulge due to the thermalexpansion. With the output power of COIL increases, the mirror surfaces, especially the back surface ofthe scraper mirror, absorb more and more heat, which causes the drift and deformation of far field beamspot seriously. The initial misalignment direction is an important factor for the far field beam spot driftingand deformation.

  11. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output.

    Science.gov (United States)

    Lee, Bo-Ae; Oh, Deuk-Ja

    2016-02-01

    The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers-including 10 people who have continued regular exercises and 12 people as the control group-were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups.

  12. Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery.

    Science.gov (United States)

    Verweij, E J; Hogenbirk, Karin; Roest, Arno A W; van Brempt, Ronald; Hazekamp, Mark G; de Jonge, Evert

    2012-10-01

    Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency. A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of cortisol of ≥ 100 nmol/l. A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.

  13. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output.

    Science.gov (United States)

    Smerup, Morten; Damkjær, Mads; Brøndum, Emil; Baandrup, Ulrik T; Kristiansen, Steen Buus; Nygaard, Hans; Funder, Jonas; Aalkjær, Christian; Sauer, Cathrine; Buchanan, Rasmus; Bertelsen, Mads Frost; Østergaard, Kristine; Grøndahl, Carsten; Candy, Geoffrey; Hasenkam, J Michael; Secher, Niels H; Bie, Peter; Wang, Tobias

    2016-02-01

    Giraffes--the tallest extant animals on Earth--are renowned for their high central arterial blood pressure, which is necessary to secure brain perfusion. Arterial pressure may exceed 300 mmHg and has historically been attributed to an exceptionally large heart. Recently, this has been refuted by several studies demonstrating that the mass of giraffe heart is similar to that of other mammals when expressed relative to body mass. It thus remains unexplained how the normal-sized giraffe heart generates such massive arterial pressures. We hypothesized that giraffe hearts have a small intraventricular cavity and a relatively thick ventricular wall, allowing for generation of high arterial pressures at normal left ventricular wall tension. In nine anaesthetized giraffes (495±38 kg), we determined in vivo ventricular dimensions using echocardiography along with intraventricular and aortic pressures to calculate left ventricular wall stress. Cardiac output was also determined by inert gas rebreathing to provide an additional and independent estimate of stroke volume. Echocardiography and inert gas-rebreathing yielded similar cardiac outputs of 16.1±2.5 and 16.4±1.4 l min(-1), respectively. End-diastolic and end-systolic volumes were 521±61 ml and 228±42 ml, respectively, yielding an ejection fraction of 56±4% and a stroke volume of 0.59 ml kg(-1). Left ventricular circumferential wall stress was 7.83±1.76 kPa. We conclude that, relative to body mass, a small left ventricular cavity and a low stroke volume characterizes the giraffe heart. The adaptations result in typical mammalian left ventricular wall tensions, but produce a lowered cardiac output.

  14. Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique

    DEFF Research Database (Denmark)

    Gabrielsen, Anders; Videbaek, Regitze; Schou, Morten

    2002-01-01

    Values of effective pulmonary blood flow (Q(EP)) and cardiac output, determined by a non-invasive foreign gas rebreathing method (CO(RB)) using a new infrared photoacoustic gas analysing system, were compared with measurements of cardiac output obtained by the direct Fick (CO(FICK)) and thermodil......Values of effective pulmonary blood flow (Q(EP)) and cardiac output, determined by a non-invasive foreign gas rebreathing method (CO(RB)) using a new infrared photoacoustic gas analysing system, were compared with measurements of cardiac output obtained by the direct Fick (CO...... with significant shunt flow. In the eight patients without significant shunt flow, the agreement between Q(EP) and CO(FICK) was 0.3 +/- 0.9 litre x min(-1). In conclusion, a foreign gas rebreathing method with a new infrared photoacoustic gas analyser provided at least as reliable a measure of cardiac output...... as did thermodilution. In the absence of significant shunt flow, measurement of Q(EP) itself provides a reliable estimate of cardiac output in heart failure patients. The infrared photoacoustic gas analyser markedly facilitates clinical use of the rebreathing method in general, which makes the method...

  15. Cardiac output assessment using oxygen consumption estimated from the left ventricular pressure-volume area.

    Science.gov (United States)

    Negroni, Jorge A; Lascano, Elena C; Bertolotti, Alejandro M; Gómez, Carmen B; Rodríguez Correa, Carlos A; Favaloro, Roberto R

    2010-01-01

    Use of a majority of structural variables (age, sex, height) to estimate oxygen consumption in the calculation of cardiac output (CO) by the Fick principle does not account for changes in physiological conditions. To improve this limitation, oxygen consumption was estimated based on the left ventricular pressure-volume area. A pilot study with 10 patients undergoing right cardiac catheterization showed that this approach was successful to estimate CO (r=0,73, vs. thermodilution measured CO). Further essays changing end-diastolic-volume in the pressure-volume area formula by body weight or body surface area showed that this last yielded the best correlation with the thermodilution measured CO (slope=1, ordinate =0.01 and r=0.93). These preliminary results indicate that use of a formula originated from the pressure-volume-area concept is a good alternative to estimate oxygen consumption for CO calculation.

  16. Arterial pulse cardiac output agreement with thermodilution in patients in hyperdynamic conditions.

    Science.gov (United States)

    Della Rocca, Giorgio; Costa, Maria Gabriella; Chiarandini, Paolo; Bertossi, Gaia; Lugano, Manuela; Pompei, Livia; Coccia, Cecilia; Sainz-Barriga, Mauricio; Pietropaoli, Paolo

    2008-10-01

    This study aimed to compare continuous cardiac output (CCO) obtained using the arterial pulse wave (APCO) measurement with a simultaneous measurement of the intermittent cardiac output (ICO) and CCO obtained with a pulmonary artery catheter (PAC) in liver transplant patients. A prospective, single-center evaluation. A university hospital intensive care unit. Eighteen patients after liver transplantation. Pulmonary artery catheters were placed in all patients, and ICO and CCO were determined using thermodilution. APCO measurements were made with the Vigileo System (Edwards Lifesciences, Irvine, CA). The authors obtained 126 data pairs of ICO and APCO and 864 pairs of CCO and APCO. ICO data were collected after intensive care unit admission and every 8 hours until the 48th postoperative hour. CCO and APCO data were collected every hour from admission until the 48th postoperative hour. Bias and precision were 0.95 +/- 1.41 L/min for ICO versus APCO and 1.29 +/- 1.28 L/min for CCO and APCO. Bias and precision for cardiac output (CO) data pairs less than 8 L/min were 0.32 +/- 1.14 L/min between ICO and APCO and 0.71 +/- 0.98 L/min between CCO and APCO. For CO data pairs higher than 8 L/min, bias and precision were 1.79 +/- 1.54 L/min between ICO and APCO and 2.25 +/- 1.14 L/min between CCO and APCO. APCO enables the assessment of CO with clinically acceptable bias and precision. At higher CO levels, APCO underestimates PAC measurements and it is not as reliable as thermodilution in hyperdynamic liver transplant patients.

  17. Evaluation of cardiac output from a tidally ventilated homogeneous lung model.

    Science.gov (United States)

    Benallal, Habib; Beck, Kenneth C; Johnson, Bruce D; Busso, Thierry

    2005-10-01

    We used the direct Fick measurements to validate a method for estimating cardiac output by iteratively fitting VCO(2) at the mouth to lung model values. This model was run using a series of 50, 30 and 10 breaths to test sensitivity to number of breaths used for fitting. The lung was treated as a catenary two-compartment lung model consisting of a dead space compartment connected with a single alveolar space compartment, perfused with constant pulmonary blood flow. The implemented mathematical modeling described variations in O(2) and CO(2) compartmental fractions and alveolar volume. This model also included pulmonary capillary gas exchange. Experimental data were collected from measurements performed on six healthy subjects at rest and during 20, 40, 60 and 85-90% of peak V(O)(2). The correlation between the two methods was highest and the average agreement between the methods was best using 50 breaths R = 095; P model) = 1.1Q(Fick) - 2.3). The mean difference and lower to upper limits of agreement between measured and estimated data were 0.7 l/min (-2.7 to 4.1 l/min) for cardiac output; -0.9 ml/100 ml (-1.3 to -0.5 ml/100 ml) for arterial O(2) content; -0.8 ml/100 ml (-3.8 to 2.2 ml/100 ml) for mixed venous O(2) content and -0.1 ml/100 ml (-2.9 to 2.7 ml/100 ml) for arteriovenous difference O(2) content. The cardiac output estimated by the lung model was in good agreement with the direct Fick measurements in young healthy subjects.

  18. Non-invasive measurements of cardiac output in atrial fibrillation: Inert gas rebreathing and impedance cardiography

    DEFF Research Database (Denmark)

    Osbak, Philip S; Henriksen, Jens Henrik Sahl; Kofoed, Klaus F

    2011-01-01

    Abstract Background. Atrial fibrillation (AF) is associated with significant morbidity and mortality. To test the effect of interventions, knowledge of cardiac output (CO) is important. However, the irregular heart rate might cause some methods for determination of CO to have inherent weaknesses....... Objective. To assess the validity of these methods in AF, a new inert gas rebreathing device and impedance cardiography was tested with echocardiography as reference. Methods. Using a cross-sectional design, 127 patients with AF and 24 in SR were consecutively recruited. Resting CO was measured using inert...

  19. Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study.

    Science.gov (United States)

    Pérez Vela, J L; Jiménez Rivera, J J; Alcalá Llorente, M Á; González de Marcos, B; Torrado, H; García Laborda, C; Fernández Zamora, M D; González Fernández, F J; Martín Benítez, J C

    2017-07-20

    An analysis is made of the clinical profile, evolution and differences in morbidity and mortality of low cardiac output syndrome (LCOS) in the postoperative period of cardiac surgery, according to the 3 diagnostic subgroups defined by the SEMICYUC Consensus 2012. A multicenter, prospective cohort study was carried out. ICUs of Spanish hospitals with cardiac surgery. A consecutive sample of 2,070 cardiac surgery patients was included, with the analysis of 137 patients with LCOS. No intervention was carried out. The mean patient age was 68.3±9.3 years (65.2% males), with a EuroSCORE II of 9.99±13. NYHA functional class III-IV (52.9%), left ventricular ejection fraction<35% (33.6%), AMI (31.9%), severe PHT (21.7%), critical preoperative condition (18.8%), prior cardiac surgery (18.1%), PTCA/stent placement (16.7%). According to subgroups, 46 patients fulfilled hemodynamic criteria of LCOS (group A), 50 clinical criteria (group B), and the rest (n=41) presented cardiogenic shock (group C). Significant differences were observed over the evolutive course between the subgroups in terms of time subjected to mechanical ventilation (114.4, 135.4 and 180.3min in groups A, B and C, respectively; P<.001), renal replacement requirements (11.4, 14.6 and 36.6%; P=.007), multiorgan failure (16.7, 13 and 47.5%), and mortality (13.6, 12.5 and 35.9%; P=.01). The mean maximum lactate concentration was higher in cardiogenic shock patients (P=.002). The clinical evolution of these patients leads to high morbidity and mortality. We found differences between the subgroups in terms of the postoperative clinical course and mortality. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  20. Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine.

    Science.gov (United States)

    Monnet, Xavier; Letierce, Alexia; Hamzaoui, Olfa; Chemla, Denis; Anguel, Nadia; Osman, David; Richard, Christian; Teboul, Jean-Louis

    2011-06-01

    To evaluate to which extent the systemic arterial pulse pressure could be used as a surrogate of cardiac output for assessing the effects of a fluid challenge and of norepinephrine. Observational study. Medical intensive care unit. Patients with an acute circulatory failure who received a fluid challenge (228 patients, group 1) or in whom norepinephrine was introduced or increased (145 patients, group 2). We measured the systolic, diastolic, and mean arterial pressure, pulse pressure, and the transpulmonary thermodilution cardiac output before and after the therapeutic interventions. In group 1, the fluid challenge significantly increased cardiac output by 24% ± 25%. It significantly increased cardiac output by ≥15% (+35% ± 27%) in 142 patients ("responders"). The fluid-induced changes in cardiac output were correlated with the changes in pulse pressure (r = .56, p arterial pressure (r = .55, p arterial pressure (r = .37, p arterial pressure (r = .52, p pressure were significantly related to changes in stroke volume (multiple r = .52) and to age (r = .12). A fluid-induced increase in pulse pressure of ≥17% allowed detecting a fluid-induced increase in cardiac output of ≥15% with a sensitivity of 65[56-72]% and a specificity of 85[76-92]%. The area under the receiver operating characteristic curves for the fluid-induced changes in mean arterial pressure and in diastolic arterial pressure was significantly lower than for pulse pressure. In group 2, the introduction/increase of norepinephrine significantly increased cardiac output by 14% ± 18%. The changes in cardiac output induced by the introduction/increase in the dose of norepinephrine were correlated with the changes in pulse pressure and systolic arterial pressure (r = .21 and .29, respectively, p = .001) but to a significantly lesser extent than in group 1. Pulse pressure and systolic arterial pressure could be used for detecting the fluid-induced changes in cardiac output, in spite of a significant

  1. Comparison of cardiac output determined by different rebreathing methods at rest and at peak exercise.

    Science.gov (United States)

    Jakovljevic, Djordje G; Nunan, David; Donovan, Gay; Hodges, Lynette D; Sandercock, Gavin R H; Brodie, David A

    2008-03-01

    Several rebreathing methods are available for cardiac output (Q (T)) measurement. The aims of this study were threefold: first, to compare values for resting Q (T) produced by the equilibrium-CO(2), exponential-CO(2) and inert gas-N(2)O rebreathing methods and, second, to evaluate the reproducibility of these three methods at rest. The third aim was to assess the agreement between estimates of peak exercise Q (T) derived from the exponential and inert gas rebreathing methods. A total of 18 healthy subjects visited the exercise laboratory on different days. Repeated measures of Q (T), measured in a seated position, were separated by a 5 min rest period. Twelve participants performed an incremental exercise test to determine peak oxygen consumption. Two more exercise tests were used to measure Q (T) at peak exercise using the exponential and inert gas rebreathing methods. The exponential method produced significantly higher estimates at rest (averaging 10.9 l min(-1)) compared with the equilibrium method (averaging 6.6 l min(-1)) and the inert gas rebreathing method (averaging 5.1 l min(-1); P < 0.01). All methods were highly reproducible with the exponential method having the largest coefficient of variation (5.3%). At peak exercise, there were non-significant differences between the exponential and inert gas rebreathing methods (P = 0.14). The limits of agreement were -0.49 to 0.79 l min(-1). Due to the ability to evaluate the degree of gas mixing and to estimate intra-pulmonary shunt, we believe that the inert gas rebreathing method has the potential to measure Q (T) more precisely than either of the CO(2) rebreathing methods used in this study. At peak exercise, the exponential and inert gas rebreathing methods both showed acceptable limits of agreement.

  2. Cardiac output and vasodilation in the vasovagal response: An analysis of the classic papers.

    Science.gov (United States)

    Wieling, Wouter; Jardine, David L; de Lange, Frederik J; Brignole, Michele; Nielsen, Henning B; Stewart, Julian; Sutton, Richard

    2016-03-01

    The simple faint is secondary to hypotension and bradycardia resulting in transient loss of consciousness. According to Ohm's law applied to the circulation, BP = SVR × CO, hypotension can result from a decrease in systemic vascular resistance (SVR), cardiac output (CO), or both. It is important to understand that when blood pressure (BP) is falling, SVR and CO do not change reciprocally as they do in the steady state. In 1932, Lewis, assuming that decreased SVR alone accounted for hypotension, defined "the vasovagal response" along pathophysiologic lines to denote the association of vasodilation with vagal-induced bradycardia in simple faint. Studies performed by Barcroft and Sharpey-Schafer between 1940 and 1950 used volume-based plethysmography to demonstrate major forearm vasodilation during extreme hypotension and concluded that the main mechanism for hypotension was vasodilation. Plethysmographic measurements were intermittent and not frequent enough to capture rapid changes in blood flow during progressive hypotension. However, later investigations by Weissler, Murray, and Stevens performed between 1950 and 1970 used invasive beat-to-beat BP measurements and more frequent measurements of CO using the Fick principle. They demonstrated that CO significantly fell before syncope, and little vasodilation occurred until very late in the vasovagal reaction Thus, since the 1970s, decreasing cardiac output rather than vasodilation has been regarded as the principal mechanism for the hypotension of vasovagal syncope.

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

    Science.gov (United States)

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

    2005-02-01

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

  4. Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies

    Energy Technology Data Exchange (ETDEWEB)

    Gemert, Martin J C van [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Umur, Asli [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Wijngaard, Jeroen P H M van den [Laser Center and Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); VanBavel, Ed [Department of Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Vandenbussche, Frank P H A [Department of Obstetrics, Leiden University Medical Center, Leiden (Netherlands); Nikkels, Peter G J [Department of Pathology, University Medical Center, Utrecht (Netherlands)

    2005-02-07

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

  5. Differences between directly measured and calculated values for cardiac output in the dogfish: a criticism of the Fick method.

    Science.gov (United States)

    Metcalfe, J D; Butler, P J

    1982-08-01

    Cardiac output has been measured directly, and calculated by the Fick method, during normoxia and hypoxia in six artificially perfused dogfish (Scyliorhinus canicula) in an attempt to estimate the accuracy of this method in fish. The construction and operation of a simple extra-corporeal cardiac bypass pump is described. This pump closely mimics the flow pulse profiles of the fish's own heart and allows complete control of both cardiac stroke volume and systolic and diastolic periods. During normoxia (PO2 = 21 kPa) there was no significant difference between directly measured and calculated values for cardiac output. However, some shunting of blood past the respiratory surface of the gills may have been obscured by cutaneous oxygen uptake. In response to hypoxia (PO2 = 8.6 kPa) there is either a decrease in the amount of blood being shunted past the respiratory surface of the gills and/or an increase in cutaneous oxygen uptake such that the Fick calculated value for cardiac output is on average 38% greater than the measured value. It is proposed that the increase in the levels of circulating catecholamines that is reported to occur in response to hypoxia in this species may play an important role in the observed response to hypoxia. The results are discussed in terms of their implications for the calculation of cardiac output by the Fick principle in fish.

  6. The ability of the Vigileo-FloTrac system to measure cardiac output and track cardiac output changes during one-lung ventilation.

    Science.gov (United States)

    Suehiro, Koichi; Tanaka, Katsuaki; Yamada, Tokuhiro; Matsuura, Tadashi; Mori, Takashi; Funao, Tomoharu; Nishikawa, Kiyonobu

    2015-06-01

    This study was aimed at comparing the cardiac output (CO) measured by the Vigileo™-FloTrac™ system with that estimated by the thermodilution pulmonary artery catheter (PAC) during one-lung ventilation (OLV) and determining the reliability of this system in tracking phenylephrine-induced CO changes during OLV. Sixteen patients scheduled for descending aorta replacement were enrolled. The study was performed 30 min after starting OLV under stable hemodynamic conditions. We recorded hemodynamic variables, CO measured by PAC thermodilution (ICO), CO measured by Vigileo™-FloTrac™ system (Version 3.02, Edwards Lifesciences, Irvine, CA, USA) (APCO), and systemic vascular resistance index (SVRI) before (T0) and after (T1) phenylephrine (100 μg) administration. We used Bland-Altman analysis to compare ICO and APCO. Polar plot and four-quadrant plot were used to assess the tracking ability of the Vigileo™-FloTrac™ system against ICO after administration of phenylephrine. Ninety hemodynamic interventions were performed. Bland-Altman analysis revealed that the mean bias between APCO and ICO was 0.05 L/min and the percentage error, 46.9 %. Four-quadrant plot analysis showed a concordance rate of 24.7 %, while polar plot analysis showed that the concordance rate was 13.3 %; the angular bias, -45.9°; radial limit of agreement, 85.3°. The bias between APCO and ICO was significantly correlated with the SVRI value (p < 0.001, r(2) = 0.822). The reliability of the Vigileo™-FloTrac™ system during OLV to estimate CO and track phenylephrine-induced CO changes was not acceptable.

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

    Directory of Open Access Journals (Sweden)

    Amann Matthias

    2007-11-01

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

  8. Chronic measurement of cardiac output in unanesthetized rats using miniature thermocouples.

    Science.gov (United States)

    Osborn, J W; Barber, B J; Quillen, E W; Abram, R J; Cowley, A W

    1986-12-01

    A thermodilution technique is described for measuring steady-state cardiac output (CO) in conscious rats for periods of 2-3 wk. The method utilizes small implantable aortic thermocouples inserted via the femoral artery at the time of placement of other chronic indwelling catheters. Data are presented to validate the accuracy and reproducibility of the technique by acute in situ comparison with electromagnetic flowmeter measurements. Responses in chronically instrumented rats were tested with hemorrhage and infusions of vasodilator and vasoconstrictor agents administered repeatedly over a period of 9 days. The results show that the system is capable of measuring CO chronically and provides reproducible responses for periods of at least several weeks. We conclude that these methods provide a single, inexpensive, and accurate way to measure steady-state CO in conscious, unrestrained rats.

  9. Phlebotomy eliminates the maximal cardiac output response to six weeks of exercise training

    DEFF Research Database (Denmark)

    Bonne, Thomas Christian; Doucende, Gregory; Flück, Daniela

    2014-01-01

    -breathing) was re-established to pre-training values by phlebotomy and Qmax was quantified again. Resting echography revealed no structural heart adaptations as a consequence of the training intervention. Following the training period, plasma volume (PV), red blood cell volume (RBCV) and BV increased (p......With this study we tested the hypothesis that six weeks of endurance training increases maximal cardiac output (Qmax) relatively more by elevating blood volume (BV) than by inducing structural and functional changes within the heart. Nine healthy but untrained volunteers (VO2max 47 ± 5 ml.min(-1......).kg(-1)) underwent supervised training (60 min; 4 times weekly at 65% VO2max for six weeks) and Qmax was determined by inert gas re-breathing during cycle ergometer exercise before and after the training period. After the training period, blood volume (determined in duplicates by CO re...

  10. Correlation of cardiac output and sevoflurane required to maintain anesthetic depth targeted with entropy index

    Directory of Open Access Journals (Sweden)

    Andrei E Bautin

    2014-01-01

    Full Text Available Aims and Objectives: We investigated the correlation of reduced cardiac output on required sevoflurane to maintain targeted anesthesia depth. Materials and Methods: 36 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were prospectively included in the study. Inspired sevoflurane concentration was adjusted to ensure state entropy index 2.2 l/min/m 2 (1.37% ± 0.31%, P = 0.01. Conclusion: Relationship between CI and ETsev required for maintaining target level of anesthesia is non-linear. Patients with CI ≤ 2.2 l/min/m 2 need lower levels of the ETsev for maintenance of the target anesthesia at an entropy index < 40.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-09-01

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

  12. Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

    Directory of Open Access Journals (Sweden)

    Dany E. Weisz

    2014-05-01

    Full Text Available Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU, including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU.

  13. Femoral Blood Flow and Cardiac Output During Blood Flow Restricted Leg Press Exercise

    Science.gov (United States)

    Everett, M. E.; Hackney, K.; Ploutz-Snyder, L.

    2011-01-01

    Low load blood flow restricted resistance exercise (LBFR) causes muscle hypertrophy that may be stimulated by the local ischemic environment created by the cuff pressure. However, local blood flow (BF) during such exercise is not well understood. PURPOSE: To characterize femoral artery BF and cardiac output (CO) during leg press exercise (LP) performed at a high load (HL) and low load (LL) with different levels of cuff pressure. METHODS: Eleven subjects (men/women 4/7, age 31.4+/-12.8 y, weight 68.9+/-13.2 kg, mean+/-SD) performed 3 sets of supine left LP to fatigue with 90 s of rest in 4 conditions: HL (%1-RM/cuff pressure: 80%/0); LL (20%/0); LBFR(sub DBP) (20%/1.3 x diastolic blood pressure, BP); LBFR(sub SBP) (20%/1.3 x supine systolic BP). The cuff remained inflated throughout the LBFR exercise sessions. Artery diameter, velocity time integral (VTI), and stroke volume (SV) were measured using Doppler ultrasound at rest and immediately after each set of exercise. Heart rate (HR) was monitored using a 3-lead ECG. BF was calculated as VTI x vessel cross-sectional area. CO was calculated as HR x SV. The data obtained after each set of exercise were averaged and used for analyses. Multi-level modeling was used to determine the effect of exercise condition on dependent variables. Statistical significance was set a priori at p LL (9.92+/-0.82 cm3) > LBFR(sub dBP)(6.47+/-0.79 cm3) > LBFR(sub SBP) (3.51+/-0.59 cm3). Blunted exercise induced increases occurred in HR, SV, and CO after LBFR compared to HL and LL. HR increased 45% after HL and LL and 28% after LBFR (p<0.05), but SV increased (p<0.05) only after HL. Consequently, the increase (p<0.05) in CO was greater in HL and LL (approximately 3 L/min) than in LBFR (approximately 1 L/min). CONCLUSION: BF during LBFR(sub SBP) was 1/3 of that observed in LL, which supports the hypothesis that local ischemia stimulates the LBFR hypertrophic response. As the cuff did not compress the artery, the ischemia may have occurred

  14. Cardiac output in exercise by impedance cardiography during breath holding and normal breathing.

    Science.gov (United States)

    Du Quesnay, M C; Stoute, G J; Hughson, R L

    1987-01-01

    Estimation of cardiac output by impedance cardiography (QZ) in exercise during normal breathing (NB) has been limited by motion artifact. Our objective was to obtain readable impedance cardiograms on five subjects during upright cycle exercise at 0, 50, 100, 150, and 200 W to permit comparisons of QZ during NB, expiratory breath hold (EXP) and inspiratory breath hold (INSP). Q was also determined using an equilibration CO2 rebreathing method [Q(RB)]. QZ during NB exceeded EXP QZ at 100, 150, and 200 W, and exceeded INSP QZ at 100 W (P less than 0.05). The low EXP QZ values were due to a significantly lower stroke volume at 100, 150, and 200 W (P less than 0.05). For the INSP QZ at 100 W, heart rate was lower than during EXP (P less than 0.05). Regression of QZ (NB) against Q(RB) resulted in a linear relationship (r = 0.93) over the range of Q = 7-26 1/min. The slope of the regression differed significantly from 1.0 (P less than 0.05). We conclude that QZ values obtained during EXP or INSP should not be assumed to represent QZ during NB, at least at work rates greater than 50 W. A consequence of the linear relationship between QZ(NB) and Q(RB) over the range of 0-200 W is that estimates of CO2 rebreathing cardiac output can be obtained by impedance cardiography if QZ is adjusted using an appropriate empirical factor.

  15. Rowing increases stroke volume and cardiac output to a greater extent than cycling.

    Science.gov (United States)

    Horn, P; Ostadal, P; Ostadal, B

    2015-01-01

    Exercise stimulates increases in heart rate (HR), stroke volume (SV) and cardiac output (CO). These adaptive mechanisms are strongly dependent on the type of exercise. Both rowing and cycling are widely used for physical training worldwide; however, evidence regarding the differences in major hemodynamic parameters during rowing and cycling remains insufficient. Ten healthy male volunteers were randomly assigned to perform either a rowing or cycling exercise. After 20 min rest, the group who had rowed first performed the cycling exercise and vice versa. Exercise was performed at a power-to-weight ratio of 2 W/kg for 2 min. HR, SV, CO and blood pressure (BP) were measured noninvasively using pulse-wave analysis at baseline and immediately after each exercise. HR, SV and CO were significantly higher after exercise than at rest. Whereas HR was comparable between rowing and cycling, SV and CO were significantly higher after rowing than after cycling. BP was comparable among all three measurements. Rowing increased SV and CO to a greater extent than cycling, whereas HR and BP were not influenced by the type of exercise. Our data suggest that rowing leads to more extensive stimulation of cardiac contractility and/or decreases in peripheral vascular resistance compared with cycling.

  16. Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

    Science.gov (United States)

    Bein, Berthold; Gruenewald, Matthias; Masing, Sarah; Huenges, Katharina; Haneya, Assad; Steinfath, Markus; Renner, Jochen

    2016-01-01

    Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).

  17. Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output

    DEFF Research Database (Denmark)

    Steding-Ehrenborg, Katarina; Boushel, Robert C; Calbet, José A

    2015-01-01

    BACKGROUND: Age-related decline in cardiac function can be prevented or postponed by lifelong endurance training. However, effects of normal ageing as well as of lifelong endurance exercise on longitudinal and radial contribution to stroke volume are unknown. The aim of this study was to determine...... subjects (29 ± 4 years) underwent cardiac MR. All subjects underwent maximal exercise testing and for elderly subjects maximal cardiac output during cycling was determined using dye dilution technique. RESULTS: Longitudinal and radial contribution to stroke volume did not differ between groups...... and exercise capacity. This article is protected by copyright. All rights reserved....

  18. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Energy Technology Data Exchange (ETDEWEB)

    Nillesen, M M; Lopata, R G P; Gerrits, I H; Thijssen, J M; De Korte, C L [Clinical Physics Laboratory-833, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); De Boode, W P [Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Huisman, H J [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kapusta, L [Pediatric Cardiology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)], E-mail: m.m.nillesen@cukz.umcn.nl

    2009-04-07

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  19. Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output.

    Science.gov (United States)

    van Brussel, Peter M; van den Bogaard, Bas; de Weijer, Barbara A; Truijen, Jasper; Krediet, C T Paul; Janssen, Ignace M; van de Laar, Arnold; Kaasjager, Karin; Fliers, Eric; van Lieshout, Johannes J; Serlie, Mireille J; van den Born, Bert-Jan H

    2017-02-01

    Blood pressure (BP) decreases in the first weeks after Roux-and-Y gastric bypass surgery. Yet the pathophysiology of the BP-lowering effects observed after gastric bypass surgery is incompletely understood. We evaluated BP, systemic hemodynamics, and baroreflex sensitivity in 15 obese women[mean age 42 ± 7 standard deviation (SD) yr, body mass index 45 ± 6 kg/m(2)] 2 wk before and 6 wk following Roux-and-Y gastric bypass surgery. Six weeks after gastric bypass surgery, mean body weight decreased by 13 ± 5 kg (10%, P decreased from 137 ± 10/86 ± 6 to 128 ± 12/81 ± 9 mmHg (P decreased from 128 ± 14/80 ± 9 to 114 ± 10/73 ± 6 mmHg (P = 0.01, P = 0.05), whereas nighttime BP decreased from 111 ± 13/66 ± 7 to 102 ± 9/62 ± 7 mmHg (P = 0.04, P decrease in BP was associated with a 1.6 ± 1.2 l/min (20%, P decrease in cardiac output (CO), while systemic vascular resistance increased (153 ± 189 dyn·s·cm(-5), 15%, P decreased (192 mmHg/s, 19%, P = 0.01), suggesting a reduction in left ventricular contractility. Baroreflex sensitivity increased from 9.0 [6.4-14.3] to 13.8 [8.5-19.0] ms/mmHg (median [interquartile range]; P decrease in CO independent of changes in body weight. The contribution of heart rate to the reduction in CO together with enhanced baroreflex sensitivity suggests a shift toward increased parasympathetic cardiovascular control. The reason for the decrease in blood pressure (BP) in the first weeks after gastric bypass surgery remains to be elucidated. We show that the reduction in BP following surgery is caused by a decrease in cardiac output. In addition, the maximal ascending slope in systolic blood pressure decreased suggesting a reduction in left ventricular contractility and cardiac workload. These findings help to understand the physiological changes following gastric bypass surgery and are relevant in light of the increased risk of heart failure in these patients. Copyright © 2017 the American Physiological Society.

  20. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Science.gov (United States)

    Nillesen, M. M.; Lopata, R. G. P.; de Boode, W. P.; Gerrits, I. H.; Huisman, H. J.; Thijssen, J. M.; Kapusta, L.; de Korte, C. L.

    2009-04-01

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  1. Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient.

    LENUS (Irish Health Repository)

    Healy, David G

    2012-02-03

    We have previously demonstrated the role of univentricular pacing modalities in influencing coronary conduit flow in the immediate post-operative period in the cardiac surgery patient. We wanted to determine the mechanism of this improved coronary conduit and, in addition, to explore the possible benefits with biventricular pacing. Sixteen patients undergoing first time elective coronary artery bypass grafting who required pacing following surgery were recruited. Comparison of cardiac output and coronary conduit flow was performed between VVI and DDD pacing with a single right ventricular lead and biventricular pacing lead placement. Cardiac output was measured using arterial pulse waveform analysis while conduit flow was measured using ultrasonic transit time methodology. Cardiac output was greatest with DDD pacing using right ventricular lead placement only [DDD-univentricular 5.42 l (0.7), DDD-biventricular 5.33 l (0.8), VVI-univentricular 4.71 l (0.8), VVI-biventricular 4.68 l (0.6)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.023) and VVI-biventricular pacing (P=0.001) but there was no significant advantage to DDD-biventricular pacing (P=0.45). In relation to coronary conduit flow, DDD pacing again had the highest flow [DDD-univentricular 55 ml\\/min (24), DDD-biventricular 52 ml\\/min (25), VVI-univentricular 47 ml\\/min (23), VVI-biventricular 50 ml\\/min (26)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.006) pacing but not significantly different to VVI-biventricular pacing (P=0.109) or DDD-biventricular pacing (P=0.171). Pacing with a DDD modality offers the optimal coronary conduit flow by maximising cardiac output. Biventricular lead placement offered no significant benefit to coronary conduit flow or cardiac output.

  2. Constructions of vector output Boolean functions with high generalized nonlinearity

    Institute of Scientific and Technical Information of China (English)

    KE Pin-hui; ZHANG Sheng-yuan

    2008-01-01

    Carlet et al. recently introduced generalized nonlinearity to measure the ability to resist the improved correlation attack of a vector output Boolean function. This article presents a construction of vector output Boolean functions with high generalized nonlinearity using the sample space. The relation between the resilient order and generalized nonlinearity is also discussed.

  3. Finger arterial versus intrabrachial pressure and continuous cardiac output during head-up tilt testing in healthy subjects

    NARCIS (Netherlands)

    Jellema, W.T.; Imholz, B.P.M.; Goudoever, J. van; Wesseling, K.H.; Lieshout, J.J. van

    1996-01-01

    1. The aims of this study were to determine the clinical feasibility of continuous, non-invasive Finapres recordings as a replacement for intrabrachial pressure during a 30 min head-up tilt, and the reliability of continuous cardiac output computation by pulse contour analysis from the finger arteri

  4. [Anesthesia management of geriatric patients with arterial pressure-based cardiac output monitoring FloTrac sensor for emergency surgery].

    Science.gov (United States)

    Yamamoto, Shunsuke; Goto, Koji; Yasuda, Norihisa; Kusaka, Junya; Hidaka, Seigo; Miyakawa, Hiroshi; Noguchi, Takayuki

    2009-06-01

    In cases of emergency surgery for geriatric patients, immediate anesthesia induction and careful intraoperative management is necessary without sufficient preoperative information. We report anesthesia management of a 96-year and a 90-year old patients with FloTrac sensor which is an arterial pressure-based cardiac output monitoring device and is able to manage critical patients effectively and safely during anesthesia.

  5. ADRB2 gly16gly Genotype, Cardiac Output, and Cerebral Oxygenation in Patients Undergoing Anesthesia for Abdominal Aortic Aneurysm Surgery

    DEFF Research Database (Denmark)

    Staalso, Jonatan Myrup; Rokamp, Kim Zillo; Olesen, Niels D.

    2016-01-01

    BACKGROUND: Gly16arg polymorphism of the adrenergic [beta]2-receptor is associated with the elevated cardiac output (Q) in healthy gly16-homozygotic subjects. We questioned whether this polymorphism also affects Q and regional cerebral oxygen saturation (SCO2) during anesthesia in vascular surgic...

  6. Use of electroconvulsive therapy in an elderly after 5 weeks of myocardial infraction with 30% cardiac output

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2015-01-01

    Full Text Available There is limited literature on the use of electroconvulsive therapy (ECT in patients with recent myocardial infarction and in those with reduced cardiac output. In this report, we describe the safe use of ECT in a 70-year-male suffering from severe depressive episode with psychotic symptoms. He had a history of poor response to adequate pharmacotherapy and had suffered from myocardial infraction (MI, about 3 weeks prior to admission to the psychiatric unit. In view of severe depression associated with marked anxiety, agitation, psychotic symptoms, and poor food intake he was started on ECT after 5 weeks of MI when his cardiac output was only 30%. He received nine sessions of ECT without any cardiac complications and his depression remitted with ECT.

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

    Science.gov (United States)

    Peyton, P

    2014-05-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

  9. Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output.

    Science.gov (United States)

    Steding-Ehrenborg, Katarina; Boushel, Robert C; Calbet, José A; Åkeson, Per; Mortensen, Stefan P

    2015-12-01

    Age-related decline in cardiac function can be prevented or postponed by lifelong endurance training. However, effects of normal ageing as well as of lifelong endurance exercise on longitudinal and radial contribution to stroke volume are unknown. The aim of this study was to determine resting longitudinal and radial pumping in elderly athletes, sedentary elderly and young sedentary subjects. Furthermore, we aimed to investigate determinants of maximal cardiac output in elderly. Eight elderly athletes (63 ± 4 years), seven elderly sedentary (66 ± 4 years) and ten young sedentary subjects (29 ± 4 years) underwent cardiac magnetic resonance imaging. All subjects underwent maximal exercise testing and for elderly subjects maximal cardiac output during cycling was determined using a dye dilution technique. Longitudinal and radial contribution to stroke volume did not differ between groups (longitudinal left ventricle (LV) 52-65%, P = 0.12, right ventricle (RV) 77-87%, P = 0.16, radial 7.9-8.6%, P = 1.0). Left ventricular atrioventricular plane displacement (LVAVPD) was higher in elderly athletes and young sedentary compared with elderly sedentary subjects (14 ± 3, 15 ± 2 and 11 ± 1 mm, respectively, P cardiac output (R(2) = 0.61, P Longitudinal and radial contributions to stroke volume did not differ between groups. However, how longitudinal pumping was achieved differed; elderly athletes and young sedentary subjects showed similar AVPD whereas this was significantly lower in elderly sedentary subjects. Elderly sedentary subjects achieved longitudinal pumping through increased short-axis area of the ventricle. Large AVPD was a determinant of maximal cardiac output and exercise capacity.

  10. Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures: a prospective observational study.

    Science.gov (United States)

    Schramm, P; Tzanova, I; Hagen, F; Berres, M; Closhen, D; Pestel, G; Engelhard, K

    2016-10-01

    Neurosurgical operations in the dorsal cranium often require the patient to be positioned in a sitting position. This can be associated with decreased cardiac output and cerebral hypoperfusion, and possibly, inadequate cerebral oxygenation. In the present study, cerebral oxygen saturation was measured during neurosurgery in the sitting position and correlated with cardiac output. Perioperative cerebral oxygen saturation was measured continuously with two different monitors, INVOS(®) and FORE-SIGHT(®). Cardiac output was measured at eight predefined time points using transoesophageal echocardiography. Forty patients were enrolled, but only 35 (20 female) were eventually operated on in the sitting position. At the first time point, the regional cerebral oxygen saturation measured with INVOS(®) was 70 (sd 9)%; thereafter, it increased by 0.0187% min(-1) (P<0.01). The cerebral tissue oxygen saturation measured with FORE-SIGHT(®) started at 68 (sd 13)% and increased by 0.0142% min(-1) (P<0.01). The mean arterial blood pressure did not change. Cardiac output was between 6.3 (sd 1.3) and 7.2 (1.8) litre min(-1) at the predefined time points. Cardiac output, but not mean arterial blood pressure, showed a positive and significant correlation with cerebral oxygen saturation. During neurosurgery in the sitting position, the cerebral oxygen saturation slowly increases and, therefore, this position seems to be safe with regard to cerebral oxygen saturation. Cerebral oxygen saturation is stable because of constant CO and MAP, while the influence of CO on cerebral oxygen saturation seems to be more relevant. NCT01275898. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Noninvasive assessment of cardiac output from arterial pressure profiles during exercise.

    Science.gov (United States)

    Antonutto, G; Girardis, M; Tuniz, D; di Prampero, P E

    1995-01-01

    , MAPin, HR, PP, MAP are the above parameters at rest and during exercise, respectively. Also in this case, the coefficients f to 1 were determined by a computerized statistical method using Z* as the experimental reference. The values of Zcor so obtained allowed us to calculate SV from arterial pulse contour analysis as SVF = As.Z-1cor. The mean percentage error between the SVF obtained and the values simultaneously determined by PDE, was 10.0 (SD 8.7)%. It is concluded that the SV of the left ventricle, and hence cardiac output, can be determined during exercise from photoplethysmograph tracings with reasonable accuracy, provided that an initial estimate of SV at rest is made by means an independent high quality reference method.

  12. Estimation of cardiac output and peripheral resistance using square-wave-approximated aortic flow signal

    Directory of Open Access Journals (Sweden)

    Nima eFazeli

    2012-07-01

    Full Text Available This paper presents a model-based approach to estimation of cardiac output (CO and total peripheral resistance (TPR. In the proposed approach, the response of cardiovascular system (CVS, described by the windkessel model, is tuned to the measurements of systolic, diastolic and mean arterial blood pressures (BP so as to yield optimal individual- and time-specific system time constant that is used to estimate CO and TPR. Unique aspects of the proposed approach are that it approximates the aortic flow as a train of square waves, and that it also assumes pressure-dependent arterial compliance, as opposed to the traditional windkessel model in which aortic flow is approximated as a train of impulses and constant arterial compliance is assumed. It was shown that the proposed model encompasses the standard windkessel model as a limiting case, and that it also yields more realistic BP waveform response than the standard windkessel model. The proposed approach has potential to outperform its standard counterpart by treating systolic, diastolic and mean BP as independent features in estimating CO and TPR, rather than solely resorting to pulse pressure as in the case of the standard windkessel model. Experimental results from in-vivo data collected from a number of animal subjects supports the viability of the proposed approach in that it could achieve approximately 29% and 24% reduction in CO and TPR errors when compared with its standard counterpart.

  13. Resistance reconstructed estimation of total peripheral resistance from computationally derived cardiac output - biomed 2013.

    Science.gov (United States)

    Hill, Labarron K; Sollers Iii, John J; Thayer, Julian F

    2013-01-01

    Efficient functioning of the peripheral vasculature is an essential component in healthy cardiovascular regulation. Alterations in this functioning have been linked to the etiology and pathophysiological course of cardiovascular disease (CVD), especially hypertension. Given its significant role in the maintenance of both healthy and pathological blood pressure, total peripheral resistance (TPR), an index of the vasoconstrictive and elastic properties of the peripheral vasculature, has received much attention in this regard. However, obtaining a reliable estimate of TPR remains a complex and costly endeavor, primarily due to the necessity for sophisticated instrumentation as well as associated limitations in deriving cardiac output (CO). We have previously described a simple estimation method for CO using only arterial blood pressure and heart rate (Hill et al, 2012). In the present study we extend this technique to the estimation of TPR using beat-to-beat blood pressure data from the same sample of 67 young (mean age = 20.04± 2.8), healthy men (n = 30) and women (n = 37). Estimated TPR (TPRest) was calculated from the computationally-derived estimate of CO and mean arterial pressure (MAP). Correlation between TPR obtained via the validated Model-Flow technique and TPRest was moderate (r =.73, p <. 000) and stronger in men (r =.78, p <. 000) compared to women (r =.66, p <. 001). These data further suggest that reconstructed measures of hemodynamic functioning may be validly and adequately estimated from limited data sources.

  14. Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease.

    Science.gov (United States)

    Weaver, Donald J; Kimball, Thomas R; Koury, Phillip R; Mitsnefes, Mark M

    2009-03-01

    A significant number of children with chronic kidney disease (CKD) have eccentric left ventricular hypertrophy (LVH), suggesting the role of preload overload. Therefore, we hypothesized that increased cardiac output (CO) might be a contributing factor for increased left ventricular mass index (LVMI) in these children. Patients aged 6-20 years with CKD stages 2-4 were enrolled. Echocardiograms were performed to assess LV function and geometry at rest and during exercise. Heart rate, stroke volume, and CO were also assessed at rest and during exercise. Twenty-four-hour ambulatory blood pressure (AMBP) monitoring was performed. Of the patients enrolled in this study, 17% had LVH. Increased stroke volume and CO were observed in patients with LVH compared to patients without LVH. Univariate analysis revealed significant positive associations between LVMI and CO, stroke volume, body mass index, pulse pressure from mean 24-h AMBP, and mean 24-h systolic BP load. No association with heart rate, age, parathyroid hormone, glomerular filtration rate, or anemia was observed. Only CO (beta = 1.98, p = 0.0005) was independently associated with increased LVMI in multivariate modeling (model R (2) = 0.25). The results of this study suggest that increased CO might predispose to increased LVMI in pediatric patients with CKD. Adaptations may be required to meet increased metabolic demand in these patients.

  15. Kinetics of Cardiac Output at the Onset of Exercise in Precapillary Pulmonary Hypertension

    Science.gov (United States)

    Bengueddache, Samir; Ferretti, Guido; Soccal, Paola M.; Noble, Stéphane; Beghetti, Maurice; Chemla, Denis; Hervé, Philippe; Sitbon, Olivier

    2016-01-01

    Purpose. Cardiac output (CO) is a cornerstone parameter in precapillary pulmonary hypertension (PH). The Modelflow (MF) method offers a reliable noninvasive determination of its beat-by-beat changes. So MF allows exploration of CO adjustment with the best temporal resolution. Methods. Fifteen subjects (5 PH patients, 10 healthy controls) performed a submaximal supine exercise on a cycle ergometer after 5 min of rest. CO was continuously determined by MF (COMF). Kinetics of heart rate (HR), stroke volume (SV), and CO were determined with 3 monoexponential models. Results. In PH patients, we observed a sudden and transitory drop of SV upon exercise onset. This implied a transitory drop of CO whose adjustment to a new steady state depended on HR increase. The kinetics of HR and CO for PH patients was slower than that of controls for all models and for SV in model 1. SV kinetics was faster for PH patients in models 2 and 3. Conclusion. This is the first description of beat-by-beat cardiovascular adjustments upon exercise onset in PH. The kinetics of HR and CO appeared slower than those of healthy controls and there was a transitory drop of CO upon exercise onset in PH due to a sudden drop of SV. PMID:27990432

  16. Kinetics of Cardiac Output at the Onset of Exercise in Precapillary Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Frédéric Lador

    2016-01-01

    Full Text Available Purpose. Cardiac output (CO is a cornerstone parameter in precapillary pulmonary hypertension (PH. The Modelflow (MF method offers a reliable noninvasive determination of its beat-by-beat changes. So MF allows exploration of CO adjustment with the best temporal resolution. Methods. Fifteen subjects (5 PH patients, 10 healthy controls performed a submaximal supine exercise on a cycle ergometer after 5 min of rest. CO was continuously determined by MF (COMF. Kinetics of heart rate (HR, stroke volume (SV, and CO were determined with 3 monoexponential models. Results. In PH patients, we observed a sudden and transitory drop of SV upon exercise onset. This implied a transitory drop of CO whose adjustment to a new steady state depended on HR increase. The kinetics of HR and CO for PH patients was slower than that of controls for all models and for SV in model 1. SV kinetics was faster for PH patients in models 2 and 3. Conclusion. This is the first description of beat-by-beat cardiovascular adjustments upon exercise onset in PH. The kinetics of HR and CO appeared slower than those of healthy controls and there was a transitory drop of CO upon exercise onset in PH due to a sudden drop of SV.

  17. A computational model-based validation of Guyton's analysis of cardiac output and venous return curves

    Science.gov (United States)

    Mukkamala, R.; Cohen, R. J.; Mark, R. G.

    2002-01-01

    Guyton developed a popular approach for understanding the factors responsible for cardiac output (CO) regulation in which 1) the heart-lung unit and systemic circulation are independently characterized via CO and venous return (VR) curves, and 2) average CO and right atrial pressure (RAP) of the intact circulation are predicted by graphically intersecting the curves. However, this approach is virtually impossible to verify experimentally. We theoretically evaluated the approach with respect to a nonlinear, computational model of the pulsatile heart and circulation. We developed two sets of open circulation models to generate CO and VR curves, differing by the manner in which average RAP was varied. One set applied constant RAPs, while the other set applied pulsatile RAPs. Accurate prediction of intact, average CO and RAP was achieved only by intersecting the CO and VR curves generated with pulsatile RAPs because of the pulsatility and nonlinearity (e.g., systemic venous collapse) of the intact model. The CO and VR curves generated with pulsatile RAPs were also practically independent. This theoretical study therefore supports the validity of Guyton's graphical analysis.

  18. A computational model-based validation of Guyton's analysis of cardiac output and venous return curves

    Science.gov (United States)

    Mukkamala, R.; Cohen, R. J.; Mark, R. G.

    2002-01-01

    Guyton developed a popular approach for understanding the factors responsible for cardiac output (CO) regulation in which 1) the heart-lung unit and systemic circulation are independently characterized via CO and venous return (VR) curves, and 2) average CO and right atrial pressure (RAP) of the intact circulation are predicted by graphically intersecting the curves. However, this approach is virtually impossible to verify experimentally. We theoretically evaluated the approach with respect to a nonlinear, computational model of the pulsatile heart and circulation. We developed two sets of open circulation models to generate CO and VR curves, differing by the manner in which average RAP was varied. One set applied constant RAPs, while the other set applied pulsatile RAPs. Accurate prediction of intact, average CO and RAP was achieved only by intersecting the CO and VR curves generated with pulsatile RAPs because of the pulsatility and nonlinearity (e.g., systemic venous collapse) of the intact model. The CO and VR curves generated with pulsatile RAPs were also practically independent. This theoretical study therefore supports the validity of Guyton's graphical analysis.

  19. Dynamic vs. fixed bag filling: impact on cardiac output rebreathing protocol.

    Science.gov (United States)

    Zavorsky, Gerald S; Beck, Kenneth C; Cass, Lauren M; Artal, Raul; Wagner, Peter D

    2010-04-15

    The purpose of this study was to compare the repeatability (2.77 multiplied by the within-subject SD)between two different rebreathing protocols on cardiac output ( ˙Q ), pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), and pulmonary capillary blood volume (Vc). This study compared two bag volume protocols [Fixed Bag Volume (FBV) = bag volume fixed at 60% of forced vital capacity; Dynamic Bag Volume (DBV) = bag volume matched to tidal volume at each stage of exercise].Ten females (age = 27±8 yrs; ˙VO2, (peak)=2.5±0.6 L/min had measurements at rest (12%), 52%, 88%, and 100% of ˙VO2, (peak) on two study days. Neither the slope nor intercept of ˙Q vs. ˙VO2 were different between either bag volume protocols. The slope of DLCO vs. ˙Q was the same but the intercept was higher for the FBV protocol. The bag volume affected the slope and the intercept between DLNO vs. ˙Q (p DLNO (p ≤ 0.06). Measurement error was lower for Vc when using the FBV protocol (p = 0.02). Also, the pattern of bag volume used during rebreathing maneuvers affected the relation between DLNO vs. ˙Q more than it affected DLCO vs. ˙Q , or Vc vs. ˙Q. Additionally, the FBV protocol provided less measurement error for Vc compared to the DBV protocol [corrected].

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

    Directory of Open Access Journals (Sweden)

    Sophia Horster

    2012-01-01

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

  1. Authentication of Radial Versus Femoral Arterial Pressure Waveform-Derived Cardiac Output With Transesophageal Echocardiography-Derived Cardiac Output Measurements in Patients Undergoing On-Pump Coronary Bypass Surgery.

    Science.gov (United States)

    Maddali, Madan Mohan; Waje, Niranjan Dilip; Sathiya, Panchatcharam Murthi

    2017-08-01

    The aim of this study was to ascertain if arterial waveform-derived cardiac output measurements from radial and femoral cannulation sites were reliable as compared with transesophageal echocardiography (TEE)-derived cardiac output (CO) values, and which of the CO measurements derived from radial and the femoral arterial pressure waveforms closely tracked simultaneously measured TEE-derived CO values. This study also aimed to ascertain if cardiopulmonary bypass (CPB) would impact the accuracy of arterial pressure-derived CO values from either of the 2 sites. A prospective observational study. Tertiary care cardiac center. Cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery. Waveform-derived CO monitoring through radial and femoral artery cannulation using a FloTrac/Vigileo system. Twenty-seven consecutive cardiac surgical patients undergoing on-pump primary coronary artery bypass surgery were included in the study. Cardiac output was measured sequentially by the arterial pressure waveform analysis method from radial and femoral arterial sites and compared with simultaneously measured TEE-derived CO. Cardiac output data were obtained in triplicate at 6 predefined time intervals: before and after sternotomy, 5, 15, and 30 minutes after separation from CPB and prior to shifting the patient out of the operating room. The overall bias of the study was 0.11 and 0.27, the percentage error was 19.31 and 18.45, respectively, for radial and femoral arterial waveform-derived CO values as compared with TEE-derived CO measurements. The overall precision as compared with the TEE-derived CO values was 16.94 and 15.95 for the radial and femoral cannulation sites, respectively. The bias calculated by the Bland-Altman method suggested that CO measurements from the radial arterial site were in closer agreement with TEE-derived CO values at all time periods, and the relation was not affected by CPB. However, percentage error and precision calculations

  2. Adrenomedullin-epinephrine cotreatment enhances cardiac output and left ventricular function by energetically neutral mechanisms.

    Science.gov (United States)

    Stenberg, Thor Allan; Kildal, Anders Benjamin; How, Ole-Jakob; Myrmel, Truls

    2012-04-15

    Adrenomedullin (AM) used therapeutically reduces mortality in the acute phase of experimental myocardial infarction. However, AM is potentially deleterious in acute heart failure as it is vasodilative and inotropically neutral. AM and epinephrine (EPI) are cosecreted from chromaffin cells, indicating a physiological interaction. We assessed the hemodynamic and energetic profile of AM-EPI cotreatment, exploring whether drug interaction improves cardiac function. Left ventricular (LV) mechanoenergetics were evaluated in 14 open-chest pigs using pressure-volume analysis and the pressure-volume area-myocardial O(2) consumption (PVA-MVo(2)) framework. AM (15 ng·kg(-1)·min(-1), n = 8) or saline (controls, n = 6) was infused for 120 min. Subsequently, a concurrent infusion of EPI (50 ng·kg(-1)·min(-1)) was added in both groups (AM-EPI vs. EPI). AM increased cardiac output (CO) and coronary blood flow by 20 ± 10% and 39 ± 14% (means ± SD, P < 0.05 vs. baseline), whereas controls were unaffected. AM-EPI increased CO and coronary blood flow by 55 ± 17% and 75 ± 16% (P < 0.05, AM-EPI interaction) compared with 13 ± 12% (P < 0.05 vs. baseline) and 18 ± 31% (P = not significant) with EPI. LV systolic capacitance decreased by -37 ± 22% and peak positive derivative of LV pressure (dP/dt(max)) increased by 32 ± 7% with AM-EPI (P < 0.05, AM-EPI interaction), whereas no significant effects were observed with EPI. Mean arterial pressure was maintained by AM-EPI and tended to decrease with EPI (+2 ± 13% vs. -11 ± 10%, P = not significant). PVA-MVo(2) relationships were unaffected by all treatments. In conclusion, AM-EPI cotreatment has an inodilator profile with CO and LV function augmented beyond individual drug effects and is not associated with relative increases in energetic cost. This can possibly take the inodilator treatment strategy beyond hemodynamic goals and exploit the cardioprotective effects of AM in acute heart failure.

  3. Low Cardiac Output Leads Hepatic Fibrosis in Right Heart Failure Model Rats.

    Directory of Open Access Journals (Sweden)

    Yoshitaka Fujimoto

    Full Text Available Hepatic fibrosis progresses with right heart failure, and becomes cardiac cirrhosis in a severe case. Although its causal factor still remains unclear. Here we evaluated the progression of hepatic fibrosis using a pulmonary artery banding (PAB-induced right heart failure model and investigated whether cardiac output (CO is responsible for the progression of hepatic fibrosis.Five-week-old Sprague-Dawley rats divided into the PAB and sham-operated control groups. After 4 weeks from operation, we measured CO by echocardiography, and hepatic fibrosis ratio by pathological examination using a color analyzer. In the PAB group, CO was significantly lower by 48% than that in the control group (78.2±27.6 and 150.1±31.2 ml/min, P<0.01. Hepatic fibrosis ratio and serum hyaluronic acid, an index of hepatic fibrosis, were significantly increased in the PAB group than those in the control group (7.8±1.7 and 1.0±0.2%, P<0.01, 76.2±27.5 and 32.7±7.5 ng/ml, P<0.01. Notably, the degree of hepatic fibrosis significantly correlated a decrease in CO. Immunohistological analysis revealed that hepatic stellate cells were markedly activated in hypoxic areas, and HIF-1α positive hepatic cells were increased in the PAB group. Furthermore, by real-time PCR analyses, transcripts of profibrotic and fibrotic factors (TGF-β1, CTGF, procollargen I, procollargen III, MMP 2, MMP 9, TIMP 1, TIMP 2 were significantly increased in the PAB group. In addition, western blot analyses revealed that the protein level of HIF-1α was significantly increased in the PAB group than that in the control group (2.31±0.84 and 1.0±0.18 arbitrary units, P<0.05.Our study demonstrated that low CO and tissue hypoxia were responsible for hepatic fibrosis in right failure heart model rats.

  4. Nutritional and fluid requirements: high-output stomas.

    Science.gov (United States)

    Medlin, Sophie

    Based on the current available evidence, this article explores the nutritional management of those with a high-output stoma. The main alterations required to the intake of patients with a high-output stoma include the use of an oral rehydration solution to ensure optimum absorption of fluid and sodium, and a high-calorie, high-protein diet, with the aim of optimizing nutritional status. Diet advice should be delivered by a dietitian with experience in managing these complex patients. Monitoring of electrolytes and micronutrients is essential, and long-term follow up from a multidisciplinary nutrition support team is invaluable in coordinating this. Patients with high-output stomas can enjoy good quality of life and long-term health if their condition is managed effectively by a well-organized multidisciplinary team.

  5. Orchestrating the management of patients with high-output stomas.

    Science.gov (United States)

    McDonald, Alison

    Working in isolation, managing high-output stomas can be stressful and difficult, with patient outcomes varying significantly. For the stoma care clinical nurse specialist, managing the choice of stoma appliance is only a small part of the care provided. To standardise and improve outcomes for patients with high-output stomas, team working is required. After contacting other stoma care services and using guidance from the High Impact Actions for Stoma Care document ( Coloplast, 2010 ), it was evident that the team should put together an algorithm/flow chart to guide both specialists and ward nursing staff in the evidence-based and standardised management of patients with high-output stomas. This article presents the flowchart that was produced and uses case studies to demonstrate improvements.

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

    Directory of Open Access Journals (Sweden)

    Sabzi Feridoun

    2015-03-01

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

  7. [Echocardiographic evaluation of cardiac output in patients with acute myocardial infarction (author's transl)].

    Science.gov (United States)

    Nador, F; De Martini, M; Binda, A; Salmaso, G C; Radrizzani, D; Lotto, A

    1980-01-01

    Echocardiography is a non invasive technique particularly useful to assess both hemodynamics and left ventricular performances; different methods have been proposed to evaluate echocardiographically the cardiac output. The aim of this work is to suggest a new method (planimetry of the area enclosed by echoes from the mitral valve) stating its advantages and limits and to test three already known methods (cubes method, method of Lalani and Lee, method of Rasmussen and coll.) comparing them to thermodilution. In 24 patients admitted in our Coronary Care Unit for acute myocardial infarction 30 measurements have been performed simultaneously with echocardiography and thermodilution. Statistical analysis (correlation coefficient with the method of the square minimums and Student's 't') of the results has shown that the cubes method is unprecise (P = NS) and unbiased (d = 0.97 +/- 15.46); Lalani-Lee method is unprecise (P = NS) and biased (d = 9.64 +/- 21.36) by a systematic underestimate error concealed by the poor precision; Rasmussen and coll. method is precise (P < 0.01) but biased (d = --3.03 +/- 5.5), the systematic mistake being entirely due to the group of patients with abnormal hemodynamics. Our method is precise (P < 0.01) and unbiased (d = --0.04 +/- 9.62) in patients both with normal and abnormal hemodynamics. Therefore this method offers the following advantages: 1) it is unbiased, even in the presence of abnormal left ventricular performance; 2) it is sufficiently precise, having a correlation coefficient with thermodilution of r = 0.80; 3) it measures directly the amount of flow due to the atrial systole; 4) the measurement is rapid and hardly biased by the reader.

  8. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output

    DEFF Research Database (Denmark)

    Smerup, Morten Holdgaard; Damkjær, Mads; Brøndum, Emil

    2016-01-01

    to calculate left ventricular wall stress. Cardiac output was also determined by inert gas rebreathing to provide an additional and independent estimate of stroke volume. Echocardiography and inert gas-rebreathing yielded similar cardiac outputs of 16.1±2.5 and 16.4±1.4 l min(-1), respectively. End......-diastolic and end-systolic volumes were 521±61 ml and 228±42 ml, respectively, yielding an ejection fraction of 56±4% and a stroke volume of 0.59 ml kg(-1). Left ventricular circumferential wall stress was 7.83±1.76 kPa. We conclude that, relative to body mass, a small left ventricular cavity and a low stroke...

  9. Quantum dot amplifiers with high output power and low noise

    DEFF Research Database (Denmark)

    Berg, Tommy Winther; Mørk, Jesper

    2003-01-01

    Quantum dot semiconductor optical amplifiers have been theoretically investigated and are predicted to achieve high saturated output power, large gain, and low noise figure. We discuss the device dynamics and, in particular, show that the presence of highly inverted barrier states does not limit ...

  10. Non-invasive measurement of cardiac output in heart failure patients using a new foreign gas rebreathing technique.

    Science.gov (United States)

    Gabrielsen, Anders; Videbaek, Regitze; Schou, Morten; Damgaard, Morten; Kastrup, Jens; Norsk, Peter

    2002-02-01

    Values of effective pulmonary blood flow (Q(EP)) and cardiac output, determined by a non-invasive foreign gas rebreathing method (CO(RB)) using a new infrared photoacoustic gas analysing system, were compared with measurements of cardiac output obtained by the direct Fick (CO(FICK)) and thermodilution (CO(TD)) methods in patients with heart failure or pulmonary hypertension. In 11 patients, of which three had shunt flow through areas without significant gas exchange, the mean difference (bias) and limits of agreement (+/- 2 S.D.) were 0.6 +/- 1.2 litre x min(-1) when comparing CO(FICK) and Q(EP), and -0.8 +/- 1.3 litre x min(-1) when comparing CO(FICK) and CO(TD). When correction for intrapulmonary shunt flow was applied (i.e. calculation of CO(RB)) in all 11 patients, the bias between CO(FICK) and CO(RB) was 0.1 +/- 0.9 litre x min(-1), primarily because agreement improved in the three patients with significant shunt flow. In the eight patients without significant shunt flow, the agreement between Q(EP) and CO(FICK) was 0.3 +/- 0.9 litre x min(-1). In conclusion, a foreign gas rebreathing method with a new infrared photoacoustic gas analyser provided at least as reliable a measure of cardiac output as did thermodilution. In the absence of significant shunt flow, measurement of Q(EP) itself provides a reliable estimate of cardiac output in heart failure patients. The infrared photoacoustic gas analyser markedly facilitates clinical use of the rebreathing method in general, which makes the method available to a larger group of clinicians working with patients with cardiovascular diseases.

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

    OpenAIRE

    William R Henderson; Griesdale, Donald EG; Walley, Keith R; Sheel, A. William

    2010-01-01

    Arthur Guyton's concepts of the determinative role of right heart filling in cardiac output continue to be controversial. This paper reviews his seminal experiments in detail and clarifies the often confusing concepts underpinning his model. One primary criticism of Guyton's model is that the parameters describing venous return had not been measured in a functioning cardiovascular system in humans. Thus, concerns have been expressed in regard to the ability of Guyton's simplistic model, with ...

  12. Combined use of phenoxybenzamine and dopamine for low cardiac output syndrome in children at withdrawal from cardiopulmonary bypass.

    OpenAIRE

    Kawamura, M.; Minamikawa, O; Yokochi, H; Maki, S.; Yasuda, T.; Mizukawa, Y

    1980-01-01

    The combined use of phenoxybenzamine and dopamine was applied in infants and children when it was difficult to come off cardiopulmonary bypass for low cardiac output. The rationale of this method is to prevent the alpha-adrenergic action of dopamine by phenoxybenzamine and to encourage the beta-adrenergic and direct specific action of dopamine. Dopamine was used in dosage of 10 to 30 micrograms/kg per min after the additional administration of a half of the initial dosage of phenoxybenzamine;...

  13. Signal processing technique for non-invasive real-time estimation of cardiac output by inductance cardiography (thoracocardiography).

    Science.gov (United States)

    Bucklar, G B; Kaplan, V; Bloch, K E

    2003-05-01

    Inductance cardiography (thoracocardiography) non-invasively monitors changes in stroke volume by recording ventricular volume curves with an inductive plethysmographic transducer encircling the chest at the level of the heart. Clinical application of this method has been hampered, as data analysis has not been feasible in real time. Therefore a novel, real-time signal processing technique for inductance cardiography has been developed. Its essential concept consists in performance of multiple tasks by several, logically linked signal processing modules that have access to common databases. Based on these principles, a software application was designed that performs acquisition, display, filtering and ECG-triggered ensemble averaging of inductance signals and separates cardiogenic waveforms from noise related to respiration and other sources. The resulting ventricular volume curves are automatically analysed. Performance of the technique for monitoring cardiac output in real time was compared with thermodilution in four patients in an intensive care unit. The bias (mean difference) among 76 paired thoracocardiographic and thermodilution derived changes in cardiac output was 0%; limits of agreement (+/- 2 SD of the bias) were +/- 25%. It is concluded that the proposed signal processing technique for inductance cardiography holds promise for non-invasive, real-time estimation of changes in cardiac output.

  14. GaN Nanowire Arrays for High-Output Nanogenerators

    KAUST Repository

    Huang, Chi-Te

    2010-04-07

    Three-fold symmetrically distributed GaN nanowire (NW) arrays have been epitaxially grown on GaN/sapphire substrates. The GaN NW possesses a triangular cross section enclosed by (0001), (2112), and (2112) planes, and the angle between the GaN NW and the substrate surface is ∼62°. The GaN NW arrays produce negative output voltage pulses when scanned by a conductive atomic force microscope in contact mode. The average of piezoelectric output voltage was about -20 mV, while 5-10% of the NWs had piezoelectric output voltages exceeding -(0.15-0.35) V. The GaN NW arrays are highly stable and highly tolerate to moisture in the atmosphere. The GaN NW arrays demonstrate an outstanding potential to be utilized for piezoelectric energy generation with a performance probably better than that of ZnO NWs. © 2010 American Chemical Society.

  15. A high energy output nanogenerator based on reduced graphene oxide

    Science.gov (United States)

    Li, Weiping; Zhang, Yupeng; Liu, Liangliang; Li, Delong; Liao, Lei; Pan, Chunxu

    2015-10-01

    In this paper, we report a novel graphene-based nanogenerator for high energy harvesting. Experimental and theoretical results revealed that the energy output mechanism is the joint action of the strain effect (band engineering) and the triboelectric effect of reduced graphene oxide. It was found that the current could be adjusted by experimental parameters, such as the electrolyte concentration and rotation rate. Furthermore, the voltage output could be amplified by series connection of the system. Compared with other nanogenerators, the present graphene-based nanogenerator provides advantages, such as simple assembly, flexibility and high structural stability. It is expected that this nanogenerator will be of potential application in active sensors and sustainable power sources.In this paper, we report a novel graphene-based nanogenerator for high energy harvesting. Experimental and theoretical results revealed that the energy output mechanism is the joint action of the strain effect (band engineering) and the triboelectric effect of reduced graphene oxide. It was found that the current could be adjusted by experimental parameters, such as the electrolyte concentration and rotation rate. Furthermore, the voltage output could be amplified by series connection of the system. Compared with other nanogenerators, the present graphene-based nanogenerator provides advantages, such as simple assembly, flexibility and high structural stability. It is expected that this nanogenerator will be of potential application in active sensors and sustainable power sources. Electronic supplementary information (ESI) available. See DOI: 10.1039/c5nr04971g

  16. High output paraffin actuators: Utilization in aerospace mechanisms

    Science.gov (United States)

    Tibbitts, Scott

    1988-01-01

    High Output Paraffin (HOP) thermal actuators were developed to provide an alternative to conventional aerospace actuators: HOP actuators directly convert temperature changes to useful mechanical work. When fabricated with internal resistance heating elements, they provide an electric linear motor. For applications in which slower response times are acceptable or preferred, HOP actuators have distinct advantages over conventional approaches.

  17. Possibilities and constraints for grazing in high output dairy systems

    NARCIS (Netherlands)

    Hennessy, D.; Delaby, L.; Pol, van den A.; Shalloo, L.

    2015-01-01

    In temperate and oceanic regions, grazed grass is the lowest cost feed available for milk production. In
    other regions, grazed grass is less important but can contribute to the diet of livestock. Within high output
    systems the interaction between the animal and sward is challenging for a

  18. Non-Invasive Determination of Cardiac Output in Pre-Capillary Pulmonary Hypertension.

    Directory of Open Access Journals (Sweden)

    Frédéric Lador

    Full Text Available Cardiac output (CO is a major diagnostic and prognostic factor in pre-capillary pulmonary hypertension (PH. Reference methods for CO determination, like thermodilution (TD, require invasive procedures and allow only steady-state measurements. The Modelflow (MF method is an appealing technique for this purpose as it allows non-invasive and beat-by-beat determination of CO.We aimed to compare CO values obtained simultaneously from non-invasive pulse wave analysis by MF (COMF and by TD (COTD to determine its precision and accuracy in pre-capillary PH. The study was performed on 50 patients with pulmonary arterial hypertension (PAH or chronic thrombo-embolic PH (CTEPH. CO was determined at rest in all patients (n = 50 and during nitric oxide vasoreactivity test, fluid challenge or exercise (n = 48.Baseline COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. Limits of agreement (LoA ranged from -1.32 to 2.76 L·min-1. Percentage error (PE was ±35.7%. Overall sensitivity and specificity of COMF for directional change were 95.2% and 82.4%, (n = 48 and 93.3% and 100% for directional changes during exercise (n = 16, respectively. After application of a correction factor (1.17 ± 0.25, neither proportional nor fixed bias was found for subsequent CO determination (n = 48. Accuracy was -0.03 L·min-1 and precision 0.61 L·min-1. LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

  19. Effect of hemorrhage on cardiac output, vasopressin, aldosterone, and diuresis during immersion in men

    Science.gov (United States)

    Greenleaf, J. E.; Simanonok, K.; Bernauer, E. M.; Wade, C. E.; Keil, L. C.

    1992-01-01

    The purpose of this research was to test the hypotesis that a reduction in blood volume would attenuate or eliminate immersion-induced increases in cardiac output (Q(sub co)) and urine excretion, and to investigate accompanying vasoactive and fluid-electrolyte hormonal responses. Eight men (19-23 yr) were supine during a 2-hr control period in air, and then sat for 5-hr test periods in air at 20 C (dry control, DC); water at 34.5 C (wet control, WC); and water (34.5 C) after hemorrhage (WH) of 14.8 plus or minus 0.3 percent of their blood volume. Blood volume was -11.6 plus or minus 0.6 percent at immersion (time 0). Mean (bar-X hrs 1-5) Q(sub co) was unchanged in WC (5.3 plus or minus 0.01 l/min) and in WH (4.5 plus or minus 0.1 l/min), but decreased (P less than 0.05) in DC to 3.6 plus or minus 0.1 l/min. Mean urine excretion rates were 1.0 plus or minus 0.2 ml/min for DC and 1.1 plus or minus 0.2 ml/min for WH; both were lower (P less than 0.05) than that for WC of 2.0 plus or minus 0.4 ml/min. Plasma (Na+) and (Osm) were unchanged in all experiments. Mean plasma vasopressin (PVP) (bar-X hrs 1-5) was 1.1 plus or minus 0.1 pg/ml in WC, and higher (P less than 0.05) in DC (2.1 plus or minus 0.2 pg/ml)and WH (2.1 plus or minus 0.1 pg/ml); it was unchanged during air and water test periods. Thus, hemorrhage attenuated the immersion-induced increase in Q(sub co), eliminated the WC diuresis, maintained plasma renin activity and PVP at DC levels and did not change immersion-induced aldosterone suppression; the osmotic diuresis during control immersion is apparently not due to either aldosterone suppression or vasopressin suppression.

  20. Estimation of cardiac output in patients with congestive heart failure by analysis of right ventricular pressure waveforms

    Directory of Open Access Journals (Sweden)

    Linde Cecilia

    2011-05-01

    Full Text Available Abstract Background Cardiac output (CO is an important determinant of the hemodynamic state in patients with congestive heart failure (CHF. We tested the hypothesis that CO can be estimated from the right ventricular (RV pressure waveform in CHF patients using a pulse contour cardiac output algorithm that considers constant but patient specific RV outflow tract characteristic impedance. Method In 12 patients with CHF, breath-by-breath Fick CO and RV pressure waveforms were recorded utilizing an implantable hemodynamic monitor during a bicycle exercise protocol. These data were analyzed retrospectively to assess changes in characteristic impedance of the RV outflow tract during exercise. Four patients that were implanted with an implantable cardiac defibrillator (ICD implementing the algorithm were studied prospectively. During a two staged sub-maximal bicycle exercise test conducted at 4 and 16 weeks of implant, COs measured by direct Fick technique and estimated by the ICD were recorded and compared. Results At rest the total pulmonary arterial resistance and the characteristic impedance were 675 ± 345 and 48 ± 18 dyn.s.cm-5, respectively. During sub-maximal exercise, the total pulmonary arterial resistance decreased (Δ 91 ± 159 dyn.s.cm-5, p -5, NS. The algorithm derived cardiac output estimates correlated with Fick CO (7.6 ± 2.5 L/min, R2 = 0.92 with a limit of agreement of 1.7 L/min and tracked changes in Fick CO (R2 = 0.73. Conclusions The analysis of right ventricular pressure waveforms continuously recorded by an implantable hemodynamic monitor provides an estimate of CO and may prove useful in guiding treatment in patients with CHF.

  1. High Output LED-Based Profile Lighting Fixture

    DEFF Research Database (Denmark)

    Török, Lajos; Beczkowski, Szymon; Munk-Nielsen, Stig

    2011-01-01

    Recent developments in power light emitting diode (LED) industry have made LEDs suitable for being efficiently used in high intensity lighting fixtures instead of the commonly used high intensity discharge (HID) lamps. A high output LEDbased profile-light fixture is presented in this paper....... The system consists of a power supply with power factor correction (PFC), a LED-driver and an optical system designed for an overall high efficiency. An interleaved boost converter was chosen as PFC converter. A soft switching phase-shifted full-bridge converter with current doubler provides isolation from...... the grid and delivers the required voltage to the LEDdriver which is a dual interleaved buck converter. Twelve highpower CBT-90 LEDs have been connected in a 4xRGBconfiguration to deliver high output of saturated colors without the need for subtractive color filters. More than 6000 lm of fixture light...

  2. Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.

    Science.gov (United States)

    Hummel, Johanna; Rücker, Gerta; Stiller, Brigitte

    2017-08-02

    summarise the results and the quality of evidence for each outcome. We included five randomised controlled trials with a total of 212 participants in the analyses. All included participants were under five years of age. Using GRADE, we assessed there was low-quality evidence for all analysed outcomes. We assessed high risk of performance and detection bias for two studies due to their unblinded setting. Levosimendan showed no clear effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants = 83; studies = 2) compared to standard treatments. Data on time-to-death were not available from any of the included studies.There was no conclusive evidence on the effect of levosimendan on the secondary outcomes. The length of intensive care unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4), length of hospital stays (MD 0.26 days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), duration of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00; participants = 208; studies = 5), and the risk of mechanical circulatory support or cardiac transplantation (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2) did not clearly differ between the groups. Published data about adverse effects of levosimendan were limited. A meta-analysis of hypotension, one of the most feared side effects of levosimendan, was not feasible because of the heterogeneous expression of blood pressure values. The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. So far, no significant differences have been detected between levosimendan and standard inotrope treatments in this setting.The authors evaluated the quality of evidence as

  3. Pulse Wave Velocity and Cardiac Output vs. Heart Rate in Patients with an Implanted Pacemaker Based on Electric Impedance Method Measurement

    Science.gov (United States)

    Soukup, Ladislav; Vondra, Vlastimil; Viščor, Ivo; Jurák, Pavel; Halámek, Josef

    2013-04-01

    The methods and device for estimation of cardiac output and measurement of pulse wave velocity simultaneously is presented here. The beat-to-beat cardiac output as well as pulse wave velocity measurement is based on application of electrical impedance method on the thorax and calf. The results are demonstrated in a study of 24 subjects. The dependence of pulse wave velocity and cardiac output on heart rate during rest in patients with an implanted pacemaker was evaluated. The heart rate was changed by pacemaker programming while neither exercise nor drugs were applied. The most important result is that the pulse wave velocity, cardiac output and blood pressure do not depend significantly on heart rate, while the stroke volume is reciprocal proportionally to the heart rate.

  4. 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

    , 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, P... 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...

  5. Validation of the use of foreign gas rebreathing method for non-invasive determination of cardiac output in heart disease patients

    Institute of Scientific and Technical Information of China (English)

    DONG Liang; WANG Jian-an; JIANG Chen-yang

    2005-01-01

    Objective: To compare a new device (Innocor) for non-invasive measurement of cardiac output (CO) by foreign gas rebreathing method with conventional techniques used in the measurements of cardiac function. Methods: Cardiac outputs measured by Innocor (CORB) were compared with CO obtained by echocardiography (COEC), Swan-Ganz thermodilution (COTD),and left ventricle radiography (COLVR) in 34 patients subjected to cardiac catheterization. Values obtained from the four methods were analyzed by linear regression and paired values were compared by the method of Bland and Altman in SPSS. Results: There was strong positive correlation (r=0.94) between Innocor cardiac output values and the corresponding values obtained by thermodilution and between COEC and COLVR values. Thermodilution appears to overestimate cardiac output when compared to the values obtained with Innocor by (0.66±0.22) L/min (P<0.0001). There was no correlation between data obtained by Innocor and the corresponding COEC and COLVR values. Conclusion: Innocor CORB is an easy, safe and well established method for non-invasive measurement of cardiac output with good prospects for clinical application in heart disease patients.

  6. PMN-PT/PVDF Nanocomposite for High Output Nanogenerator Applications

    Directory of Open Access Journals (Sweden)

    Chuan Li

    2016-04-01

    Full Text Available The 0.7Pb(Mg1/3Nb2/3O3-0.3PbTiO3(0.7PMN-0.3PT nanorods were obtained via hydrothermal method with high yield (over 78%. Then, new piezoelectric nanocomposites based on (1−xPb(Mg1/3Nb2/3O3-xPbTiO3 (PMN-PT nanorods were fabricated by dispersing the 0.7PMN-0.3PT nanorods into piezoelectric poly(vinylidene fluoride (PVDF polymer. The mechanical behaviors of the nanocomposites were investigated. The voltage and current generation of PMN-PT/PVDF nanocomposites were also measured. The results showed that the tensile strength, yield strength, and Young’s modulus of nanocomposites were enhanced as compared to that of the pure PVDF. The largest Young’s modulus of 1.71 GPa was found in the samples with 20 wt % nanorod content. The maximum output voltage of 10.3 V and output current of 46 nA were obtained in the samples with 20 wt % nanorod content, which was able to provide a 13-fold larger output voltage and a 4.5-fold larger output current than that of pure PVDF piezoelectric polymer. The current density of PMN-PT/PVDF nanocomposites is 20 nA/cm2. The PMN-PT/PVDF nanocomposites exhibited great potential for flexible self-powered sensing applications.

  7. PMN-PT/PVDF Nanocomposite for High Output Nanogenerator Applications.

    Science.gov (United States)

    Li, Chuan; Luo, Wenbo; Liu, Xingzhao; Xu, Dong; He, Kai

    2016-04-11

    The 0.7Pb(Mg1/3Nb2/3)O₃-0.3PbTiO₃(0.7PMN-0.3PT) nanorods were obtained via hydrothermal method with high yield (over 78%). Then, new piezoelectric nanocomposites based on (1-x)Pb(Mg1/3Nb2/3)O₃-xPbTiO₃ (PMN-PT) nanorods were fabricated by dispersing the 0.7PMN-0.3PT nanorods into piezoelectric poly(vinylidene fluoride) (PVDF) polymer. The mechanical behaviors of the nanocomposites were investigated. The voltage and current generation of PMN-PT/PVDF nanocomposites were also measured. The results showed that the tensile strength, yield strength, and Young's modulus of nanocomposites were enhanced as compared to that of the pure PVDF. The largest Young's modulus of 1.71 GPa was found in the samples with 20 wt % nanorod content. The maximum output voltage of 10.3 V and output current of 46 nA were obtained in the samples with 20 wt % nanorod content, which was able to provide a 13-fold larger output voltage and a 4.5-fold larger output current than that of pure PVDF piezoelectric polymer. The current density of PMN-PT/PVDF nanocomposites is 20 nA/cm². The PMN-PT/PVDF nanocomposites exhibited great potential for flexible self-powered sensing applications.

  8. Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

    Science.gov (United States)

    Chouhan, Manil D.; Bainbridge, Alan; Atkinson, David; Punwani, Shonit; Mookerjee, Rajeshwar P.; Lythgoe, Mark F.; Taylor, Stuart A.

    2017-02-01

    Liver dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling could be useful in the assessment of diffuse liver disease and focal liver lesions, but is compromised by errors in arterial input function (AIF) sampling. In this study, we apply cardiac output correction to arterial input functions (AIFs) for liver DCE MRI and investigate the effect on dual-input single compartment hepatic perfusion parameter estimation and reproducibility. Thirteen healthy volunteers (28.7  ±  1.94 years, seven males) underwent liver DCE MRI and cardiac output measurement using aortic root phase contrast MRI (PCMRI), with reproducibility (n  =  9) measured at 7 d. Cardiac output AIF correction was undertaken by constraining the first pass AIF enhancement curve using the indicator-dilution principle. Hepatic perfusion parameters with and without cardiac output AIF correction were compared and 7 d reproducibility assessed. Differences between cardiac output corrected and uncorrected liver DCE MRI portal venous (PV) perfusion (p  =  0.066), total liver blood flow (TLBF) (p  =  0.101), hepatic arterial (HA) fraction (p  =  0.895), mean transit time (MTT) (p  =  0.646), distribution volume (DV) (p  =  0.890) were not significantly different. Seven day corrected HA fraction reproducibility was improved (mean difference 0.3%, Bland–Altman 95% limits-of-agreement (BA95%LoA)  ±27.9%, coefficient of variation (CoV) 61.4% versus 9.3%, ±35.5%, 81.7% respectively without correction). Seven day uncorrected PV perfusion was also improved (mean difference 9.3 ml min‑1/100 g, BA95%LoA  ±506.1 ml min‑1/100 g, CoV 64.1% versus 0.9 ml min‑1/100 g, ±562.8 ml min‑1/100 g, 65.1% respectively with correction) as was uncorrected TLBF (mean difference 43.8 ml min‑1/100 g, BA95%LoA  ±586.7 ml min‑1/ 100 g, CoV 58.3% versus 13.3 ml min‑1/100 g, ±661.5 ml min‑1/100 g, 60

  9. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient.

    Science.gov (United States)

    Mercado, Pablo; Maizel, Julien; Beyls, Christophe; Titeca-Beauport, Dimitri; Joris, Magalie; Kontar, Loay; Riviere, Antoine; Bonef, Olivier; Soupison, Thierry; Tribouilloy, Christophe; de Cagny, Bertrand; Slama, Michel

    2017-06-09

    Cardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients. Thirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral. Sixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were -1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was -0.1 L/min and the LOAs were -1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of -26.8 to 28.8°. The concordance rate was 100% between 30 and -30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62-0.94) (p < 0.001). A ΔCO-TTE of more than 8

  10. Characterizing pyrotechnic igniter output with high-speed schlieren imaging

    Science.gov (United States)

    Skaggs, M. N.; Hargather, M. J.; Cooper, M. A.

    2017-01-01

    Small-scale pyrotechnic igniter output has been characterized using a high-speed schlieren imaging system for observing critical features of the post-combustion flow. The diagnostic, with laser illumination, was successfully applied towards the quantitative characterization of the output from Ti/KClO_4 and TiH_{1.65}/KClO_4 pyrotechnic igniters. The high-speed image sequences showed shock motion, burned gas expansion, and particle motion. A statistical-based analysis methodology for tracking the full-field shock motion enabled straightforward comparisons across the experimental parameters of pyrotechnic material and initial density. This characterization of the mechanical energy of the shock front within the post-combustion environment is a necessary addition to the large body of literature focused on pyrotechnic combustion behavior within the powder bed. Ultimately, understanding the role that the combustion behavior has on the resulting multiphase environment is required for tailored igniter development and comparative performance assessments.

  11. Uncalibrated continuous cardiac output measurement in liver transplant patients: LiDCOrapid™ system versus pulmonary artery catheter.

    Science.gov (United States)

    Costa, Maria Gabriella; Chiarandini, Paolo; Scudeller, Luigia; Vetrugno, Luigi; Pompei, Livia; Serena, Giovanni; Buttera, Stefania; Della Rocca, Giorgio

    2014-06-01

    The aim of the study was to assess the level of agreement between continuous cardiac output estimated by uncalibrated pulse-power analysis (PulseCOLiR) and intermittent (ICO) and continuous cardiac output (CCO) obtained using a pulmonary artery catheter (PAC). Prospective cohort study. University hospital intensive care unit. Twenty patients after liver transplantation. Pulmonary artery catheters were placed in all patients, and ICO and CCO were determined using thermodilution. PulseCOLiR measurements were made using a LiDCOrapid(TM) (LiDCO Ltd, Cambridge, UK). ICO data were determined after intensive care unit admission and every 8 hours until the 48th postoperative hour. CCO and PulseCOLiR measurements were recorded simultaneously at these same time intervals as well as hourly. For the 8-hour data set (140 data pairs), the mean bias and percentage errors (PE) were, respectively,-0.10 L/min and 39.2% for ICO versus PulseCOLiR and 0.79 L/min and 34.6% for CCO versus PulseCOLiR. For the hourly comparison of CCO versus PulseCOLiR (980 data pairs), the bias was 0.75 L/min and the PE 37%. To assess the ability to measure change, a 4-quadrant plot was produced for each pair of methods. The performance of PulseCOLiR was moderate in detecting changes in ICO. In conclusion, the uncalibrated PulseCOLir method should not be used as a substitute for the thermodilution technique for the monitoring of cardiac output in liver transplant patients. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Henderson, William R; Griesdale, Donald E G; Walley, Keith R; Sheel, A William

    2010-01-01

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

  13. Combined use of phenoxybenzamine and dopamine for low cardiac output syndrome in children at withdrawal from cardiopulmonary bypass.

    Science.gov (United States)

    Kawamura, M; Minamikawa, O; Yokochi, H; Maki, S; Yasuda, T; Mizukawa, Y

    1980-04-01

    The combined use of phenoxybenzamine and dopamine was applied in infants and children when it was difficult to come off cardiopulmonary bypass for low cardiac output. The rationale of this method is to prevent the alpha-adrenergic action of dopamine by phenoxybenzamine and to encourage the beta-adrenergic and direct specific action of dopamine. Dopamine was used in dosage of 10 to 30 micrograms/kg per min after the additional administration of a half of the initial dosage of phenoxybenzamine; this was infused by drip always in a dosage of 0.5 to 1.0 mg/kg during the first half of cardiopulmonary bypass. It was possible to come off cardiopulmonary bypass with a stable haemodynamic state (mean arterial pressure more than 60 mmHg and total peripheral vascular resistance less than 2000 bynes s cm-5) and a good urinary output.

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

    Directory of Open Access Journals (Sweden)

    Robert A. Phillips

    2012-01-01

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

  15. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Suehiro, Koichi; Joosten, Alexandre; Murphy, Linda Suk-Ling; Desebbe, Olivier; Alexander, Brenton; Kim, Sang-Hyun; Cannesson, Maxime

    2016-10-01

    Several minimally-invasive technologies are available for cardiac output (CO) measurement in children, but the accuracy and precision of these devices have not yet been evaluated in a systematic review and meta-analysis. We conducted a comprehensive search of the medical literature in PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science from its inception to June 2014 assessing the accuracy and precision of all minimally-invasive CO monitoring systems used in children when compared with CO monitoring reference methods. Pooled mean bias, standard deviation, and mean percentage error of included studies were calculated using a random-effects model. The inter-study heterogeneity was also assessed using an I(2) statistic. A total of 20 studies (624 patients) were included. The overall random-effects pooled bias, and mean percentage error were 0.13 ± 0.44 l min(-1) and 29.1 %, respectively. Significant inter-study heterogeneity was detected (P error (23.6 %). Significant residual heterogeneity remained after conducting sensitivity and subgroup analyses based on the various study characteristics. By meta-regression analysis, we found no independent effects of study characteristics on weighted mean difference between reference and tested methods. Although the pooled bias was small, the mean pooled percentage error was in the gray zone of clinical applicability. In the sub-group analysis, electrical cardiometry was the device that provided the most accurate measurement. However, a high heterogeneity between studies was found, likely due to a wide range of study characteristics.

  16. High Output LED-Based Profile Lighting Fixture

    DEFF Research Database (Denmark)

    Török, Lajos; Beczkowski, Szymon; Munk-Nielsen, Stig;

    2011-01-01

    . The system consists of a power supply with power factor correction (PFC), a LED-driver and an optical system designed for an overall high efficiency. An interleaved boost converter was chosen as PFC converter. A soft switching phase-shifted full-bridge converter with current doubler provides isolation from...... the grid and delivers the required voltage to the LEDdriver which is a dual interleaved buck converter. Twelve highpower CBT-90 LEDs have been connected in a 4xRGBconfiguration to deliver high output of saturated colors without the need for subtractive color filters. More than 6000 lm of fixture light...

  17. High-sensitive cardiac troponin T

    Institute of Scientific and Technical Information of China (English)

    Ru-Yi Xu; Xiao-Fa Zhu; Ye Yang; Ping Ye

    2013-01-01

    Cardiac troponin is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). The recent development of a high-sensitive cardiac troponin T (hs-cTnT) assay permits detection of very low levels of cTnT. Using the hs-cTnT assay improves the overall diagnostic accuracy in patients with suspected AMI, while a negative result also has a high negative predictive value. The gain in sensitivity may be particularly important in patients with a short duration from symptom onset to admission. Measurement of cardiac troponin T with the hs-cTnT assay may provide strong prognostic information in patients with acute coronary syndromes, stable coronary artery disease, heart failure and even in the general population; however, increased sensitivity comes at a cost of decreased specificity. Serial testing, as well as clinical context and co-existing diseases, are likely to become increasingly important for the interpretation of hs-cTnT assay results.

  18. Malignant hepatic epithelioid hemangioendothelioma with high-output heart failure: successful management of heart failure with transcatheter arterial chemoembolization.

    Science.gov (United States)

    Hsu, Chien-Yi; Liu, Yao-Chung; Li, Chung-Pin; Huang, Po-Hsun; Lin, Chin-Hsuan; Chao, Yee

    2014-06-01

    A 73-year-old woman was admitted to hospital because of progressive dyspnea on exertion. Computed tomography revealed a large hepatic tumor, which was proved to be a hepatic epithelioid hemangioendothelioma (EHE). Echocardiography demonstrated high cardiac output, for which the tumor was considered to be the leading cause. A transcatheter arterial chemoembolization (TACE) was performed sequentially at 1-month intervals to reduce the size of the hepatic tumor, and this temporarily improved the patient's cardiac condition and quality of life. In this case, we successfully used TACE in the treatment of hepatic EHE with high-output heart failure. TACE is a reasonable choice of treatment both for managing malignant hepatic tumors and resolving low systemic vascular resistance by embolization of the abnormal neoangiogenic vessels. Nevertheless, clinicians should be aware of the potential adverse effect of hepatic decompensation induced by TACE, especially when the tumor involvement is widespread and poorly preserved hepatic function is encountered.

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

    Directory of Open Access Journals (Sweden)

    Leng Xiaoyan

    2009-11-01

    Full Text Available Abstract Background Older heart failure (HF patients exhibit exercise intolerance during activities of daily living. We hypothesized that reduced lower extremity blood flow (LBF due to reduced forward cardiac output would contribute to submaximal exercise intolerance in older HF patients. Methods and Results Twelve HF patients both with preserved and reduced left ventricular ejection fraction (LVEF (aged 68 ± 10 years without large (aorta or medium sized (iliac or femoral artery vessel atherosclerosis, and 13 age and gender matched healthy volunteers underwent a sophisticated battery of assessments including a peak exercise oxygen consumption (peak VO2, b physical function, c cardiovascular magnetic resonance (CMR submaximal exercise measures of aortic and femoral arterial blood flow, and d determination of thigh muscle area. Peak VO2 was reduced in HF subjects (14 ± 3 ml/kg/min compared to healthy elderly subjects (20 ± 6 ml/kg/min (p = 0.01. Four-meter walk speed was 1.35 ± 0.24 m/sec in healthy elderly verses 0.98 ± 0.15 m/sec in HF subjects (p p ≤ 0.03. Conclusion During CMR submaximal bike exercise in the elderly with heart failure, mechanisms other than low cardiac output are responsible for reduced lower extremity blood flow.

  20. Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study.

    Science.gov (United States)

    de Souza, Vanessa; Zeitoun, Sandra Salloum; Lopes, Camila Takao; de Oliveira, Ana Paula Dias; Lopes, Juliana de Lima; de Barros, Alba Lucia Bottura Leite

    2015-09-01

    To assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure. Content validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation. This was a descriptive exploratory study. Two expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses. Assessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses. The operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance. The operational definitions may favour early recognition of the sequence of responses to decompensation

  1. Surfing the High Energy Output Branch of Nonlinear Energy Harvesters

    Science.gov (United States)

    Mallick, D.; Amann, A.; Roy, S.

    2016-11-01

    Hysteresis and multistability are fundamental phenomena of driven nonlinear oscillators, which, however, restrict many applications such as mechanical energy harvesting. We introduce an electrical control mechanism to switch from the low to the high energy output branch of a nonlinear energy harvester by exploiting the strong interplay between its electrical and mechanical degrees of freedom. This method improves the energy conversion efficiency over a wide bandwidth in a frequency-amplitude-varying environment using only a small energy budget. The underlying effect is independent of the device scale and the transduction method and is explained using a modified Duffing oscillator model.

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

    Science.gov (United States)

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

    2007-01-01

    Background Whole‐body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. Aim To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). Methods 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (V̇o2) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak V̇o2 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak V̇o2 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32°C) water immersion and exercise was measured using a non‐invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. Results Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). V̇o2 during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. Conclusions Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak V̇o2 of at least 15 ml/kg/min during a symptom‐limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and V̇o2 are lower than in patients

  3. Guns and High Gas Output Devices Panel: Introduction

    Science.gov (United States)

    Simmons, Ronald L.; Kaste, Pamela J.

    2000-01-01

    A new panel known as the Guns and High Gas Output Panel was organized in 1999 under the auspices of the JANNAF Propellant and Characterization SubCommittee (PDCS). This is an introduction to our first meeting, purpose of the panel, and the scope of activities to be covered. The primary purpose of the panel is very simple: to provide a single focal point for interfacing Government Laboratories (Department of Defense and Department of Energy) and commercial industry researchers to share R&D activities and findings (i.e. facilitate the exchange of information) specifically aimed at gun-launched propulsion and high-gas output devices (gas generators and air bag inflators). Specific areas of interest included in the Panel's scope (and the Technical Data Base) are the following: (1) new propellant formulations and chemistry, (2) new ingredients, (3) ballistic effects of the new formulations and ingredients, (4) new processing methods unique to gun propellants, (5) thermochemistry of new ingredients, (6) unique physical and mechanical properties, (7) burning rates of new propellants and small scale closed bomb testing, (8) plasma effects on the propellant, and (9) unique safety and insensitive munitions properties.

  4. Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    LU Jia-kai; ZHU Chen; JING He; WANG Yi-jun; QING En-ming

    2012-01-01

    Background For patients undergoing off-pump coronary artery bypass grafting (OPCABG),it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment.This study aimed to observe the clinical feasibility of artedal pressure-based cardiac output (APCO) for cardiac output (CO) monitoring and to evaluate the correlation between APCO and pulmonary artery catheter (PAC) for CO measurement for patients undergoing OPCABG intraoperatively.Methods Fifty patients of Amedcan Society of Anaesthesiologists (ASA) classification Ⅱ-Ⅲ,undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study.All patients were assigned to CO monitoring by PAC and APCO simultaneously.Patients with pacemaker,severe valvular heart disease,left ventdcular ejection fraction (EF) <40%,cardiac arrhythmias,peripheral vascular disease,application of intra-aortic balloon pump (IABP) and emergent diversion to cardiac pulmonary bypass were excluded.The radial artery wavaform was analyzed to estimate the stroke volume (SV) and heart rate (HR) continuously.CO was calculated as SV x HR; other derived parameters were cardiac index (CI),stroke volume index (SVI),systemic vascular resistance (SVR),and systemic vascular resistance index (SVRI).PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms.Continuous cardiac output (CCO),CI and other hemodynamic parameters were monitored at following 5 time points:immediate after anesthesia induction (baseline value),anastomosis of left intemal mammary artery to left anterior descending artery (LAD),anastomosis of left circumflex (LCX),anastomosis of posterior descending artery (PDA) and immediate after sternal closure.Results In the 50 patients,preoperative echocardiography measured left ventricular EF was (52.8±11.5)%,and 35 patients (70%) showed regional wall motion abnormalities.The correlation coefficient of CO

  5. High Work Output Ni-Ti-Pt High Temperature Shape Memory Alloys and Associated Processing Methods

    Science.gov (United States)

    Noebe, Ronald D. (Inventor); Draper, Susan L. (Inventor); Nathal, Michael V. (Inventor); Garg, Anita (Inventor)

    2009-01-01

    According to the invention, compositions of Ni-Ti-Pt high temperature, high force, shape memory alloys are disclosed that have transition temperatures above 100 C.; have narrow hysteresis; and produce a high specific work output.

  6. PP097. Cardiac output and systemic vascular resistance in normal pregnancy and in control non-pregnant women.

    Science.gov (United States)

    Khalil, A; Goodyear, Gemma; Joseph, Ehizele; Khalil, Asma

    2012-07-01

    Changes in cardiac output (CO) and systemic vascular resistance (SVR) have been shown to precede the clinical onset of pregnancy complications, such as pre-eclampsia and fetal growth restriction. CO and SVR undergo major changes during normal pregnancy. However, assessment of these vascular parameters requires intensive training and expensive techniques, so currently can be performed only in specialised centres. The aim of this study was to investigate maternal cardiovascular function measured using an ultrasonic cardiac output monitor (USCOM), a simple non-invasive continuous wave Doppler device, in a cohort of pregnant women and non-pregnant controls. This was a cross sectional study including 185 women with normal singleton pregnancies at 11-40weeks of gestation and 49 non-pregnant controls. Stroke volume (SV), CO and SVR were measured using the USCOM device. All measurements were performed with the patients in supine position. All women with a gestational age of >20weeks were in a left lateral position by placing a wedge-shaped pillow under their right side to prevent vena cava compression. In a group of 25 pregnant women, each measurement was repeated three times to evaluate the reproducibility of this technique. Cardiac index (CI), SV index (SVI) and SVR index (SVRI) relate CO, SV and SVR to the body surface area. The data were normally distributed after logarithmic transformation. Comparisons between pregnant and non-pregnant women were performed using Studentt-test, Chi-Square test or multiple regression analysis, when adjustment for potential confounders was necessary. Data analysis was performed using SPSS 16.0. In the first trimester, all of the following vascular parameters were higher in pregnant women compared to non-pregnant controls: CO [median (IQR): 4.86 (4.45-5.57) vs 5.57 (4.76-6.52)L/min, PPregnant women had significantly lower SVR [median (IQR): 1458 (1261-1649) vs 1165 (1023-1406)sec/cm(-5), P<0.001] and SVRI [median (IQR): 2646 (2307

  7. Plasma volume expansion does not increase maximal cardiac output or VO2 max in lowlanders acclimatized to altitude

    DEFF Research Database (Denmark)

    Calbet, José A L; Rådegran, Göran; Boushel, Robert Christopher

    2004-01-01

    With altitude acclimatization, blood hemoglobin concentration increases while plasma volume (PV) and maximal cardiac output (Qmax) decrease. This investigation aimed to determine whether reduction of Qmax at altitude is due to low circulating blood volume (BV). Eight Danish lowlanders (3 females, 5...... males: age 24.0 +/- 0.6 yr; mean +/- SE) performed submaximal and maximal exercise on a cycle ergometer after 9 wk at 5,260 m altitude (Mt. Chacaltaya, Bolivia). This was done first with BV resulting from acclimatization (BV = 5.40 +/- 0.39 liters) and again 2-4 days later, 1 h after PV expansion with 1...... level Qmax and exercise capacity were restored with hyperoxia at altitude independently of BV. Low BV is not a primary cause for reduction of Qmax at altitude when acclimatized. Furthermore, hemodilution caused by PV expansion at altitude is compensated for by increased systemic O2 extraction...

  8. A Review of Intraoperative Goal-Directed Therapy Using Arterial Waveform Analysis for Assessment of Cardiac Output

    Directory of Open Access Journals (Sweden)

    Neil Mehta

    2014-01-01

    Full Text Available Increasing evidence shows that goal-directed hemodynamic management can improve outcomes in surgical and intensive care settings. Arterial waveform analysis is one of the different techniques used for guiding goal-directed therapy. Multiple proprietary systems have developed algorithms for obtaining cardiac output from an arterial waveform, including the FloTrac, LiDCO, and PiCCO systems. These systems vary in terms of how they analyze the arterial pressure waveform as well as their requirements for invasive line placement and calibration. Although small-scale clinical trials using these monitors show promising data, large-scale multicenter trials are still needed to better determine how intraoperative goal-directed therapy with arterial waveform analysis can improve patient outcomes. This review provides a comparative analysis of the different arterial waveform monitors for intraoperative goal-directed therapy.

  9. Noninvasive cardiac output determination using applanation tonometry-derived radial artery pulse contour analysis in critically ill patients

    DEFF Research Database (Denmark)

    Compton, Friederike; Wittrock, Marc; Schaefer, Juergen-Heiner

    2008-01-01

    Conventional thermodilution cardiac output (CO) monitoring is limited mainly to intensive care units and operating rooms because it requires the use of invasive techniques. To reduce the potential for complications and to broaden the applicability of hemodynamic monitoring, noninvasive methods...... for CO determination are being sought. Applanation tonometry allows noninvasive CO estimation through pulse contour analysis, but the method has not been evaluated in critically ill patients. We therefore performed noninvasive radial artery applanation tonometry in 49 critically ill medical intensive...... care unit patients and compared CO estimates to invasive CO measurements obtained using a pulmonary artery catheter or the PiCCO transpulmonary thermodilution system. One-hundred-sixteen measurements were performed, and patients were receiving vasopressor support during 78 measurements. When the data...

  10. A review of intraoperative goal-directed therapy using arterial waveform analysis for assessment of cardiac output.

    Science.gov (United States)

    Mehta, Neil; Fernandez-Bustamante, Ana; Seres, Tamas

    2014-01-01

    Increasing evidence shows that goal-directed hemodynamic management can improve outcomes in surgical and intensive care settings. Arterial waveform analysis is one of the different techniques used for guiding goal-directed therapy. Multiple proprietary systems have developed algorithms for obtaining cardiac output from an arterial waveform, including the FloTrac, LiDCO, and PiCCO systems. These systems vary in terms of how they analyze the arterial pressure waveform as well as their requirements for invasive line placement and calibration. Although small-scale clinical trials using these monitors show promising data, large-scale multicenter trials are still needed to better determine how intraoperative goal-directed therapy with arterial waveform analysis can improve patient outcomes. This review provides a comparative analysis of the different arterial waveform monitors for intraoperative goal-directed therapy.

  11. Cardiac output measured by electrical velocimetry in the CT suite correlates with coronary artery enhancement: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Flinck, Marianne; Graden, Aasa; Milde, Helen; Flinck, Agneta; Hellstroem, Mikael (Dept. of Radiology, Sahlgrenska Univ. Hospital and Sahlgrenska Academy at Goetenborg Univ., Goeteborg (Sweden)); Bjoerk, Jonas (Competence Centre for Clinical Research, Lund Univ. Hospital, Lund (Sweden)); Nyman, Ulf (Dept. of Radiology, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden)), e-mail: ulf.nyman@skane.se

    2010-10-15

    Background: Cardiac output (CO) is inversely related to vascular contrast medium (CM) enhancement during computed tomography (CT). Impedance cardiography with a new technique, electrical velocimetry (EV), may create opportunities to measure CO pre-examination for adaptation of CM injection parameters. Purpose: To relate COEV measured by radiology staff to aortic attenuation as a measure of coronary artery attenuation during CT coronary angiography (CTCA), and to formulate a tentative statistical model to adapt CM injection parameters to CO. Material and Methods: COEV was measured immediately before 100 kVp CTCA (64-multirow detector) in 27 patients with presumed coronary artery disease. For CTCA, 260 mg I/kg (maximum dosage weight: 80/90 kg for women/men) was injected intravenously during 12 s. Simple linear regression analysis was performed to explore the correlation between aortic attenuation (Hounsfield units, HU) and body weight, the influence of COEV on aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s), and to establish a tentative formula on how to adapt CM injection parameters to COEV and desired aortic attenuation. Results: The correlation between aortic attenuation and body weight was weak and non-significant (r=-0.14 after outlier exclusion). A significant negative correlation (r=-0.63) was found between aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s) and COEV. The resulting formula, CM dose rate=COEVx(aortic attenuation-240)/55, made it possible to calculate CM volumes and injection rates at various COs and, for example, the present mean aortic attenuation (438 HU), injection time (12 s), CM concentration (320 mg I/ml), and a certain body weight. Conclusion: EV makes it possible to measure CO in the CT suite before vascular examinations. Hence, CM doses may be decreased in low CO states to reduce the risk of CM-induced nephropathy without jeopardizing diagnostic quality and may be increased in high CO states

  12. High Performance Input/Output Systems for High Performance Computing and Four-Dimensional Data Assimilation

    Science.gov (United States)

    Fox, Geoffrey C.; Ou, Chao-Wei

    1997-01-01

    The approach of this task was to apply leading parallel computing research to a number of existing techniques for assimilation, and extract parameters indicating where and how input/output limits computational performance. The following was used for detailed knowledge of the application problems: 1. Developing a parallel input/output system specifically for this application 2. Extracting the important input/output characteristics of data assimilation problems; and 3. Building these characteristics s parameters into our runtime library (Fortran D/High Performance Fortran) for parallel input/output support.

  13. High Efficiency, High Output Plastic Melt Waste Compactor (HEHO-PMWC) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The innovative High Efficiency, High Output Plastic Melt Waste Compactor (HEHO-PMWC) is a trash dewatering and volume reduction system that uses heat melt compaction...

  14. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.

    Science.gov (United States)

    Peyton, Philip J; Chong, Simon W

    2010-11-01

    When assessing the accuracy and precision of a new technique for cardiac output measurement, the commonly quoted criterion for acceptability of agreement with a reference standard is that the percentage error (95% limits of agreement/mean cardiac output) should be 30% or less. We reviewed published data on four different minimally invasive methods adapted for use during surgery and critical care: pulse contour techniques, esophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bioimpedance, to assess their bias, precision, and percentage error in agreement with thermodilution. An English language literature search identified published papers since 2000 which examined the agreement in adult patients between bolus thermodilution and each method. For each method a meta-analysis was done using studies in which the first measurement point for each patient could be identified, to obtain a pooled mean bias, precision, and percentage error weighted according to the number of measurements in each study. Forty-seven studies were identified as suitable for inclusion: N studies, n measurements: mean weighted bias [precision, percentage error] were: pulse contour N = 24, n = 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57: -0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8, n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N = 13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has achieved agreement with bolus thermodilution which meets the expected 30% limits. The relevance in clinical practice of these arbitrary limits should be reassessed.

  15. DESIGN NOTE: A very high output resistance current source

    Science.gov (United States)

    Hayatleh, K.; Terzopoulos, N.; Hart, B. L.

    2007-01-01

    The vertical stacking of two identical sub-circuits—improved versions of a bipolar transistor configuration proposed by Baxandall and Swallow—driven by dual output current mirrors, facilitates the design of a current generator producing a direct current of 1 mA with an incremental output resistance exceeding 200 GΩ.

  16. Cardiac output by Doppler echocardiography in the premature baboon: comparison with radiolabeled microspheres.

    Science.gov (United States)

    Kinsella, J P; Morrow, W R; Gerstmann, D R; Taylor, A F; deLemos, R A

    1991-04-01

    Pulsed-Doppler echocardiography (PDE) is a useful noninvasive method for determining left ventricular output (LVO). However, despite increasingly widespread use in neonatal intensive care units, validation studies in prematures with cardiopulmonary disease are lacking. The purpose of this study was to compare radiolabeled microsphere (RLM) and PDE measurements of LVO, using the critically ill premature baboon as a model of the human neonate. Twenty-two paired RLM and PDE measurements of LVO were obtained in 14 animals between 3 and 24 h of age. Average PDE LVO was 152 ml/min/kg (range, 40-258 ml/min/kg) compared to 158 ml/min/kg (range, 67-278 ml/min/kg) measured by RLM. Linear regression analysis of the paired measurements showed good correlation with a slope near unity (gamma = 0.94x + 4.20, r = 0.91, SEE = 25.7 ml). We conclude that PDE determinations of LVO compare well with those measured by RLM in the premature baboon. PDE appears to provide a valid estimate of LVO and should be useful in human prematures with cardiopulmonary distress.

  17. Use of nitric oxide in thoracic surgery for a high risk cardiac patient

    Directory of Open Access Journals (Sweden)

    Vishal Garg

    2014-01-01

    Full Text Available Nitric oxide (NO is a selective pulmonary vasodilator especially in the presence of pulmonary artery hypertension. With right ventricle (RV dysfunction, inhaled NO may increase RV ejection fraction and cardiac output. The main advantage of NO over intravenous therapy is its inability to decrease systemic pressure thereby maintaining the coronary perfusion pressure and the myocardial perfusion. In this case report, we discuss the use of NO in a routine thoracic surgery patient suffering with severe left ventricular dysfunction and a potential candidate for a very high cardiac risk.

  18. Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study

    NARCIS (Netherlands)

    Slagt, C.; Helmi, M.; Malagon, I.; Groeneveld, A.B.

    2015-01-01

    BACKGROUND: Cardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock. OBJECTIVES: To compare calibrated arterial pressure waveform analysis-derived CO (COap, Vo

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

    Science.gov (United States)

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

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

  20. Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study

    NARCIS (Netherlands)

    Slagt, C.; Helmi, M.; Malagon, I.; Groeneveld, A.B.

    2015-01-01

    BACKGROUND: Cardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock. OBJECTIVES: To compare calibrated arterial pressure waveform analysis-derived CO (COap,

  1. Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study

    NARCIS (Netherlands)

    Slagt, C.; Helmi, M.; Malagon, I.; Groeneveld, A.B.

    2015-01-01

    BACKGROUND: Cardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock. OBJECTIVES: To compare calibrated arterial pressure waveform analysis-derived CO (COap, Vo

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

    Science.gov (United States)

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

    2011-02-01

    Second-generation FloTrac software has been shown to reliably measure cardiac output (CO) in cardiac surgical patients. However, concerns have been raised regarding its accuracy in vasoplegic states. The aim of the present multicenter study was to investigate the accuracy of the third-generation software in patients with sepsis, particularly when total systemic vascular resistance (TSVR) is low. Fifty-eight septic patients were included in this prospective observational study in four university-affiliated ICUs. Reference CO was measured by bolus pulmonary thermodilution (iCO) using 3-5 cold saline boluses. Simultaneously, CO was computed from the arterial pressure curve recorded on a computer using the second-generation (CO(G2)) and third-generation (CO(G3)) FloTrac software. CO was also measured by semi-continuous pulmonary thermodilution (CCO). A total of 401 simultaneous measurements of iCO, CO(G2), CO(G3), and CCO were recorded. The mean (95%CI) biases between CO(G2) and iCO, CO(G3) and iCO, and CCO and iCO were -10 (-15 to -5)% [-0.8 (-1.1 to -0.4) L/min], 0 (-4 to 4)% [0 (-0.3 to 0.3) L/min], and 9 (6-13)% [0.7 (0.5-1.0) L/min], respectively. The percentage errors were 29 (20-37)% for CO(G2), 30 (24-37)% for CO(G3), and 28 (22-34)% for CCO. The difference between iCO and CO(G2) was significantly correlated with TSVR (r(2) = 0.37, p iCO and CO(G3). In patients with sepsis, the third-generation FloTrac software is more accurate, as precise, and less influenced by TSVR than the second-generation software.

  3. Effects of water immersion on cardiac output of lean and fat male subjects at rest and during exercise.

    Science.gov (United States)

    Haffor, A S; Mohler, J G; Harrison, A C

    1991-02-01

    To investigate the combined effect of water immersion (WI) and lean body mass on cardiac output (Q), 12 healthy young men, 6 lean (fat less than 9%) and 6 fat (fat greater than 18%), were studied at rest and during steady state exercise approximating 30-40% Vo2 max under three experimental conditions. There were on land at 24 degrees C (LND), and immersed in water at 33-34 degrees C to hip level (HIP), and to the xiphoid (XIP). Metabolic measures were determined during 30-s periods from the average breath measurements. Mixed venous PCO2 (PVCO2) was estimated using rebreathing equilibration technique. Cardiac output was calculated by the indirect Fick's principle. In the lean individuals the average Q rose from a resting value of 5.43 +/- 0.43 (LND) to an exercise value of 7.25 +/- 0.40 L/min (XIP), and from resting value of 5.62 +/- 0.40 to an exercise 6.47 +/- 0.5 L/min in the fat individuals. During exercise, the associated increase in Q with increasing WI was significantly (p less than 0.05) higher compared with the land experiments. Inspection of the mean profile corresponding to this increase indicated that an increase in the level of immersion results in a significant (p less than 0.05) increase in the average Q for the lean group. For the fat group, the average Q was significantly (p less than 0.05) larger only at XIP level. At rest, heart rate dropped from 67 +/- 3.36 (LND) to 60 +/- 4.13 (XIP), and from 79 +/- 3.73 to 73 +/- 4.10 BPM for the lean and fat group, respectively. MANOVA analysis showed a significant (p less than 0.05) interaction between WI and group membership, indicating that the effect of WI is significantly different between the two groups. These data indicate that the change in central blood volume with WI depends, in part, on the lean mass of the body.

  4. Multiple myeloma presenting with high-output heart failure and improving with anti-angiogenesis therapy: two case reports and a review of the literature

    Directory of Open Access Journals (Sweden)

    Robin Jason

    2008-07-01

    Full Text Available Abstract Introduction Common manifestations of multiple myeloma include osteolytic lesions, cytopenias, hypercalcemia, and renal insufficiency. Patients may also exhibit heart failure which is often associated with either past therapy or cardiac amyloidosis. A less recognized mechanism is high-output heart failure. Diuretic therapy in this setting has little efficacy in treating the congested state. Furthermore, effective pharmacotherapy has not been established. We report two patients with multiple myeloma and high-output heart failure who failed diuretic therapy. The patients were given dexamethasone in conjunction with lenalidomide and thalidomide, respectively. Shortly thereafter, each patient demonstrated a significant improvement in symptoms. This is the first report of successful treatment of multiple myeloma-induced high-output failure via the utilization of these agents. Case presentation Two patients with multiple myeloma were evaluated for volume overload. The first was a 50-year-old man with refractory disease. Magnetic resonance imaging demonstrated diffuse marrow replacement throughout the pelvis. Cardiac catheterization conveyed elevated filling pressures and a cardiac output of 15 liters/minute. He quickly decompensated and required mechanical ventilation. The second patient was a 61-year-old man recently diagnosed with multiple myeloma and volume overload. Skeletal survey demonstrated numerous lytic lesions throughout the pelvis. His cardiac catheterization also conveyed elevated filling pressures and a cardiac output of 10 liters/minute. Neither patient responded to diuretic therapy and they were subsequently started on dexamethasone plus lenalidomide and thalidomide, respectively. The first patient's brisk diuresis allowed for extubation within 48 hours after the first dose. He had a net negative fluid balance of 15 liters over 10 days. The second patient also quickly diuresed and on repeat cardiac catheterization, his cardiac

  5. Cardiac output method comparison studies: the relation of the precision of agreement and the precision of method.

    Science.gov (United States)

    Hapfelmeier, Alexander; Cecconi, Maurizio; Saugel, Bernd

    2016-04-01

    Cardiac output (CO) plays a crucial role in the hemodynamic management of critically ill patients treated in the intensive care unit and in surgical patients undergoing major surgery. In the field of cardiovascular dynamics, innovative techniques for CO determination are increasingly available. Therefore, the number of studies comparing these techniques with a reference, such as pulmonary artery thermodilution, is rapidly growing. There are mainly two outcomes of such method comparison studies: (1) the accuracy of agreement and (2) the precision of agreement. The precision of agreement depends on the precision of each method, i.e., the precision that the studied and the reference technique are able to achieve. We call this "precision of method". A decomposition of variance shows that method agreement does not only depend on the precision of method but also on another important source of variability, i.e., the method's general variability about the true values. Ignorance of that fact leads to falsified conclusions about the precision of method of the studied technique. In CO studies, serial measurements are frequently confused with repeated measurements. But as the actual CO of a subject changes from assessment to assessment, there is no real repetition of a measurement. This situation equals a scenario in which single measurements are given for multiple true values per subject. In such a case it is not possible to assess the precision of method.

  6. Plasma volume expansion does not increase maximal cardiac output or VO2 max in lowlanders acclimatized to altitude.

    Science.gov (United States)

    Calbet, José A L; Rådegran, Göran; Boushel, Robert; Søndergaard, Hans; Saltin, Bengt; Wagner, Peter D

    2004-09-01

    With altitude acclimatization, blood hemoglobin concentration increases while plasma volume (PV) and maximal cardiac output (Qmax) decrease. This investigation aimed to determine whether reduction of Qmax at altitude is due to low circulating blood volume (BV). Eight Danish lowlanders (3 females, 5 males: age 24.0 +/- 0.6 yr; mean +/- SE) performed submaximal and maximal exercise on a cycle ergometer after 9 wk at 5,260 m altitude (Mt. Chacaltaya, Bolivia). This was done first with BV resulting from acclimatization (BV = 5.40 +/- 0.39 liters) and again 2-4 days later, 1 h after PV expansion with 1 liter of 6% dextran 70 (BV = 6.32 +/- 0.34 liters). PV expansion had no effect on Qmax, maximal O2 consumption (VO2), and exercise capacity. Despite maximal systemic O2 transport being reduced 19% due to hemodilution after PV expansion, whole body VO2 was maintained by greater systemic O2 extraction (P VO2 during exercise regardless of PV. Pulmonary ventilation, gas exchange, and acid-base balance were essentially unaffected by PV expansion. Sea level Qmax and exercise capacity were restored with hyperoxia at altitude independently of BV. Low BV is not a primary cause for reduction of Qmax at altitude when acclimatized. Furthermore, hemodilution caused by PV expansion at altitude is compensated for by increased systemic O2 extraction with similar peak muscular O2 delivery, such that maximal exercise capacity is unaffected.

  7. Fetal cardiac ventricular volume, cardiac output, and ejection fraction determined with four-dimensional ultrasound using Spatio-Temporal Image Correlation (STIC) and Virtual Organ Computed-aided AnaLysis (VOCAL™)

    Science.gov (United States)

    Hamill, Neil; Yeo, Lami; Romero, Roberto; Hassan, Sonia S.; Myers, Stephen A.; Mittal, Pooja; Kusanovic, Juan Pedro; Balasubramaniam, Mamtha; Chaiworapongsa, Tinnakorn; Vaisbuch, Edi; Espinoza, Jimmy; Gotsch, Francesca; Goncalves, Luis F.; Lee, Wesley

    2011-01-01

    Objective To quantify fetal cardiovascular parameters with Spatio-Temporal Image Correlation (STIC) and Virtual Organ Computed-aided AnaLysis (VOCAL™) utilizing the sub-feature: “Contour Finder: Trace”. Study Design A cross-sectional study was designed consisting of patients with normal pregnancies between 19 and 40 weeks of gestation. After STIC datasets were acquired, analysis was performed offline (4DView) and the following cardiovascular parameters were evaluated: ventricular volume in end systole and end diastole, stroke volume, cardiac output, and ejection fraction. To account for fetal size, cardiac output was also expressed as a function of head circumference, abdominal circumference, or femoral diaphysis length. Regression models were fitted for each cardiovascular parameter to assess the effect of gestational age and paired comparisons were made between the left and right ventricles. Results 1) Two hundred and seventeen patients were retrospectively identified, of whom 184 had adequate STIC datasets (85% acceptance); 2) ventricular volume, stroke volume, cardiac output, and adjusted cardiac output increased with gestational age; whereas, the ejection fraction decreased as gestation advanced; 3) the right ventricle was larger than the left in both systole (Right: 0.50 ml, IQR: 0.2 – 0.9; vs. Left: 0.27 ml, IQR: 0.1 – 0.5; p<0.001) and diastole (Right: 1.20 ml, IQR: 0.7 – 2.2; vs. Left: 1.03 ml, IQR: 0.5 – 1.7; p<0.001); 4) there were no differences between the left and right ventricle with respect to stroke volume, cardiac output, or adjusted cardiac output; and 5) the left ventricular ejection fraction was greater than the right (Left: 72.2%, IQR: 64 – 78; vs. Right: 62.4%, IQR: 56 – 69; p<0.001). Conclusion Fetal echocardiography, utilizing STIC and VOCAL™ with the sub-feature: “Contour Finder: Trace”, allows assessment of fetal cardiovascular parameters. Normal fetal cardiovascular physiology is characterized by ventricular

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

    Science.gov (United States)

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

  9. Fístula de alto gasto High output fistula

    Directory of Open Access Journals (Sweden)

    Ricardo Almeida Varela

    2012-06-01

    Full Text Available Se presenta a un paciente de 37 años de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones torácicas y abdominales, con síntomas y signos sugestivos de fracturas costales múltiples, con hemotórax derecho y hemoperitoneo, corroborado imaginológicamente y en la punción abdominal. Se realiza pleurostomía mínima intermedia y laparotomía exploratoria. Se le encuentran lesiones hepáticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, además, deserosamientos en las asas delgadas intestinales y colon. Se realiza hepatorrafia y empaquetamiento hepático. Posteriormente van apareciendo complicaciones, por lo que tiene que ser reintervenido en más de 60 ocasiones. Entre ellas, la aparición de una fístula de alto gasto, que lo llevó a la desnutrición y a la permanencia con el abdomen expuesto durante 7 meses hasta el egreso. Se revisa la literatura correspondiente a estas entidades.A 37 years-old multi-traumatized male patient went to our emergency service. He had many injures in the thorax and the abdomen, together with symptoms and signs suggestive of multiple costal fractures, with right hemothorax and hemoperitoneum, all of which was confirmed by imaging techniques and by abdominal puncture. Minimal intermediate pleurostomy and exploratory laparoscopy were performed. We found hepatic lesions in the 6th, 5th, 8th and 4th segments, over 3 cm deep; additionally, the loss of serosa from the intestinal ansae and from the colon. Hepatorrhaphy and hepatic packing were also performed. Later on, more complications appeared, so he had to be re-operated more than 60 times. The occurrence of a high output fistula led him to malnutrition and his abdomen remained exposed for 7 months until he was finally discharged from hospital. This paper also presented a literature review on this topic.

  10. High output power electric motors with bulk HTS elements

    Science.gov (United States)

    Kovalev, L. K.; Ilushin, K. V.; Kovalev, K. L.; Penkin, V. T.; Poltavets, V. N.; Koneev, S. M.-A.; Akimov, I. I.; Gawalek, W.; Oswald, B.; Krabbes, G.

    2003-04-01

    New types of electric machines with the rotors containing bulk HTS (YBCO and Bi-Ag) elements are presented. Different schematics of hysteresis, reluctance, “trapped field” and composed synchronous HTS machines are discussed. The two-dimensional mathematical models describing the processes in such types of HTS machines were developed on the basis of the theoretical analysis of the electrodynamic and hysteresis processes in the single-domain and polycrystal YBCO ceramic samples and plate shape Bi-Ag elements. The test results of the series of hysteresis, reluctance, “trapped field” and composed with permanent magnets HTS motors with output power rating 0.1-18 kW and current frequency 50 and 400 Hz are given. These results show that in the media of liquid nitrogen the specific output power per one weight unit of HTS motors is 4-7 times better than for conventional electric machines. Comparison of the theoretical and experimental characteristics of the developed HTS motors show that they are in good agreement. The test results for liquid nitrogen cryogenic pump system with hysteresis 500 W HTS motor are discussed. The designs and first test results of HTS motor operating in the media of liquid nitrogen with output power 100 kW and power factor more than 0.8 are given. Future development and applications of new types of HTS motors for aerospace technology, on-land industry and transport systems are discussed.

  11. Cardiac output monitoring

    NARCIS (Netherlands)

    de Waal, Eric. E. C.; Wappler, Frank; Buhre, Wolfgang F.

    2009-01-01

    Purpose of review The primary goal of hemodynamic therapy is the prevention of inadequate tissue perfusion and inadequate oxygenation. Advanced cardiovascular monitoring is a prerequisite to optimize hemodynamic treatment in critically ill patients prone to cardiocirculatory failure. The most ideal

  12. Moderate intensity, but not high intensity, treadmill exercise training alters power output properties in myocardium from aged rats.

    Science.gov (United States)

    Chung, Eunhee; Diffee, Gary M

    2012-11-01

    Aging is characterized by a progressive decline in cardiac function, but endurance exercise training has been shown to retard a number of deleterious effects of aging. However, underlying mechanisms by which exercise training improves age-related decrements in myocardial contractile function are not well understood. The purpose of this study was to determine the effects of exercise training on power output properties in permeablized (skinned) myocytes of old rats. Thirty-month-old rats were divided into sedentary control (C) and groups undergoing 11 weeks of treadmill exercise training at moderate intensity (MI) and at high intensity (HI). Peak power output normalized to maximal force was significantly increased in MI but not in HI compared to C with significant increases in atrial myosin light chain 1 in ventricle. These results suggest that MI exercise training is beneficial as a significant increase was seen in the ability of the myocardium to do work, but this effect was not seen with HI training.

  13. A minimally invasive monitoring system of cardiac output using aortic flow velocity and peripheral arterial pressure profile.

    Science.gov (United States)

    Uemura, Kazunori; Kawada, Toru; Inagaki, Masashi; Sugimachi, Masaru

    2013-05-01

    In managing patients with unstable hemodynamics, monitoring cardiac output (CO) can provide critical diagnostic data. However, conventional CO measurements are invasive, intermittent, and/or inaccurate. The purpose of this study was to validate our newly developed CO monitoring system. This system automatically determines peak velocity of the ascending aortic flow using continuous-wave Doppler transthoracic echocardiography and estimates cardiac ejection time and aortic cross-sectional area using the pulse contour of the radial arterial pressure. These parameters are continuously processed to estimate CO (CO(est)). In 10 anesthetized closed-chest dogs instrumented with an aortic flowprobe to measure reference CO (CO(ref)), hemodynamic conditions were varied over wide ranges by infusing cardiovascular drugs or by random atrial pacing. Under each condition, CO(ref) and CO(est) were determined. Absolute changes of CO(ref) (ΔCOref) and CO(est) (ΔCO(est)), and relative changes of CO(ref) (%ΔCO(ref)) and CO(est) (%ΔCO(est)) from the corresponding baseline values were determined in each animal. We calibrated CO(est) against CO(ref) to obtain proportionally scaled CO(est) (CO(est)(N)). A total of 1335 datasets of CO(ref) and CO(est) were obtained, in which CO(ref) ranged from 0.17 to 5.34 L/min. Bland-Altman analysis between CO(ref) and CO(est) indicated that the limits of agreement (the bias ± 1.96 × SD of the difference) and the percentage error (1.96 × [SD of the difference]/[mean CO] × 100) were from -1.01 to 1.13 L/min (95% confidence interval, -1.76 to 1.88 L/min) and 43%, respectively. The agreement between CO(ref) and CO(est)(N) was improved, with limits of agreement from -0.53 to 0.49 L/min (95% confidence interval, -0.62 to 0.59 L/min) and the percentage error of 20%. Polar plot analysis between ΔCO(ref) and ΔCO(est) indicated that mean ± 1.96 × SD of polar angle was -2° ± 22°. Four quadrant plot analysis indicated that %ΔCO(est) correlated

  14. Effect of increased cardiac output on hepatic and intestinal microcirculatory blood flow, oxygenation, and metabolism in hyperdynamic murine septic shock.

    Science.gov (United States)

    Albuszies, Gerd; Radermacher, Peter; Vogt, Josef; Wachter, Ulrich; Weber, Sandra; Schoaff, Michael; Georgieff, Michael; Barth, Eberhard

    2005-10-01

    Septic shock-associated organ dysfunction is attributed to derangements of microcirculatory perfusion and/or impaired cellular oxygen utilization. The hepatosplanchnic organs are regarded to play a pivotal role in the pathophysiology of sepsis-related organ failure. In a murine model of septic shock, we tested the hypothesis whether achieving normotensive, hyperdynamic hemodynamics characterized by a sustained increase in cardiac output would allow maintenance of regional microvascular perfusion and oxygenation and, thus, hepatic metabolic capacity. Prospective, controlled, randomized animal study. University animal research laboratory. Male C57Bl/6 mice. Fifteen hours after sham operation (n = 11) or cecal ligation and puncture (CLP) (n = 9), mice were anesthetized, mechanically ventilated, and instrumented (central venous and left ventricular pressure-conductance catheter, portal vein and superior mesenteric artery ultrasound flow probes). Animals received continuous intravenous hydroxyethylstarch and norepinephrine to achieve normotensive and hyperdynamic hemodynamics, and glucose was infused to maintain normoglycemia. Measurements were recorded 18, 21, and 24 hrs post-CLP. In CLP mice, titration of hemodynamic targets were affiliated superior mesenteric artery and portal vein flow. Using a combined laser-Doppler flowmetry and remission spectrophotometry probe, we found well-maintained gut and liver capillary perfusion as well as intestinal microcirculatory hemoglobin oxygen saturation, whereas hepatic microcirculatory hemoglobin oxygen saturation was even increased. At 24 hrs post-CLP, the rate of de novo gluconeogenesis as derived from hepatic C-glucose isotope enrichment after continuous intravenous 1,2,3,4,5,6-C6-glucose infusion (condensation biosynthesis modeling after gas chromatography-mass spectrometry isotope measurements) was similar in the two experimental groups. During murine septic shock achieving normotensive hyperdynamic hemodynamics with fluid

  15. Estimation of cardiac output and pulmonary vascular resistance by contrast echocardiography transit time measurement: a prospective pilot study.

    Science.gov (United States)

    Choi, Brian G; Sanai, Reza; Yang, Benjamin; Young, Heather A; Mazhari, Ramesh; Reiner, Jonathan S; Lewis, Jannet F

    2014-10-31

    Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r=-0.61, p<0.001). The transit time from peak opacification of the right ventricle to first appearance in the left ventricle moderately correlated with PVR (r=0.46, p<0.01). Previously described echocardiographic methods for the determination of CO (Huntsman method) and PVR (Abbas and Haddad methods) did not correlate with RHC-determined values (p = 0.20 for CO, p = 0.18 and p = 0.22 for PVR, respectively). The contrast transit time method demonstrated reliable intra- (p<0.0001) and inter-observer correlation (p<0.001). We describe a novel method for the quantification of CO and estimation of PVR using contrast echocardiography transit time. This technique adds to the methodologies used for noninvasive hemodynamic assessment, but requires further validation to determine overall applicability.

  16. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

    NARCIS (Netherlands)

    Noordzij, P. G.; van Geffen, O.; Dijkstra, I. M.; Boerma, D.; Meinders, A. J.; Rettig, T. C D; Eefting, F. D.; van Loon, D.; van de Garde, E. M W; van Dongen, E. P A

    2015-01-01

    BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the rel

  17. Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools

    Science.gov (United States)

    Ximenes, Rafael O.; Farias, Alberto Q.; Helou, Claudia M.B.

    2015-01-01

    Background Hemodynamic abnormalities and acute kidney injury (AKI) are often present in infected cirrhotic patients. Hence, an early diagnosis of AKI is necessary, which might require the validation of new predictors as the determinations of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and cardiac output. Methods We evaluated 18 infected cirrhotic patients subdivided into two groups at admission (0 hours). In Group I, we collected urine samples at 0 hours, 6 hours, 24 hours, and 48 hours for uNGAL and fractional excretion of sodium determinations. In Group II, we measured cardiac output using echocardiography. Results The age of patients was 55.0±1.9 years, and 11 patients were males. The Model for End-Stage Liver Disease score was 21±1, whereas the Child–Pugh score was C in 11 patients and B in 7 patients. Both patients in Group I and Group II showed similar baseline characteristics. In Group I, we diagnosed AKI in 5 of 9 patients, and the mean time to this diagnosis by measuring serum creatinine was 5.4 days. Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours. The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases. In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours. Conclusion Both uNGAL and cardiac output determinations allow the prediction of AKI in infected cirrhotic patients earlier than increments in serum creatinine. PMID:26484038

  18. Preventing Inductive Output Impedance of High-Frequency Emitter Follower Stages

    Directory of Open Access Journals (Sweden)

    R. C. Tozer

    1997-04-01

    Full Text Available Large output inductance is one of major issues of high-frequency emitter follower design. The most often suggested technique to reduce its value is the decreasing of AC transconductance which offers small output inductance at the expense of loosing low output resistance. The paper presents a different approach; it is shown that output inductance can be completely cancelled while keeping very low output resistance by introducing a pole at the input node which may be more suitable in many types of design. Complete analytical evaluation based on the full hybrid-n model of the bipolar transistor device is given.

  19. Differences of cardiac output measurements by open-circuit acetylene uptake in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a cohort study

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    Schwaiblmair Martin

    2012-03-01

    Full Text Available Abstract Background As differences in gas exchange between pulmonary arterial hypertension (PAH and chronic thromboembolic pulmonary hypertension (CTEPH have been demonstrated, we asked if cardiac output measurements determined by acetylene (C2H2 uptake significantly differed in these diseases when compared to the thermodilution technique. Method Single-breath open-circuit C2H2 uptake, thermodilution, and cardiopulmonary exercise testing were performed in 72 PAH and 32 CTEPH patients. Results In PAH patients the results for cardiac output obtained by the two methods showed an acceptable agreement with a mean difference of -0.16 L/min (95% CI -2.64 to 2.32 L/min. In contrast, the agreement was poorer in the CTEPH group with the difference being -0.56 L/min (95% CI -4.96 to 3.84 L/min. Functional dead space ventilation (44.5 ± 1.6 vs. 32.2 ± 1.4%, p 2 gradient (9.9 ± 0.8 vs. 4.1 ± 0.5 mmHg, p Conclusion Cardiac output evaluation by the C2H2 technique should be interpreted with caution in CTEPH, as ventilation to perfusion mismatching might be more relevant than in PAH.

  20. Importance of re-calibration time on pulse contour analysis agreement with thermodilution measurements of cardiac output: a retrospective analysis of intensive care unit patients.

    Science.gov (United States)

    Scully, Christopher G; Gomatam, Shanti; Forrest, Shawn; Strauss, David G

    2016-10-01

    We assessed the effect of re-calibration time on cardiac output estimation and trending performance in a retrospective analysis of an intensive care unit patient population using error grid analyses. Paired thermodilution and arterial blood pressure waveform measurements (N = 2141) from 222 patient records were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. Pulse contour analysis was performed by implementing a previously reported algorithm at calibration times of 1, 2, 8 and 24 h. Cardiac output estimation agreement was assessed using Bland-Altman and error grid analyses. Trending was assessed by concordance and a 4-Quadrant error grid analysis. Error between pulse contour and thermodilution increased with longer calibration times. Limits of agreement were -1.85 to 1.66 L/min for 1 h maximum calibration time compared to -2.70 to 2.41 L/min for 24 h. Error grid analysis resulted in 74.2 % of points bounded by 20 % error limits of thermodilution measurements for 1 h calibration time compared to 65 % for 24 h. 4-Quadrant error grid analysis showed analysis method and thermodilution showed poor agreement to monitor changes in cardiac output.

  1. Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients.

    Science.gov (United States)

    Sharma, Vikas; Singh, Ajmer; Kansara, Bhuvnesh; Karlekar, Anil

    2011-01-01

    Transthoracic electrical bioimpedance (TEB) has been proposed as a non-invasive, continuous, and cost-effective method of cardiac output (CO) measurement. In this prospective, non-randomized, clinical study, we measured CO with NICOMON (Larsen and Toubro Ltd., Mysore, India) and compared it with thermodilution (TD) method in patients after off-pump coronary artery bypass (OPCAB) graft surgery. We also evaluated the effect of ventilation (mechanical and spontaneous) on the measurement of CO by the two methods. Forty-six post-OPCAB patients were studied at five predefined time points during controlled ventilation and at five time points when breathing spontaneously. A total of 230 data pairs of CO were obtained. During controlled ventilation, TD CO values ranged from 2.29 to 6.74 L/min (mean 4.45 ± 0.85 L/min), while TEB CO values ranged from 1.70 to 6.90 L/min (mean 4.43 ± 0.94 L/min). The average correlation (r) was 0.548 (P = 0.0002), accompanied by a bias of 0.015 L/min and precision of 0.859 L/min. In spontaneously breathing patients, TD CO values ranged from 2.66 to 6.92 L/min (mean 4.66 ± 0.76 L/min), while TEB CO values ranged from 3.08 to 6.90 L/min (mean 4.72 ± 0.82 L/min). Their average correlation was relatively poor (r = 0.469, P= 0.002), accompanied by a bias of -0.059 L/min and precision of 0.818 L/min. The overall percent errors between TD CO and TEB CO were 19.3% (during controlled ventilation) and 17.4% (during spontaneous breathing), respectively. To conclude, a fair correlation was found between TD CO and TEB CO measurements among post-OPCAB patients during controlled ventilation. However, the correlation was weak in spontaneously breathing patients.

  2. Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Sharma Vikas

    2011-01-01

    Full Text Available Transthoracic electrical bioimpedance (TEB has been proposed as a non-invasive, continuous, and cost-effective method of cardiac output (CO measurement. In this prospective, non-randomized, clinical study, we measured CO with NICOMON (Larsen and Toubro Ltd., Mysore, India and compared it with thermodilution (TD method in patients after off-pump coronary artery bypass (OPCAB graft surgery. We also evaluated the effect of ventilation (mechanical and spontaneous on the measurement of CO by the two methods. Forty-six post-OPCAB patients were studied at five predefined time points during controlled ventilation and at five time points when breathing spontaneously. A total of 230 data pairs of CO were obtained. During controlled ventilation, TD CO values ranged from 2.29 to 6.74 L/min (mean 4.45 ± 0.85 L/min, while TEB CO values ranged from 1.70 to 6.90 L/min (mean 4.43 ± 0.94 L/min. The average correlation (r was 0.548 (P = 0.0002, accompanied by a bias of 0.015 L/min and precision of 0.859 L/min. In spontaneously breathing patients, TD CO values ranged from 2.66 to 6.92 L/min (mean 4.66 ± 0.76 L/min, while TEB CO values ranged from 3.08 to 6.90 L/min (mean 4.72 ± 0.82 L/min. Their average correlation was relatively poor (r = 0.469, P= 0.002, accompanied by a bias of −0.059 L/min and precision of 0.818 L/min. The overall percent errors between TD CO and TEB CO were 19.3% (during controlled ventilation and 17.4% (during spontaneous breathing, respectively. To conclude, a fair correlation was found between TD CO and TEB CO measurements among post-OPCAB patients during controlled ventilation. However, the correlation was weak in spontaneously breathing patients.

  3. Cardiac output, pulmonary artery pressure, and patent ductus arteriosus during therapeutic cooling after global hypoxia-ischaemia.

    Science.gov (United States)

    Fugelseth, D; Satas, S; Steen, P A; Thoresen, M

    2003-05-01

    To assess by Doppler echocardiography the effects of 24 hours of whole body mild hypothermia compared with normothermia on cardiac output (CO), pulmonary artery pressure (PAP), and the presence of a persistent ductus arteriosus (PDA) after a global hypoxic-ischaemic insult in unsedated newborn animals. Thirty five pigs (mean (SD) age 26.6 (12.1) hours and weight 1.6 (0.3) kg) were anaesthetised with halothane, mechanically ventilated, and subjected to a 45 minute global hypoxic-ischaemic insult. At the end of hypoxia, halothane was stopped; the pigs were randomised to either normathermia (39 degrees C) or hypothermia (35 degrees C) for 24 hours. Rewarming was carried out for 24-30 hours followed by 42 hours of normothermia. Unanaesthetised pigs were examined with a VingMed CFM 750 ultrasound scanner before and 3, 24, 30, and 48 hours after the hypoxic-ischaemic insult. Aortic valve diameter, forward peak flow velocities across the four valves, and the occurrence of a PDA were measured. Tricuspid regurgitation (TR) velocity was used to estimate the PAP. Stroke volume was calculated from the aortic flow. Twelve animals (seven normothermic, five hypothermic) had a PDA on one or more examinations, which showed no association with cooling or severity of insult. There were no differences in stroke volume or TR velocity between the hypothermic and normothermic animals at any time point after the insult. CO was, however, 45% lower at the end of cooling in the subgroup of hypothermic pigs that had received a severe insult compared with the pigs with mild and moderate insults. CO and TR velocity were transiently increased three hours after the insult: 0.38 (0.08) v 0.42 (0.08) litres/min/kg (p = 0.007) for CO; 3.0 (0.42) v 3.4 (0.43) m/s (p Global hypoxia-ischaemia leads to similar transient increases in CO and estimated PAP in unsedated normothermic and hypothermic pigs. There were no signs of metabolic compromise in any subgroup, suggesting that 24 hours of mild

  4. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort.

    Science.gov (United States)

    Tan, Christina; Rubenson, David; Srivastava, Ajay; Mohan, Rajeev; Smith, Michael R; Billick, Kristen; Bardarian, Samuel; Thomas Heywood, J

    2017-07-03

    Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.

  5. Impact of changes in systemic vascular resistance on a novel non-invasive continuous cardiac output measurement system based on pulse wave transit time: a report of two cases.

    Science.gov (United States)

    Ishihara, Hironori; Tsutsui, Masato

    2014-08-01

    The inaccuracy of arterial waveform analysis for measuring continuos cardiac output (CCO) associated with changes in systemic vascular resistance (SVR) has been well documented. A new non-invasive continuous cardiac output monitoring system (esCCO) mainly utilizing pulse wave transit time (PWTT) in place of arterial waveform analysis has been developed. However, the trending ability of esCCO to measure cardiac output during changes in SVR remains unclear. After a previous multicenter study on esCCO measurement, we retrospectively identified two cases in which apparent changes in SVR developed in a short period during data collection. In each case, the trending ability of esCCO to measure cardiac output and time component of PWTT were analyzed. Recorded data suggest that the time component of PWTT may have a significant impact on the accuracy of estimating stroke volume during changes in SVR. However, further prospective clinical studies are required to test this hypothesis.

  6. Abnormally High Power Output of Wind Turbine in Cold Weather: A Preliminary Study

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    Christophe Leclerc

    2003-01-01

    Full Text Available According to popular belief, air temperature effects on wind turbine power output are produced solely by air density variations, and power is proportional to air density. However, some cases have been reported, all involving stall-controlled wind turbines, in which unexpected high power output was observed at very low temperatures.

  7. Very High Output Thermoelectric Devices Based on ITO Nanocomposites

    Science.gov (United States)

    Fralick, Gustave; Gregory, Otto J.

    2009-01-01

    A material having useful thermoelectric properties was synthesized by combining indium-tin-oxide (ITO) with a NiCoCrAlY alloy/alumina cermet. This material had a very large Seebeck coefficient with electromotive-force-versustemperature behavior that is considered to be excellent with respect to utility in thermocouples and other thermoelectric devices. When deposited in thin-film form, ceramic thermocouples offer advantages over precious-metal (based, variously, on platinum or rhodium) thermocouples that are typically used in gas turbines. Ceramic thermocouples exhibit high melting temperatures, chemical stability at high temperatures, and little or no electromigration. Oxide ceramics also resist oxidation better than metal thermocouples, cost substantially less than precious-metal thermocouples, and, unlike precious-metal thermocouples, do not exert catalytic effects.

  8. Comparing the accuracy of ES-BC, EIS-GS, and ES Oxi on body composition, autonomic nervous system activity, and cardiac output to standardized assessments

    Directory of Open Access Journals (Sweden)

    Lewis JE

    2011-09-01

    Full Text Available John E Lewis1, Stacey L Tannenbaum1, Jinrun Gao3, Angelica B Melillo1, Evan G Long1, Yaima Alonso2, Janet Konefal1, Judi M Woolger2, Susanna Leonard1, Prabjot K Singh1, Lawrence Chen1, Eduard Tiozzo1 1Department of Psychiatry and Behavioral Sciences, 2Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 3State Farm Insurance, Bloomington, IL, USA Background and purpose: The Electro Sensor Complex (ESC is software that combines three devices using bioelectrical impedance, galvanic skin response, and spectrophotometry: (1 ES-BC (Electro Sensor-Body Composition; LD Technology, Miami, FL to assess body composition, (2 EIS-GS (Electro Interstitial Scan-Galvanic Skin; LD Technology to predict autonomic nervous system activity, and (3 ES Oxi (Electro Sensor Oxi; LD Technology to assess cardiac output. The objective of this study was to compare each to a standardized assessment: ES-BC to dual-energy X-ray absorptiometry (DXA, EIS-GS to heart rate variability, and ES Oxi to BioZ Dx Diagnostic System (BioZ Dx; SonoSite Inc, Bothell, WA. Patients and methods: The study was conducted in two waves. Fifty subjects were assessed for body composition and autonomic nervous system activity. Fifty-one subjects were assessed for cardiac output. Results: We found adequate relative and absolute agreement between ES-BC and DXA for fat mass (r = 0.97, P < 0.001 with ES-BC overestimating fat mass by 0.1 kg and for body fat percentage (r = 0.92, P < 0.001 with overestimation of fat percentage by 0.4%. For autonomic nervous system activity, we found marginal relative agreement between EIS-GS and heart rate variability by using EIS-GS as the predictor in a linear regression equation (adjusted R2 = 0.56, P = 0.03. For cardiac output, adequate relative and absolute agreement was found between ES Oxi and BioZ Dx at baseline (r = 0.60, P < 0.001, after the first exercise stage (r = 0.79, P < 0.001, and after the second exercise stage (r = 0.86, P

  9. Protection of the ischaemic myocardium by L-propionylcarnitine: effects on the recovery of cardiac output after ischaemia and reperfusion, carnitine transport, and fatty acid oxidation.

    Science.gov (United States)

    Paulson, D J; Traxler, J; Schmidt, M; Noonan, J; Shug, A L

    1986-07-01

    The effects of L-propionylcarnitine on the recovery of cardiac contractile performance after global ischaemia and reperfusion were studied in isolated perfused rat hearts. The addition of either 5.5 or 11 mmol X litre-1 L-propionylcarnitine significantly improved the recovery of cardiac output, left ventricular pressure, and dP/dt after 90 min of ischaemia and 15 min of reperfusion. Myocardial adenosine triphosphate and creatine phosphate concentrations were significantly higher in the L-propionylcarnitine treated hearts than in controls, but the concentrations of long chain acyl carnitine and coenzyme A were unaffected. The protecting effects of L-propionylcarnitine were compared with those of L-carnitine and L-acetylcarnitine. A 11 mmol X litre-1 dose of L-propionylcarnitine and L-acetylcarnitine significantly improved the recovery of cardiac output after 90 min of ischaemia and 15 min of reperfusion, but L-carnitine did not. L-Propionylcarnitine was the most protective agent. The effects of these derivatives on L-3H-carnitine transport and 14C-palmitate oxidation were also measured. All of these derivatives competitively inhibited L-3H-carnitine transport in isolated cardiac myocytes, but L-propionylcarnitine was the most potent. Carnitine and L-propionylcarnitine stimulated palmitate oxidation in the homogenate, whereas L-acetylcarnitine inhibited it. In myocytes only L-propionylcarnitine affected palmitate oxidation. These data show that L-propionylcarnitine protects the ischaemic myocardium. Its protection is greater than that for L-carnitine or L-acetylcarnitine, and the difference in effectiveness may relate to the rate of transport into the cells and the effects on fatty acid utilisation.

  10. Glucagon-like peptide-1 (7-36) but not (9-36) augments cardiac output during myocardial ischemia via a Frank-Starling mechanism.

    Science.gov (United States)

    Goodwill, Adam G; Tune, Johnathan D; Noblet, Jillian N; Conteh, Abass M; Sassoon, Daniel; Casalini, Eli D; Mather, Kieren J

    2014-01-01

    This study examined the cardiovascular effects of GLP-1 (7-36) or (9-36) on myocardial oxygen consumption, function and systemic hemodynamics in vivo during normal perfusion and during acute, regional myocardial ischemia. Lean Ossabaw swine received systemic infusions of saline vehicle or GLP-1 (7-36 or 9-36) at 1.5, 3.0, and 10.0 pmol/kg/min in sequence for 30 min at each dose, followed by ligation of the left circumflex artery during continued infusion at 10.0 pmol/kg/min. Systemic GLP-1 (9-36) had no effect on coronary flow, blood pressure, heart rate or indices of cardiac function before or during regional myocardial ischemia. Systemic GLP-1 (7-36) exerted no cardiometabolic or hemodynamic effects prior to ischemia. During ischemia, GLP-1 (7-36) increased cardiac output by approximately 2 L/min relative to vehicle-controls (p = 0.003). This response was not diminished by treatment with the non-depolarizing ganglionic blocker hexamethonium. Left ventricular pressure-volume loops measured during steady-state conditions with graded occlusion of the inferior vena cava to assess load-independent contractility revealed that GLP-1 (7-36) produced marked increases in end-diastolic volume (74 ± 1 to 92 ± 5 ml; p = 0.03) and volume axis intercept (8 ± 2 to 26 ± 8; p = 0.05), without any change in the slope of the end-systolic pressure-volume relationship vs. vehicle during regional ischemia. GLP-1 (9-36) produced no changes in any of these parameters compared to vehicle. These findings indicate that short-term systemic treatment with GLP-1 (7-36) but not GLP-1 (9-36) significantly augments cardiac output during regional myocardial ischemia, via increases in ventricular preload without changes in cardiac inotropy.

  11. Substrate stiffness-regulated matrix metalloproteinase output in myocardial cells and cardiac fibroblasts: implications for myocardial fibrosis.

    Science.gov (United States)

    Xie, Jing; Zhang, Quanyou; Zhu, Ting; Zhang, Yanyan; Liu, Bailin; Xu, Jianwen; Zhao, Hucheng

    2014-06-01

    Cardiac fibrosis, an important pathological feature of structural remodeling, contributes to ventricular stiffness, diastolic dysfunction, arrhythmia and may even lead to sudden death. Matrix stiffness, one of the many mechanical factors acting on cells, is increasingly appreciated as an important mediator of myocardial cell behavior. Polydimethylsiloxane (PDMS) substrates were fabricated with different stiffnesses to mimic physiological and pathological heart tissues, and the way in which the elastic modulus of the substrate regulated matrix-degrading gelatinases in myocardial cells and cardiac fibroblasts was explored. Initially, an increase in cell spreading area was observed, concomitant with the increase in PDMS stiffness in both cells. Later, it was demonstrated that the MMP-2 gene expression and protein activity in myocardial cells and cardiac fibroblasts can be enhanced with an increase in PDMS substrate stiffness and, moreover, such gene- and protein-related increases had a significant linear correlation with the elastic modulus. In comparison, the MMP-9 gene and protein expressions were up-regulated in cardiac fibroblasts only, not in myocardial cells. These results implied that myocardial cells and cardiac fibroblasts in the myocardium could sense the stiffness in pathological fibrosis and showed a differential but positive response in the expression of matrix-degrading gelatinases when exposed to an increased stiffening of the matrix in the microenvironment. The phenomenon of cells sensing pathological matrix stiffness can help to increase understanding of the mechanism underlying myocardial fibrosis and may ultimately lead to planning cure strategies.

  12. High output power reluctance electric motors with bulk high-temperature superconductor elements

    Science.gov (United States)

    Kovalev, L. K.; Ilushin, K. V.; Penkin, V. T.; Kovalev, K. L.; Larionoff, A. E.; M-A Koneev, S.; Modestov, K. A.; Larionoff, S. A.; Poltavets, V. N.; Akimov, I. I.; Alexandrov, V. V.; Gawalek, W.; Oswald, B.; Krabbes, G.

    2002-05-01

    We present new types of electric machines with the rotors containing bulk high-temperature superconductor (HTS) - YBCO and Bi-Ag - elements. We discuss different schematics of hysteresis, reluctance, 'trapped field' and composed synchronous HTS machines. The two-dimensional mathematical models describing the processes in such types of HTS machines were developed on the basis of the theoretical analysis of the electrodynamic and hysteresis processes in the single-domain and polycrystal YBCO ceramic samples and plate shape Bi-Ag elements. We give the test results of the series of hysteresis, reluctance, 'trapped field' and composed with permanent magnets HTS motors with an output power rating of 0.1-18 kW and current frequencies 50 Hz and 400 Hz. These results show that in the media of liquid nitrogen the specific output power per one unit weight of the HTS motor is four to seven times better than for conventional electric machines. A comparison of the theoretical and experimental characteristics of the developed HTS motors show that they are in good agreement. We discuss the test results for a liquid nitrogen cryogenic pump system with a hysteresis 500 W HTS motor. We describe several designs of new HTS motors operating in the media of liquid nitrogen with an output power 125 kW (and more) and a power factor of more than 0.8. We discuss future applications of new types of HTS motors for aerospace technology, on-land industry and transport systems.

  13. Influence of pulse line switch inductance on output characteristics of high-current nanosecond accelerators

    Science.gov (United States)

    Mashchenko, A. I.; Vintizenko, I. I.

    2016-06-01

    Various types of high-current nanosecond accelerators are simulated numerically using an equivalent circuit representation. The influence of pulse forming line switch inductance on the amplitude and waveform of output voltage and current pulses is analyzed.

  14. High Power Tm3+-Doped Fiber Lasers Tuned by a Variable Reflective Output Coupler

    Directory of Open Access Journals (Sweden)

    Yulong Tang

    2008-01-01

    Full Text Available Wide wavelength tuning by a variable reflective output coupler is demonstrated in high-power double-clad Tm3+-doped silica fiber lasers diode-pumped at ∼790  nm. Varying the output coupling from 96% to 5%, the laser wavelength is tuned over a range of 106  nm from 1949 to 2055  nm. The output power exceeds 20  W over 90-nm range and the maximum output power is 32  W at 1949  nm for 51-W launched pump power, corresponding to a slope efficiency of ∼70%. Assisted with different fiber lengths, the tuning range is expanded to 240  nm from 1866 to 2107  nm with the output power larger than 10  W.

  15. High-light-output scintillator for photodiode readout: LuI3:Ce3+

    NARCIS (Netherlands)

    Birowosuto, M.D.; Dorenbos, P.; Van Eijk, C.W.E.; Krämer, K.W.; Güdel, H.U.

    2006-01-01

    In this paper, we investigated the scintillation properties of LuI3:Ce3+. Radioluminescence, light output, energy resolution, and γ-scintillation decay are reported. We find an extremely high light output of 98 000±10 000 photons/MeV. LuI3:Ce3+ also gives a very high electron-hole (e-h) pair respons

  16. Fiber laser pumped high power mid-infrared laser with picosecond pulse bunch output.

    Science.gov (United States)

    Wei, Kaihua; Chen, Tao; Jiang, Peipei; Yang, Dingzhong; Wu, Bo; Shen, Yonghang

    2013-10-21

    We report a novel quasi-synchronously pumped PPMgLN-based high power mid-infrared (MIR) laser with picosecond pulse bunch output. The pump laser is a linearly polarized MOPA structured all fiberized Yb fiber laser with picosecond pulse bunch output. The output from a mode-locked seed fiber laser was directed to pass through a FBG reflector via a circulator to narrow the pulse duration from 800 ps to less than 50 ps and the spectral FWHM from 9 nm to 0.15 nm. The narrowed pulses were further directed to pass through a novel pulse multiplier through which each pulse was made to become a pulse bunch composing of 13 sub-pulses with pulse to pulse time interval of 1.26 ns. The pulses were then amplified via two stage Yb fiber amplifiers to obtain a linearly polarized high average power output up to 85 W, which were then directed to pass through an isolator and to pump a PPMgLN-based optical parametric oscillator via quasi-synchronization pump scheme for ps pulse bunch MIR output. High MIR output with average power up to 4 W was obtained at 3.45 micron showing the feasibility of such pump scheme for ps pulse bunch MIR output.

  17. Cardiac nuclear high mobility group box 1 prevents the development of cardiac hypertrophy and heart failure.

    Science.gov (United States)

    Funayama, Akira; Shishido, Tetsuro; Netsu, Shunsuke; Narumi, Taro; Kadowaki, Shinpei; Takahashi, Hiroki; Miyamoto, Takuya; Watanabe, Tetsu; Woo, Chang-Hoon; Abe, Jun-ichi; Kuwahara, Koichiro; Nakao, Kazuwa; Takeishi, Yasuchika; Kubota, Isao

    2013-09-01

    High mobility group box 1 (HMGB1) is an abundant and ubiquitous nuclear DNA-binding protein that has multiple functions dependent on its cellular location. HMGB1 binds to DNA, facilitating numerous nuclear functions including maintenance of genome stability, transcription, and repair. However, little is known about the effects of nuclear HMGB1 on cardiac hypertrophy and heart failure. The aim of this study was to examine whether nuclear HMGB1 plays a role in the development of cardiac hypertrophy induced by pressure overload. Analysis of human biopsy samples by immunohistochemistry showed decreased nuclear HMGB1 expression in failing hearts compared with normal hearts. Nuclear HMGB1 decreased in response to both endothelin-1 (ET-1) and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes, where nuclear HMGB1 was acetylated and translocated to the cytoplasm. Overexpression of nuclear HMGB1 attenuated ET-1 induced cardiomyocyte hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild-type (WT) mice. Cardiac hypertrophy after TAC was attenuated in HMGB1-Tg mice and the survival rate after TAC was higher in HMGB1-Tg mice than in WT mice. Induction of foetal cardiac genes was decreased in HMGB1-Tg mice compared with WT mice. Nuclear HMGB1 expression was preserved in HMGB1-Tg mice compared with WT mice and significantly attenuated DNA damage after TAC was attenuated in HMGB1-TG mice. These results suggest that the maintenance of stable nuclear HMGB1 levels prevents hypertrophy and heart failure by inhibiting DNA damage.

  18. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery.

    Science.gov (United States)

    Noordzij, P G; van Geffen, O; Dijkstra, I M; Boerma, D; Meinders, A J; Rettig, T C D; Eefting, F D; van Loon, D; van de Garde, E M W; van Dongen, E P A

    2015-06-01

    Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery. This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome. In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, Pcardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery. NCT02150486. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Novel Logarithmic Active Pixel Sensor with High Dynamic Range and High Output Swing

    Institute of Scientific and Technical Information of China (English)

    FU Xian-song; YAO Su-ying; YUAN Yi-dong; XU Jiang-tao; DING Ke; YAN Kun-shan

    2008-01-01

    The logarithmic response complementary metal oxide semiconductor(CMOS) image sensor provides a wide dynamic range, but its drawback is the lack of simple fixed pattern noise(FPN) cancellation scheme. Designed is a novel logarithmic active pixel sensor(APS) with high dynamic range and high output swing. Firstly, the operation principle of mixed-model APS is introduced. The pixel can work in three operation modes by choosing the proper control signals. Then, FPN sources of logarithmic APS are analyzed, and double-sampled technique is implemented to reduce FPN. Finally, according to the simulation results, layout is designed and has passed design rule check(DRC), electronic rule check(ERC) and layout versus schematic(LVS) verifications, and the post-simulation results are basically in agreement with the simulation results. Dynamic range of the new logarithmic APS can reach about 140 dB; and the output swing is about 750 mV. Results show that by using double sampled technique, most FPN is eliminated and the dynamic range is enhanced.

  20. GASTO CARDÍACO MATERNO COMO PREDICTOR DEL SÍNDROME DE PREECLAMPSIA-ECLAMPSIA / Maternal cardiac output as a predictor of preeclampsia-eclampsia syndrome

    Directory of Open Access Journals (Sweden)

    Luis A. Díaz Moreno

    2012-03-01

    Full Text Available Resumen Introducción y objetivos: La hipertensión es la complicación médica más común del embarazo, y puede dejar secuelas permanentes como: alteraciones neurológicas, hepáticas, hematológicas o renales. Cada tres minutos muere una mujer debido a la preeclampsia. Durante el embarazo el gasto cardíaco sufre un incremento de hasta 40 %. Este incremento es secundario al aumento de aproximadamente 30 % del volumen sistólico. El objetivo de la investigación fue predecir la aparición del síndrome de preeclampsia-eclampsia mediante la identificación de alteraciones del gasto cardíaco. Método: Se realizó un estudio observacional, descriptivo, longitudinal y analítico, de cohorte prospectiva, donde se determinó, por ecocardiografía, el gasto cardíaco en 31 embarazadas, entre las semanas 11 y 13,6 de gestación como único valor; y mediante seguimiento prenatal, se observó la aparición o no del síndrome de Preeclampsia-Eclampsia. Resultados: Se logró el seguimiento de 31 embarazadas a las que se le midió el gasto cardíaco, y se encontró una prevalecía de la enfermedad de 12,9 % con un 64,5 % de pacientes correctamente diagnosticados, con una sensibilidad de 75 %, con valor predictivo positivo de 23 %, especificidad de 62 % y valor predictivo negativo de 94%, con un riesgo relativo de 4,1 (intervalo de confianza 95 %, 0,48-35,6. Conclusiones: Es posible establecer la medición de gasto cardíaco como estudio de escrutinio para predecir la aparición del síndrome de Preeclampsia desde el control prenatal, y contribuir así a la disminución de la muerte materna. / Abstract Introduction and Objectives: Hypertension is the most common medical complication of pregnancy, and it can leave permanent sequelae such as neurological, hepatic, hematological or renal disorders. Every three minutes a woman dies due to preeclampsia. During pregnancy, cardiac output suffers an increase of 40%. This increase is secondary to an increase of

  1. Noninvasive cardiac output monitoring during exercise testing: Nexfin pulse contour analysis compared to an inert gas rebreathing method and respired gas analysis.

    Science.gov (United States)

    Bartels, Sebastiaan A; Stok, Wim J; Bezemer, Rick; Boksem, Remco J; van Goudoever, Jeroen; Cherpanath, Thomas G V; van Lieshout, Johannes J; Westerhof, Berend E; Karemaker, John M; Ince, Can

    2011-10-01

    Exercise testing is often used to assess cardiac function during physical exertion to obtain diagnostic information. However, this procedure is limited to measuring the electrical activity of the heart using electrocardiography and intermittent blood pressure (BP) measurements and does not involve the continuous assessment of heart functioning. In this study, we compared continuous beat-to-beat pulse contour analysis to monitor noninvasive cardiac output (CO) during exercise with inert gas rebreathing and respired gas analysis. Nineteen healthy male volunteers were subjected to bicycle ergometry testing with increasing workloads. Cardiac output was deter- mined noninvasively by continuous beat-to-beat pulse contour analysis (Nexfin) and by inert gas rebreathing, and estimated using the respired gas analysis method. The effects of the rebreathing maneuver on heart rate (HR), stroke volume (SV), and CO were evaluated. The CO values derived from the Nexfin- and inert gas rebreathing methods were well correlated (r = 0.88, P gas analysis-derived CO values correlated even better (r = 0.94, P < 0.01) and the limits of agreement were 21.5% with a measurement bias of -0.70 ± 1.6 L/min. At rest, the rebreathing maneuver increased HR by 13 beats/min (P < 0.01), SV remained unaffected (P = 0.7), while CO increased by 1.0 L/min (P < 0.01). Rebreathing did not affect these parameters during exercise. Nexfin continuous beat-to-beat pulse contour analysis is an appropriate method for noninvasive assessment of CO during exercise.

  2. Fitting VFC's Output Using Functionally Connected High-Order Neural Networks

    Institute of Scientific and Technical Information of China (English)

    CHENG Chun-ling; ZHOU Jie

    2004-01-01

    A new method is presented in this paper for fitting Voltage-to-Frequency Converter (VFC's) output functions by using Functionally Connected High-order Neural Networks (FCHNN). The nonlinear estimation is implemented when the VFC110 is used at a full-scale output frequency of 4 MHz. Two kinds of on-line dynamic calibrating circuits are designed to improve the sampling precision. This method can also be applied to different industrial areas.

  3. Review of High-intensity Interval Training in Cardiac Rehabilitation.

    Science.gov (United States)

    Ito, Shigenori; Mizoguchi, Tatsuya; Saeki, Tomoaki

    2016-01-01

    For the secondary prevention of cardiovascular disease, comprehensive cardiac rehabilitation is required. This involves optimal medical therapy, education on nutrition and exercise therapy, and smoking cessation. Of these, efficient exercise therapy is a key factor. A highly effective training protocol is therefore warranted, which requires a high rate of compliance. Although moderate-intensity continuous training has been the main training regimen recommended in cardiac rehabilitation guidelines, high-intensity interval training has been reported to be more effective in the clinical and experimental setting from the standpoint of peak oxygen uptake and central and peripheral adaptations. In this review, we illustrate the scientific evidence for high-intensity interval training. We then verify this evidence and discuss its significance and the remaining issues.

  4. Pressure-volume loop-derived cardiac indices during dobutamine stress: a step towards understanding limitations in cardiac output in children with hypoplastic left heart syndrome.

    Science.gov (United States)

    Wong, James; Pushparajah, Kuberan; de Vecchi, Adelaide; Ruijsink, Bram; Greil, Gerald F; Hussain, Tarique; Razavi, Reza

    2017-03-01

    Children with a single systemic right ventricle, such as in hypoplastic left heart syndrome (HLHS), frequently experience reduced exercise capacity. Elucidating the causes could help with optimising treatment strategies. Prospective data from 10 consecutive symptomatic patients with HLHS undergoing clinical cardiac magnetic resonance with catheterisation (XMR) were analysed. Mean age 8.6years (range 3.5-11.6years), mean time since Fontan completion 5.5years. MR-compatible catheters were placed in the systemic right ventricle and branch pulmonary arteries to record pressures at rest, with dobutamine infusion at 10mcg/kg/min and at 20mcg/kg/min. Cine short-axis stacks of the ventricle were performed at each condition and used to construct pressure-volume loops. Compared to rest, cardiac index increased with low-dose dobutamine (pstress despite a further, albeit, blunted rise in heart rate (p=0.002). A fall in stroke volume occurred (p=0.014) despite good contractility (74% increase, p=0.045) and a well-coupled ventriculo-arterial ratio. End-diastolic pressure and early active relaxation, markers of diastolic function, were normal at rest. However, preload fell at peak stress (pstress, coinciding with a fall in preload. Markers of systolic and diastolic function remained normal. Failure to adequately fill the ventricle implies a ceiling of maximal flow through the Fontan circuit despite low PVR. Copyright © 2016. Published by Elsevier B.V.

  5. Cardiac output in idiopathic normal pressure hydrocephalus: association with arterial blood pressure and intracranial pressure wave amplitudes and outcome of shunt surgery

    Directory of Open Access Journals (Sweden)

    Eide Per K

    2011-02-01

    Full Text Available Abstract Background In patients with idiopathic normal pressure hydrocephalus (iNPH responding to shunt surgery, we have consistently found elevated intracranial pressure (ICP wave amplitudes during diagnostic ICP monitoring prior to surgery. It remains unknown why ICP wave amplitudes are increased in these patients. Since iNPH is accompanied by a high incidence of vascular co-morbidity, a possible explanation is that there is reduced vascular compliance accompanied by elevated arterial blood pressure (ABP wave amplitudes and even altered cardiac output (CO. To investigate this possibility, the present study was undertaken to continuously monitor CO to determine if it is correlated to ABP and ICP wave amplitudes and the outcome of shunting in iNPH patients. It was specifically addressed whether the increased ICP wave amplitudes seen in iNPH shunt responders were accompanied by elevated CO and/or ABP wave amplitude levels. Methods Prospective iNPH patients (29 were clinically graded using an NPH grading scale. Continuous overnight minimally-invasive monitoring of CO and ABP was done simultaneously with ICP monitoring; the CO, ABP, and ICP parameters were parsed into 6-second time windows. Patients were assessed for shunt surgery on clinical grade, Evan's index, and ICP wave amplitude. Follow-up clinical grading was performed 12 months after surgery. Results ICP wave amplitudes but not CO or ABP wave amplitude, showed good correlation with the response to shunt treatment. The patients with high ICP wave amplitude did not have accompanying high levels of CO or ABP wave amplitude. Correlation analysis between CO and ICP wave amplitudes in individual patients showed different profiles [significantly positive in 10 (35% and significantly negative in 16 (55% of 29 recordings]. This depended on whether there was also a correlation between ABP and ICP wave amplitudes and on the average level of ICP wave amplitude. Conclusions These results gave no

  6. Improving the Output Power Stability of a High Concentration Photovoltaic System with Supercapacitors: A Preliminary Evaluation

    Directory of Open Access Journals (Sweden)

    Yu-Pei Huang

    2015-01-01

    Full Text Available The output power of a high concentration photovoltaic (HCPV system is very sensitive to fluctuating tracking errors and weather patterns. To help compensate this shortcoming, supercapacitors have been successfully incorporated into photovoltaic systems to improve their output power stability. This study examined the output power stability improvement of an HCPV module with a supercapacitor integrated into its circuit. Furthermore, the equivalent model of the experimental circuit is presented and analyzed. Experimental results suggest that integrating a supercapacitor into an HCPV module could improve its output power stability and further extend its acceptance angle. This paper provides preliminary data of the improvement and its evaluation method, which could be utilized for further improvements to an HCPV system.

  7. Output Feedback Distributed Containment Control for High-Order Nonlinear Multiagent Systems.

    Science.gov (United States)

    Li, Yafeng; Hua, Changchun; Wu, Shuangshuang; Guan, Xinping

    2017-01-31

    In this paper, we study the problem of output feedback distributed containment control for a class of high-order nonlinear multiagent systems under a fixed undirected graph and a fixed directed graph, respectively. Only the output signals of the systems can be measured. The novel reduced order dynamic gain observer is constructed to estimate the unmeasured state variables of the system with the less conservative condition on nonlinear terms than traditional Lipschitz one. Via the backstepping method, output feedback distributed nonlinear controllers for the followers are designed. By means of the novel first virtual controllers, we separate the estimated state variables of different agents from each other. Consequently, the designed controllers show independence on the estimated state variables of neighbors except outputs information, and the dynamics of each agent can be greatly different, which make the design method have a wider class of applications. Finally, a numerical simulation is presented to illustrate the effectiveness of the proposed method.

  8. 连续多普勒无创血液动力学监测仪(USCOM)在危重患者中的运用%The Application of Ultrasonic Cardiac Output Monitor In the Critically Ill Patients

    Institute of Scientific and Technical Information of China (English)

    杨勤; 向明芳

    2012-01-01

    Objective: To compare the cardiac output detected by ultrasonic cardiac output monitor(USCOM) and Thoracic Electrical Bioimpedance(TEB). Methods: The cardiac outputs of 40 critically ill patients were detected by USCOM and TEB simultaneously. Results: There was no significant difference of the cardiac output detected by USCOM and TEB(P>0.10), the correlation analysis showed a positive correlation between cardiac output measured with USCOM and TEB(correlation coefficient of CO: r=0.8427, correlation coefficient of SV: r=0.8392, P0.10);且两种监测方法测得的结果具有正相关性(CO相关系数 r=0.8427,SV相关系数 r=0.8392,P均<0.01).结论采用USCOM技术监测危重患者的心输出量具有无创、连续、简便、准确的特点.

  9. Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure.

    Science.gov (United States)

    Jakovljevic, Djordje G; George, Robert S; Donovan, Gay; Nunan, David; Henderson, Keiran; Bougard, Robert S; Yacoub, Magdi H; Birks, Emma J; Brodie, David A

    2010-06-15

    Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise. These were performed in 54 patients-20 with moderate to severe heart failure, 18 with implanted LVADs, and 16 with explanted LVADs. At rest there was a nonsignificant difference in CPO among groups (p >0.05). Peak CPO was significantly higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 1.90 +/- 0.45 W, implanted LVAD 2.37 +/- 0.55 W, explanted LVAD 3.39 +/- 0.61 W, p <0.01) as was peak cardiac output (heart failure 9.1 +/- 2.1 L/min, implanted LVAD 12.4 +/- 2.2 L/min, explanted LVD 14.6 +/- 2.9 L/min, p <0.01). Peak oxygen consumption was higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 15.8 +/- 4.1 ml/kg/min, implanted LVAD 19.8 +/- 5.8 ml/kg/min, explanted LVAD 28.2 +/- 5.0 ml/kg/min, p <0.05) as was anaerobic threshold (heart failure 11.2 +/- 1.9 ml/kg/min, implanted LVAD 14.7 +/- 4.9 ml/kg/min, explanted LVAD 21.4 +/- 5.0 ml/kg/min, p <0.05). In conclusion, peak CPO differentiates well during cardiac restoration using LVADs and emphasizes the benefits of this therapy. CPO has the potential to be a key physiologic marker of heart failure severity and can guide management of patients with LVAD.

  10. High-Precision Half-Wave Rectifier Circuit In Dual Phase Output Mode

    Directory of Open Access Journals (Sweden)

    Theerayut Jamjaem

    2009-12-01

    Full Text Available This paper present high-precision half-wave rectifier circuit in dual phase output mode by 0.5 μm CMOS technology, +/- 1.5 V low voltage, it has received input signal and sent output current signal, respond in high frequency. The main structure compound with CMOS inverter circuit, common source circuit, and current mirror circuit. Simulation and confirmation quality of working by PSpice program, then it able to operating at maximum frequency about 100 MHz, maximum input current range about 400 μAp-p, high precision output signal, low power dissipation, and uses a little transistor.Keywords-component; half-wave; rectifier circuit; highprecession; dual phase;

  11. Cardiac stimulation with high voltage discharge from stun guns.

    Science.gov (United States)

    Nanthakumar, Kumaraswamy; Massé, Stephane; Umapathy, Karthikeyan; Dorian, Paul; Sevaptsidis, Elias; Waxman, Menashe

    2008-05-20

    The ability of an electrical discharge to stimulate the heart depends on the duration of the pulse, the voltage and the current density that reaches the heart. Stun guns deliver very short electrical pulses with minimal amount of current at high voltages. We discuss external stimulation of the heart by high voltage discharges and review studies that have evaluated the potential of stun guns to stimulate cardiac muscle. Despite theoretical analyses and animal studies which suggest that stun guns cannot and do not affect the heart, 3 independent investigators have shown cardiac stimulation by stun guns. Additional research studies involving people are needed to resolve the conflicting theoretical and experimental findings and to aid in the design of stun guns that are unable to stimulate the heart.

  12. High-Output Heart Failure from a Hepatic Hemangioma With Exertion-Induced Hypoxia.

    Science.gov (United States)

    Smith, Aaron A H; Nelson, Matthew

    2016-01-01

    Patients with hepatic hemangiomas have been known to have high-output heart failure as a result of left-to-right arteriovenous shunting. We report a patient with a hepatic hemangioma that presented with high-output heart failure with hypoxia on exertion. After embolization of the hemangioma, the patient's hypoxia resolved and ejection fraction improved. In the absence of cardiopulmonary pathophysiology, we presume that our patient's hemangioma was causing a right-to-left shunt as opposed to an expected left-to-right shunt.

  13. Proton Pump Inhibitors in the Management of Tachypnoea following Panproctocolectomy: A Case of High Output Ileostomy

    Directory of Open Access Journals (Sweden)

    Neville Azzopardi

    2011-04-01

    Full Text Available High output ileostomies are important complications of stoma formation following bowel surgery. Adequate management of such stomas might prevent severe morbidity and mortality when this potentially fatal complication develops. In this case report, we describe a female patient with a recent ileostomy formation following panproctocolectomy for ulcerative colitis who presented with progressively increasing shortness of breath. The patient was found to have a hypochloraemic metabolic acidosis on arterial blood gases. She rapidly improved with adequate sodium and fluid replacement and with the use of a course of proton pump inhibitors. This case highlights the importance of recognising high output ileostomies early and important management issues in their regard.

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

    Science.gov (United States)

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

    2011-09-01

    We hypothesized that the role of stroke volume (SV) in the metaboreflex-induced cardiac output (CO) increase was blunted when the metaboreflex was stimulated by exercise muscle ischemia (EMI) compared with post-exercise muscle ischemia (PEMI), because during EMI heart rate (HR) increases and limits diastolic filling. Twelve healthy volunteers were recruited and their hemodynamic responses to the metaboreflex evoked by EMI, PEMI, and by a control dynamic exercise were assessed. The main finding was that the blood pressure increment was very similar in the EMI and PEMI settings. In both conditions the main mechanism used to raise blood pressure was a CO elevation. However, during the EMI test CO was increased as a result of HR elevation whereas during the PEMI test CO was increased as a result of an increase in SV. These results were explainable on the basis of the different HR behavior between the two settings, which in turn led to different diastolic time and myocardial performance.

  15. Development of Compact Ozonizer with High Ozone Output by Pulsed Power

    Science.gov (United States)

    Tanaka, Fumiaki; Ueda, Satoru; Kouno, Kanako; Sakugawa, Takashi; Akiyama, Hidenori; Kinoshita, Youhei

    Conventional ozonizer with a high ozone output using silent or surface discharges needs a cooling system and a dielectric barrier, and therefore becomes a large machine. A compact ozonizer without the cooling system and the dielectric barrier has been developed by using a pulsed power generated discharge. The wire to plane electrodes made of metal have been used. However, the ozone output was low. Here, a compact and high repetition rate pulsed power generator is used as an electric source of a compact ozonizer. The ozone output of 6.1 g/h and the ozone yield of 86 g/kWh are achieved at 500 pulses per second, input average power of 280 W and an air flow rate of 20 L/min.

  16. Generalized design of high performance shunt active power filter with output LCL filter

    DEFF Research Database (Denmark)

    Tang, Yi; Loh, Poh Chiang; Wang, Peng

    2012-01-01

    , the proposed SAPF offers superior switching harmonic suppression using much reduced passive filtering elements. Its output currents thus have high slew rate for tracking the targeted reference closely. Smaller inductance of the LCL filter also means smaller harmonic voltage drop across the passive output......This paper concentrates on the design, control, and implementation of an LCL-filter-based shunt active power filter (SAPF), which can effectively compensate for harmonic currents produced by nonlinear loads in a three-phase three-wire power system. With an LCL filter added at its output...... filter, which in turn minimizes the possibility of overmodulation, particularly for cases where high modulation index is desired. These advantages, together with overall system stability, are guaranteed only through proper consideration of critical design and control issues, like the selection of LCL...

  17. Determinants of VO(2) kinetics at high power outputs during a ramp exercise protocol.

    Science.gov (United States)

    Lucía, Alejandro; Rivero, José-Luis L; Pérez, Margarita; Serrano, Antonio L; Calbet, José A L; Santalla, Alfredo; Chicharro, José L

    2002-02-01

    To determine the relationship between the additional, nonlinear increase in oxygen uptake (Delta VO(2)) that occurs at high power outputs during a ramp cycle ergometer test, on one hand; and possible explanatory mechanisms of the phenomenon, such as cardiorespiratory work, blood lactate, fitness level, or muscle fiber distribution, on the other. Ten healthy, sedentary young adults (age (mean +/- SEM), 22 +/- 1 yr) were chosen as subjects. A muscle biopsy specimen was taken from the vastus lateralis of the right leg to determine fiber type distribution by immunohistochemical identification of myosin heavy chain (MHC) isoforms. During the ramp tests (power output increases of 5 W every 15-s interval), the ventilatory threshold (VT) and lactate threshold (LT) were measured. We defined Delta VO(2) as the difference between "true" VO(2) values observed at the maximal power output (VO(2)obs) and those expected (VO(2)exp) from the previous linear VO2:power output relationship below the VT. A nonlinear increase was observed in VO2 (Delta VO(2) = 239 +/- 79 mL x min(-1), P < 0.05 for VO(2)obs vs VO(2)exp), which was significantly correlated with the percentage of type IIX fibers (r = 0.80, P < 0.05). No other correlations were found between Delta VO(2) and possible explanatory mechanisms. A greater percentage of type IIX fibers is associated with a higher excess VO(2) at high power outputs (above VT).

  18. High-order finite element methods for cardiac monodomain simulations

    Directory of Open Access Journals (Sweden)

    Kevin P Vincent

    2015-08-01

    Full Text Available Computational modeling of tissue-scale cardiac electrophysiology requires numerically converged solutions to avoid spurious artifacts. The steep gradients inherent to cardiac action potential propagation necessitate fine spatial scales and therefore a substantial computational burden. The use of high-order interpolation methods has previously been proposed for these simulations due to their theoretical convergence advantage. In this study, we compare the convergence behavior of linear Lagrange, cubic Hermite, and the newly proposed cubic Hermite-style serendipity interpolation methods for finite element simulations of the cardiac monodomain equation. The high-order methods reach converged solutions with fewer degrees of freedom and longer element edge lengths than traditional linear elements. Additionally, we propose a dimensionless number, the cell Thiele modulus, as a more useful metric for determining solution convergence than element size alone. Finally, we use the cell Thiele modulus to examine convergence criteria for obtaining clinically useful activation patterns for applications such as patient-specific modeling where the total activation time is known a priori.

  19. A 5 cm single-discharge CO2 laser having high power output

    NARCIS (Netherlands)

    Ernst, G.J.; Boer, A.G.

    1980-01-01

    A single-discharge self-sustained CO2 laser has been constructed with a gap distance of 5 cm. The system has a very simple construction; it produces a very uniform discharge with an output power of 50 Joules per liter for a CO2 : N2 : He = 1 : 1 : 3 mixture. The efficiency can be as high as 19%.

  20. Analysis and design of a charge pump circuit for high output current applications

    NARCIS (Netherlands)

    Steenwijk, van Gijs; Hoen, Klaas; Wallinga, Hans

    1993-01-01

    A charge pump circuit has been developed that can deliver high currents even for a system supply voltage of 3 V. The circuit consists of capacitances, connected by MOS switches. The influence of the on-resistance of the switches on the circuit's output resistance has been analysed. The switches are

  1. Kinetics of Highly Sensitive Troponin T after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Amr S. Omar

    2015-01-01

    Full Text Available Perioperative myocardial infarction (PMI confers a considerable risk in cardiac surgery settings; finding the ideal biomarker seems to be an ideal goal. Our aim was to assess the diagnostic accuracy of highly sensitive troponin T (hsTnT in cardiac surgery settings and to define a diagnostic level for PMI diagnosis. This was a single-center prospective observational study analyzing data from all patients who underwent cardiac surgeries. The primary outcome was the diagnosis of PMI through a specific level. The secondary outcome measures were the lengths of mechanical ventilation (LOV, stay in the intensive care unit (LOSICU, and hospitalization. Based on the third universal definition of PMI, patients were divided into two groups: no PMI (Group I and PMI (Group II. Data from 413 patients were analyzed. Nine patients fulfilled the diagnostic criteria of PMI, while 41 patients were identified with a 5-fold increase in their CK-MB (≥120 U/L. Using ROC analysis, a hsTnT level of 3,466 ng/L or above showed 90% sensitivity and 90% specificity for the diagnosis of PMI. Secondary outcome measures in patients with PMI were significantly prolonged. In conclusion, the hsTnT levels detected here paralleled those of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI.

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

    Science.gov (United States)

    Shykoff, Barbara E.; Swanson, Harvey T.

    1987-01-01

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

  3. High-output LED-based light engine for profile lighting fixtures with high color uniformity using freeform reflectors.

    Science.gov (United States)

    Gadegaard, Jesper; Jensen, Thøger Kari; Jørgensen, Dennis Thykjær; Kristensen, Peter Kjær; Søndergaard, Thomas; Pedersen, Thomas Garm; Pedersen, Kjeld

    2016-02-20

    In the stage lighting and entertainment market, light engines (LEs) for lighting fixtures are often based on high-intensity discharge (HID) bulbs. Switching to LED-based light engines gives possibilities for fast switching, additive color mixing, a longer lifetime, and potentially, more energy-efficient systems. The lumen output of a single LED is still not sufficient to replace an HID source in high-output profile fixtures, but combining multiple LEDs can create an LE with a similar output, but with added complexity. This paper presents the results of modeling and testing such a light engine. Custom ray-tracing software was used to design a high-output red, green and blue LED-based light engine with twelve CBT-90 LEDs using a dual-reflector principle. The simulated optical system efficiency was 0.626 with a perfect (R=1) reflector coating for light delivered on a target surface through the entire optical system. A profile lighting fixture prototype was created, and provided an output of 6744 lumen and an efficiency of 0.412. The lower efficiency was mainly due to a non-optimal reflector coating, and the optimized design is expected to reach a significantly higher efficiency.

  4. High density, multi-range analog output Versa Module Europa board for control system applications

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Kundan, E-mail: kundan@iuac.res.in [Inter-University Accelerator Centre, P. O. Box 10502, New Delhi 110067 (India); Das, Ajit Lal [Netaji Subhas Institute of Technology (NSIT), New Delhi (India)

    2014-01-15

    A new VMEDAC64, 12-bit 64 channel digital-to-analog converter, a Versa Module Europa (VME) module, features 64 analog voltage outputs with user selectable multiple ranges, has been developed for control system applications at Inter University Accelerator Centre. The FPGA (Field Programmable Gate Array) is the module's core, i.e., it implements the DAC control logic and complexity of VMEbus slave interface logic. The VMEbus slave interface and DAC control logic are completely designed and implemented on a single FPGA chip to achieve high density of 64 channels in a single width VME module and will reduce the module count in the control system applications, and hence will reduce the power consumption and cost of overall system. One of our early design goals was to develop the VME interface such that it can be easily integrated with the peripheral devices and satisfy the timing specifications of VME standard. The modular design of this module reduces the amount of time required to develop other custom modules for control system. The VME slave interface is written as a single component inside FPGA which will be used as a basic building block for any VMEbus interface project. The module offers multiple output voltage ranges depending upon the requirement. The output voltage range can be reduced or expanded by writing range selection bits in the control register. The module has programmable refresh rate and by default hold capacitors in the sample and hold circuit for each channel are charged periodically every 7.040 ms (i.e., update frequency 284 Hz). Each channel has software controlled output switch which disconnects analog output from the field. The modularity in the firmware design on FPGA makes the debugging very easy. On-board DC/DC converters are incorporated for isolated power supply for the analog section of the board.

  5. High density, multi-range analog output Versa Module Europa board for control system applications.

    Science.gov (United States)

    Singh, Kundan; Das, Ajit Lal

    2014-01-01

    A new VMEDAC64, 12-bit 64 channel digital-to-analog converter, a Versa Module Europa (VME) module, features 64 analog voltage outputs with user selectable multiple ranges, has been developed for control system applications at Inter University Accelerator Centre. The FPGA (Field Programmable Gate Array) is the module's core, i.e., it implements the DAC control logic and complexity of VMEbus slave interface logic. The VMEbus slave interface and DAC control logic are completely designed and implemented on a single FPGA chip to achieve high density of 64 channels in a single width VME module and will reduce the module count in the control system applications, and hence will reduce the power consumption and cost of overall system. One of our early design goals was to develop the VME interface such that it can be easily integrated with the peripheral devices and satisfy the timing specifications of VME standard. The modular design of this module reduces the amount of time required to develop other custom modules for control system. The VME slave interface is written as a single component inside FPGA which will be used as a basic building block for any VMEbus interface project. The module offers multiple output voltage ranges depending upon the requirement. The output voltage range can be reduced or expanded by writing range selection bits in the control register. The module has programmable refresh rate and by default hold capacitors in the sample and hold circuit for each channel are charged periodically every 7.040 ms (i.e., update frequency 284 Hz). Each channel has software controlled output switch which disconnects analog output from the field. The modularity in the firmware design on FPGA makes the debugging very easy. On-board DC/DC converters are incorporated for isolated power supply for the analog section of the board.

  6. Wide-Range Temperature Sensors with High-Level Pulse Train Output

    Science.gov (United States)

    Hammoud, Ahmad; Patterson, Richard L.

    2009-01-01

    Two types of temperature sensors have been developed for wide-range temperature applications. The two sensors measure temperature in the range of -190 to +200 C and utilize a thin-film platinum RTD (resistance temperature detector) as the temperature-sensing element. Other parts used in the fabrication of these sensors include NPO (negative-positive- zero) type ceramic capacitors for timing, thermally-stable film or wirewound resistors, and high-temperature circuit boards and solder. The first type of temperature sensor is a relaxation oscillator circuit using an SOI (silicon-on-insulator) operational amplifier as a comparator. The output is a pulse train with a period that is roughly proportional to the temperature being measured. The voltage level of the pulse train is high-level, for example 10 V. The high-level output makes the sensor less sensitive to noise or electromagnetic interference. The output can be read by a frequency or period meter and then converted into a temperature reading. The second type of temperature sensor is made up of various types of multivibrator circuits using an SOI type 555 timer and the passive components mentioned above. Three configurations have been developed that were based on the technique of charging and discharging a capacitor through a resistive element to create a train of pulses governed by the capacitor-resistor time constant. Both types of sensors, which operated successfully over the wide temperature range, have potential use in extreme temperature environments including jet engines and space exploration missions.

  7. Central venous oxygen saturation in septic shock - a marker of cardiac output, microvascular shunting and/or dysoxia?

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2011-01-01

    Shock therapy aims at increasing central venous oxygen saturation (ScvO2), which is a marker of inadequate oxygen delivery. In this issue of Critical Care, Textoris and colleagues challenge this notion by reporting that high levels of ScvO2 are associated with mortality in patients with septic...

  8. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

    OpenAIRE

    Uygar Teomete; Rubee Anne Gugol; Holly Neville; Ozgur Dandin; Ming-Lon Young

    2016-01-01

    Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention b...

  9. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output

    DEFF Research Database (Denmark)

    Smerup, Morten Holdgaard; Damkjær, Mads; Brøndum, Emil

    2016-01-01

    cavity and a relatively thick ventricular wall, allowing for generation of high arterial pressures at normal left ventricular wall tension. In nine anaesthetized giraffes (495±38 kg), we determined in vivo ventricular dimensions using echocardiography along with intraventricular and aortic pressures......Giraffes--the tallest extant animals on Earth--are renowned for their high central arterial blood pressure, which is necessary to secure brain perfusion. Arterial pressure may exceed 300 mmHg and has historically been attributed to an exceptionally large heart. Recently, this has been refuted...... by several studies demonstrating that the mass of giraffe heart is similar to that of other mammals when expressed relative to body mass. It thus remains unexplained how the normal-sized giraffe heart generates such massive arterial pressures. We hypothesized that giraffe hearts have a small intraventricular...

  10. High repetition rate Q-switched radially polarized laser with a graphene-based output coupler

    Energy Technology Data Exchange (ETDEWEB)

    Li, Lifei; Jin, Chenjie; Qi, Mei; Chen, Xiaoming; Ren, Zhaoyu, E-mail: zhengxl@nwu.edu.cn, E-mail: rzy@nwu.edu.cn [National Key Laboratory of Photoelectric Technology and Functional Materials (Culture Base), and Institute of Photonics and Photon-Technology, Northwest University, Xi' an 710069 (China); Zheng, Xinliang, E-mail: zhengxl@nwu.edu.cn, E-mail: rzy@nwu.edu.cn [Department of Physics, Northwest University, Xi' an 710069 (China); Bai, Jintao [National Key Laboratory of Photoelectric Technology and Functional Materials (Culture Base), and Institute of Photonics and Photon-Technology, Northwest University, Xi' an 710069 (China); Department of Physics, Northwest University, Xi' an 710069 (China); Sun, Zhipei [Department of Micro- and Nanosciences, Aalto University, P.O. Box 13500, FI-00076 Aalto (Finland)

    2014-12-01

    We demonstrate a Q-switched radially polarized all-solid-state laser by transferring a graphene film directly onto an output coupler. The laser generates Q-switched radially polarized beam (QRPB) with a pulse width of 192 ns and 2.7 W average output power. The corresponding single pulse energy is up to 16.2 μJ with a high repetition rate of 167 kHz. The M{sup 2} factor and the polarization purity are ∼2.1 and 96%, respectively. Our QRPB source is a simple and low-cost source for a variety of applications, such as industrial material processing, optical trapping, and microscopy.

  11. Direct recording of cardiac output- and venous return-curves in the dog heart-lung preparation for a graphical analysis of the effects of cardioactive drugs.

    Science.gov (United States)

    Ishikawa, N; Taki, K; Hojo, Y; Hagino, Y; Shigei, T

    1978-09-01

    The dog heart-lung preparations were prepared. The "equilibrium point", which could be defined as the point at which the cardiac output (CO)-curve and the venous return (VR)-curve crossed, when the CO and VR were plotted against the right atrial pressure, was recorded directly by utilizing an X-Y recorder. The CO-curve was obtained, as a locus of the equilibrium point, by raising and lowering the level of blood in the venous reservoir (competence test). The meaning of the procedure was shown to increase or decrease the mean systemic pressure, and to cause the corresponding parallel shift in the VR-curve. The VR-curve was obtained by changing myocardial contractility. When heart failure was induced by pentobarbital or by chloroform, the equilibrium point shifted downwards to the right, depicting the VR-curve. During development of the failure, the slopes of CO-curves decreased gradually. Effects of cinobufagin and norepinephrine were also analyzed. Utilization of the X-Y recorder enabled us to settle the uniform experimental conditions more easily, and to follow the effects of drugs continuously on a diagram equating the CO- and VR-curves (Gyton's scheme).

  12. A Novel Idea to Improve Cardiac Output of Mechanical Circulatory Support Devices by Optimizing Kinetic Energy Transfer Available in Forward Moving Aortic Blood Flow.

    Science.gov (United States)

    Qureshi, Muhammad B; Glower, Jacob; Ewert, Daniel L; Koenig, Steven C

    2017-06-01

    Mechanical circulatory support devices (MCSDs) have gained widespread clinical acceptance as an effective heart failure (HF) therapy. The concept of harnessing the kinetic energy (KE) available in the forward aortic flow (AOF) is proposed as a novel control strategy to further increase the cardiac output (CO) provided by MCSDs. A complete mathematical development of the proposed theory and its application to an example MCSDs (two-segment extra-aortic cuff) are presented. To achieve improved device performance and physiologic benefit, the example MCSD timing is regulated to maximize the forward AOF KE and minimize retrograde flow. The proof-of-concept was tested to provide support with and without KE control in a computational HF model over a wide range of HF test conditions. The simulation predicted increased stroke volume (SV) by 20% (9 mL), CO by 23% (0.50 L/min), left ventricle ejection fraction (LVEF) by 23%, and diastolic coronary artery flow (CAF) by 55% (3 mL) in severe HF at a heart rate (HR) of 60 beats per minute (BPM) during counterpulsation (CP) support with KE control. The proposed KE control concept may improve performance of other MCSDs to further enhance their potential clinical benefits, which warrants further investigation. The next step is to investigate various assist technologies and determine where this concept is best applied. Then bench-test the combination of kinetic energy optimization and its associated technology choice and finally test the combination in animals.

  13. G16R single nucleotide polymorphism but not haplotypes of the ß2-adrenergic receptor gene alters cardiac output in humans

    DEFF Research Database (Denmark)

    Rokamp, Kim Z; Staalsø, Jonatan M; Gartmann, Martin

    2013-01-01

    studied. Five SNPs within ADRB2 (46G>A, 79C>G, 491C>T, 523C>A and 1053G>C by a pairwise tagging principle) and the I/D (insertion/deletion) polymorphism in ACE were genotyped in 143 subjects. Cardiovascular variables were evaluated by the Model flow method at rest and during incremental cycling exercise......Variation in genes encoding the ß2-adrenergic receptor (ADRB2) and angiotensin-converting enzyme (ACE) may influence Q¿ (cardiac output). The 46G>A (G16R) SNP (single nucleotide polymorphism) has been associated with ß2-mediated vasodilation, but the effect of ADRB2 haplotypes on Q¿ has not been...... V¿O2 (oxygen uptake) in G16G subjects, but the increase was 0.5 (0.0-0.9) l/min lower in Arg16 carriers (P=0.035). A similar effect size was observed for the Arg16 haplotypes ACCCG and ACCCC. No interaction was found between ADRB2 and ACE polymorphisms. During exercise, the increase in Q¿ was 0...

  14. Optimization and design of inter-stage amplifier with wide output swing,high speed and high accuracy

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yi-qiang; SUN Quan; GAO Jing

    2008-01-01

    To satisfy the design requirements of analog-to-digital converter (ADC) of high speed sampling sys-tem in an infrared focal plane array tester with 1024 × 1024 pixels, a first inter-stage amplifier of 12-bit 40-Msample/s pipelined ADC was designed with 0.35 μm CMOS technology. On the basis of traditional two-stage amplifier, the cross-coupled class AB output stage and cascode compensation were adopted to improve the out-put voltage swing and bandwidth. Power dissipation was optimized with math tools. Circuit and layout design were completed. Simulation results show that the designed amplifier has good performance of 95 dB de gain, ±2 V output voltage swing, 190 MHz bandwidth and 63° phase margin with feedback factor 1/4, 33 mW pow-er dissipation and so on, which can meet the system requirements.

  15. Cardiac diastolic dysfunction in high-fat diet fed mice is associated with lipotoxicity without impairment of cardiac energetics in vivo

    NARCIS (Netherlands)

    Abdurrachim, Desiree; Ciapaite, Jolita; Wessels, Bart; Nabben, Miranda; Luiken, Joost J. F. P.; Nicolay, Klaas; Prompers, Jeanine J.

    2014-01-01

    Obesity is often associated with abnormalities in cardiac morphology and function. This study tested the hypothesis that obesity-related cardiomyopathy is caused by impaired cardiac energetics. In a mouse model of high-fat diet (HFD)-induced obesity, we applied in vivo cardiac P-31 magnetic resonanc

  16. A highly efficient PV system using a series connection of DC-DC converter output with a photovoltaic panel

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ho-sung [Department of Electrical Engineering, Pusan National University, Jangjeon-dong, Geumjeong-gu, Busan 609-735 (Korea); New and Renewable Energy System Research Center, Korea Electro-technology Research Institute, 28-1, Sungju-dong Changwon-si, Kyungsannam-do, 641-120 (Korea); Kim, Jong-Hyun; Min, Byung-Duk; Yoo, Dong-Wook [New and Renewable Energy System Research Center, Korea Electro-technology Research Institute, 28-1, Sungju-dong Changwon-si, Kyungsannam-do, 641-120 (Korea); Kim, Hee-Je [Department of Electrical Engineering, Pusan National University, Jangjeon-dong, Geumjeong-gu, Busan 609-735 (Korea)

    2009-11-15

    A photovoltaic (PV) power conditioning system (PCS) must have high conversion efficiency and low cost. Generally, a PV PCS uses either a single string converter or a multilevel module integrated converter (MIC). Each of these approaches has both advantages and disadvantages. For a high conversion efficiency and low cost PV module, a series connection of a module integrated DC-DC converter output with a photovoltaic panel was proposed. The output voltage of the PV panel is connected to the output capacitor of the fly-back converter. Thus, the converter output voltage is added to the output voltage of the PV panel. The isolated DC-DC converter generates only the difference voltage between the PV panel voltage and the required total output voltage. This method reduces the power level of the DC-DC converter and enhances energy conversion efficiency compared with a conventional DC-DC converter. (author)

  17. Research on a Linear Piezoelectric Actuator Using T-Shape Transducer to Realize High Mechanical Output

    Directory of Open Access Journals (Sweden)

    Sijia Shao

    2016-04-01

    Full Text Available A modified large thrust ultrasonic linear motor using a T-shape configuration composed of two orthogonal sandwich-type transducers has been proposed in this paper. It is an improved version of a previous T-shape motor. The vertical transducer is used to generate the normal force between the driving foot and slider, while the other push-pull–type horizontal transducer is applied to generate driving force to push the working platform. By superimposing the two longitudinal vibrations, the proposed motor generates an elliptical movement on the driving foot. In order to improve the vibration characteristics and amplify the driving vibration amplitude, the shape of the driving foot and horn have been redesigned and optimized. The finite element method (FEM is used to adjust the structural parameters to degenerate the two working mode frequencies. The prototype has been fabricated and its mechanical output ability has been measured. The output characteristics of the modified motor, compared with the previous T-shape motor, achieve a relatively high level. The typical no-load speed and maximum output thrust of the prototype are 0.83 m/s and 56 N under an exciting voltage of 150 Vrms.

  18. Cardiac-respiratory self-gated cine ultra-short echo time (UTE) cardiovascular magnetic resonance for assessment of functional cardiac parameters at high magnetic fields.

    Science.gov (United States)

    Hoerr, Verena; Nagelmann, Nina; Nauerth, Arno; Kuhlmann, Michael T; Stypmann, Jörg; Faber, Cornelius

    2013-07-04

    To overcome flow and electrocardiogram-trigger artifacts in cardiovascular magnetic resonance (CMR), we have implemented a cardiac and respiratory self-gated cine ultra-short echo time (UTE) sequence. We have assessed its performance in healthy mice by comparing the results with those obtained with a self-gated cine fast low angle shot (FLASH) sequence and with echocardiography. 2D self-gated cine UTE (TE/TR = 314 μs/6.2 ms, resolution: 129 × 129 μm, scan time per slice: 5 min 5 sec) and self-gated cine FLASH (TE/TR = 3 ms/6.2 ms, resolution: 129 × 129 μm, scan time per slice: 4 min 49 sec) images were acquired at 9.4 T. Volume of the left and right ventricular (LV, RV) myocardium as well as the end-diastolic and -systolic volume was segmented manually in MR images and myocardial mass, stroke volume (SV), ejection fraction (EF) and cardiac output (CO) were determined. Statistical differences were analyzed by using Student t test and Bland-Altman analyses. Self-gated cine UTE provided high quality images with high contrast-to-noise ratio (CNR) also for the RV myocardium (CNRblood-myocardium = 25.5 ± 7.8). Compared to cine FLASH, susceptibility, motion, and flow artifacts were considerably reduced due to the short TE of 314 μs. The aortic valve was clearly discernible over the entire cardiac cycle. Myocardial mass, SV, EF and CO determined by self-gated UTE were identical to the values measured with self-gated FLASH and showed good agreement to the results obtained by echocardiography. Self-gated UTE allows for robust measurement of cardiac parameters of diagnostic interest. Image quality is superior to self-gated FLASH, rendering the method a powerful alternative for the assessment of cardiac function at high magnetic fields.

  19. The effect of intermittent intraabdominal pressure elevations and low cardiac output on the femoral to carotid arterial blood pressure difference in piglets.

    Science.gov (United States)

    Aksakal, Devrim; Hückstädt, Thomas; Richter, Steffen; Klitscher, Daniela; Wowra, Tobias; Schier, Felix; Wessel, Lucas M; Kubiak, Rainer

    2016-11-01

    Our previous work in a laparoscopic setting in piglets revealed that the systolic femoral artery pressure was approximately 5 % higher than its carotid counterpart, whereas the mean and diastolic values showed no significant difference. This remained idem when the intraabdominal pressure (IAP) was gradually increased. In this study, we aimed to investigate the effect of (1) intermittent IAP elevations and (2) a low cardiac output (CO) on the blood pressure (BP) difference cranially (carotid artery) and caudally (femoral artery) of a capnoperitoneum (ΔP = P a fem-P a carot). A total of twenty-two piglets (mean body weight 11.0 kg; range 8.9-13.3 kg) were studied. Of these, 14 underwent intermittent IAP elevations at 8 and 16 mmHg, and ΔP was measured. In another 8 piglets, a model of reduced CO was created by introducing an air embolism (2 ml/kg over 30 s) in the inferior caval vein (VCI) at 12 mmHg IAP to further assess the influence of this variable on ΔP. Systolic ΔP remained at a mean of 5.6 mmHg and was not significantly affected by insufflation or exsufflation up to an IAP of 16 mmHg. Diastolic and mean values showed no differences between P a carot and P a fem. P a fem, systol remained higher than its carotid counterpart as long as the cardiac index (CI) was above 1.5 l/min/m(2), but fell significantly below P a carot, systol at a low CI. There was no CO-dependent effect on diastolic and mean ΔP. Repeated IAP elevations do not significantly influence ΔP. Intermittent IAP elevations do not significantly influence ΔP. Despite of a CO-dependent inversion of systolic ΔP, mean BP measurements at the leg during laparoscopy remain representative even at low CO values.

  20. High Output Maximum Efficiency Resonator (HOMER) Laser for NASA's Global Ecosystem Dynamics Investigation (GEDI) Lidar Mission

    Science.gov (United States)

    Stysley, Paul; Coyle, Barry; Clarke, Greg; Poulios, Demetrios; Kay, Richard

    2015-01-01

    The Global Ecosystems Dynamics Investigation (GEDI) is a planned mission sending a LIDAR instrument to the International Space Station that will employ three NASA laser transmitters. This instrument will produce parallel tracks on the Earth's surface that will provide global 3D vegetation canopy measurements. To meet the mission goals a total of 5 High Output Maximum Efficiency Resonator lasers will to be built (1 ETU + 3 Flight + 1 spare) in-house at NASA-GSFC. This presentation will summarize the HOMER design, the testing the design has completed in the past, and the plans to successfully build the units needed for the GEDI mission.

  1. Single session of sprint interval training elicits similar cardiac output but lower oxygen uptake versus ramp exercise to exhaustion in men and women

    Science.gov (United States)

    Horn, Trevor; Roverud, Garret; Sutzko, Kandice; Browne, Melissa; Parra, Cristina; Astorino, Todd A

    2016-01-01

    Sprint interval training (SIT) elicits comparable long-term adaptations versus continuous exercise training (CEX) including increased maximal oxygen uptake (VO2max) and fat utilization. However, there is limited research examining acute hemodynamic responses to SIT. The aim of this study was to examine hemodynamic responses to low-volume SIT. Active men (n=6, VO2max = 39.8 ± 1.7 mL/kg/min) and women (n=7, VO2max = 37.3 ± 5.7 mL/kg/min) performed a ramp-based VO2max test (RAMP) to determine workload for the SIT session. Subjects returned within 1 wk and completed a session of SIT consisting of six 30-s bouts of “all-out” cycling at 130% maximal workload (Wmax) interspersed with 120 s of active recovery. Continuously during RAMP and exercise and recovery in SIT, VO2 was obtained and thoracic impedance was used to estimate heart rate (HR), stroke volume (SV), and cardiac output (CO). Results revealed no significant differences in COmax (p = 0.12, 19.7 ± 2.4 L/min vs. 20.3 ± 1.8 L/min) but lower SVmax (p = 0.004, 110.4 ± 15.7 mL vs. 119.4 ± 15.5 mL) in RAMP versus SIT. HRmax from SIT (179.0 ± 11.8 b/min) was lower (p = 0.008) versus RAMP (184.4 ± 7.9 b/min). Peak VO2 (L/min) was lower (p Sprint interval training consisting of 3 min of supramaximal exercise elicits similar CO yet lower VO2 compared to RAMP.

  2. High-sensitivity Cardiac Troponin Elevation after Electroconvulsive Therapy: A Prospective, Observational Cohort Study.

    Science.gov (United States)

    Duma, Andreas; Pal, Swatilika; Johnston, Joshua; Helwani, Mohammad A; Bhat, Adithya; Gill, Bali; Rosenkvist, Jessica; Cartmill, Christopher; Brown, Frank; Miller, J Philip; Scott, Mitchell G; Sanchez-Conde, Francisco; Jarvis, Michael; Farber, Nuri B; Zorumski, Charles F; Conway, Charles; Nagele, Peter

    2017-04-01

    While electroconvulsive therapy is widely regarded as a lifesaving and safe procedure, evidence regarding its effects on myocardial cell injury is sparse. The objective of this investigation was to determine the incidence and magnitude of new cardiac troponin elevation after electroconvulsive therapy using a novel high-sensitivity cardiac troponin I assay. This was a prospective cohort study in adult patients undergoing electroconvulsive therapy in a single academic center (up to three electroconvulsive therapy treatments per patient). The primary outcome was new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy, defined as an increase of high-sensitivity cardiac troponin I greater than 100% after electroconvulsive therapy compared to baseline with at least one value above the limit of quantification (10 ng/l). Twelve-lead electrocardiogram and high-sensitivity cardiac troponin I values were obtained before and 15 to 30 min after electroconvulsive therapy; in a subset of patients, an additional 2-h high-sensitivity cardiac troponin I value was obtained. The final study population was 100 patients and a total of 245 electroconvulsive therapy treatment sessions. Eight patients (8 of 100; 8%) experienced new high-sensitivity cardiac troponin I elevation after electroconvulsive therapy with a cumulative incidence of 3.7% (9 of 245 treatments; one patient had two high-sensitivity cardiac troponin I elevations), two of whom had a non-ST-elevation myocardial infarction (incidence 2 of 245; 0.8%). Median high-sensitivity cardiac troponin I concentrations did not increase significantly after electroconvulsive therapy. Tachycardia and/or elevated systolic blood pressure developed after approximately two thirds of electroconvulsive therapy treatments. Electroconvulsive therapy appears safe from a cardiac standpoint in a large majority of patients. A small subset of patients with preexisting cardiovascular risk factors, however, may develop new

  3. Fistuloclysis improves liver function and nutritional status in patients with high-output upper enteric fistula.

    Science.gov (United States)

    Wu, Yin; Ren, Jianan; Wang, Gefei; Zhou, Bo; Ding, Chao; Gu, Guosheng; Chen, Jun; Liu, Song; Li, Jieshou

    2014-01-01

    Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF). Methods. Patients were assigned into the fistuloclysis group (n = 35, receiving fistuloclysis plus total enteral nutrition (TEN)) and the control group (n = 60, receiving TEN). Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB): 20.3 ± 9.7 in the fistuloclysis group versus 15.6 ± 6.3 in the control group, P = 0.040; Delta direct bilirubin (DB): 12.5 ± 3.4 versus 10.0 ± 3.6, P = 0.011; Delta alkaline phosphatase (ALP): 98.4 ± 33.5 versus 57.6 ± 20.9, P fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients.

  4. An Optimized Grey Dynamic Model for Forecasting the Output of High-Tech Industry in China

    Directory of Open Access Journals (Sweden)

    Zheng-Xin Wang

    2014-01-01

    Full Text Available The grey dynamic model by convolution integral with the first-order derivative of the 1-AGO data and n series related, abbreviated as GDMC(1,n, performs well in modelling and forecasting of a grey system. To improve the modelling accuracy of GDMC(1,n, n interpolation coefficients (taken as unknown parameters are introduced into the background values of the n variables. The parameters optimization is formulated as a combinatorial optimization problem and is solved collectively using the particle swarm optimization algorithm. The optimized result has been verified by a case study of the economic output of high-tech industry in China. Comparisons of the obtained modelling results from the optimized GDMC(1,n model with the traditional one demonstrate that the optimal algorithm is a good alternative for parameters optimization of the GDMC(1,n model. The modelling results can assist the government in developing future policies regarding high-tech industry management.

  5. The Improved Power of the Central Lobe in the Beam Combination and High Power Output

    Institute of Scientific and Technical Information of China (English)

    LIU Hou-Kang; WEI Yun-Rong; DONG Jing-Xing; LOU Qi-Hong; XUE Yu-Hao; LI Zhen; HE Bing; ZHOU Jun; DING Ya-Qian; JIAO Meng-Li; LIU Chi; QI Yun-Feng

    2012-01-01

    In order to increase the power fraction of the central lobe in the coherent beam combination of lasers in an array,the effects of the distance factor of near-field distribution on far-field interference patterns are calculated and demonstrated experimentally.An improved beam array of interwoven distribution is demonstrated to enable the power in the central lobe to reach 41%.An optimized mirror array is carefully designed to obtain a high duty ratio,which is up to 53.3% at a high power level.By using these optimized methods and designs,the passive phase locking of eight Yb-doped fiber amplifiers with ring cavities are obtained,and a pleasing interference pattern with 87% visibility is observed.The maximum coherent output power of the system is up to 1066 W.%In order to increase the power fraction of the central lobe in the coherent beam combination of lasers in an array, the effects of the distance factor of near-field distribution on far-field interference patterns are calculated and demonstrated experimentally. An improved beam array of interwoven distribution is demonstrated to enable the power in the central lobe to reach 41%. An optimized mirror array is carefully designed to obtain a high duty ratio, which is up to 53.3% at a high power level. By using these optimized methods and designs, the passive phase locking of eight Yb-doped fiber amplifiers with ring cavities are obtained, and a pleasing interference pattern with 87% visibility is observed. The maximum coherent output power of the system is up to 1066 W.

  6. Microgap thermophotovoltaic systems with low emission temperature and high electric output

    Science.gov (United States)

    Mirmoosa, M. S.; Omelyanovich, M.; Simovski, C. R.

    2016-11-01

    We theoretically show that a thermophotovoltaic (TPV) system enhanced by a wire metamaterial opens the door to a prospective microgap TPVs which will combine high electric output with relatively low temperatures of the emitter. The suggested system comprises an array of parallel metal nanowires grown on top of a photovoltaic semiconductor and standing free in the vacuum gap between the host dielectric layer and the emitter, so that their ends are sufficiently close to the emitting surface. Due to the resonant near-field coupling between this wire medium and the emitter and due to the optimized layered structure of the whole system, the strongly super-Planckian radiative heat flux of resonant nature is engineered. In the suggested system, heavily doped silicon and indium antimonide are considered as the materials for the emitter and the photovoltaic cell, respectively. Also, the parallel nanowires are made of tungsten. Employing the minority-carrier transport model, it is shown that a power output equal to 26 kW m-2 can be achieved when the temperature of the doped-silicon emitter is only 500 °C.

  7. Depict noise-driven nonlinear dynamic networks from output data by using high-order correlations

    CERN Document Server

    Chen, Yang; Chen, Tianyu; Wang, Shihong; Hu, Gang

    2016-01-01

    Many practical systems can be described by dynamic networks, for which modern technique can measure their output signals, and accumulate extremely rich data. Nevertheless, the network structures producing these data are often deeply hidden in these data. Depicting network structures by analysing the available data turns to be significant inverse problems. On one hand, dynamics are often driven by various unknown facts, called noises. On the other hand, network structures of practical systems are commonly nonlinear, and different nonlinearities can provide rich dynamic features and meaningful functions of realistic networks. So far, no method, both theoretically or numerically, has been found to systematically treat the both difficulties together. Here we propose to use high-order correlation computations (HOCC) to treat nonlinear dynamics; use two-time correlations to treat noise effects; and use suitable basis and correlator vectors to unifiedly depict all dynamic nonlinearities and topological interaction l...

  8. Systematic Observation of Time-Dependent Phenomena in the RF Output Spectrum of High Power Gyrotrons

    Directory of Open Access Journals (Sweden)

    Kern Stefan

    2012-09-01

    Full Text Available At IHM/KIT, high power gyrotrons with conventional cavity (e.g. 1 MW CW at 140 GHz for the stellarator Wendelstein 7-X and coaxial cavity (2 MW shortpulse at 170 GHz for ITER for fusion applications are being developed and verified experimentally. Especially with respect to the problem of parasitic RF oscillations in the beam tunnel of some W7-X tubes, investigations of the gyrotron RF output spectrum have proved to be a valuable source of diagnostic information. Signs of transient effects in millisecond pulses, like frequency switching or intermittent low-frequency modulation, have indicated that truly time-dependent measurements with high frequency resolution and dynamic range could give deeper insight into these phenomena. In this paper, an improved measurement system is presented, which employs a fast oscilloscope as receiver. Shorttime Fourier transform (STFT is applied to the time-domain signal, yielding time-variant spectra with frequency resolutions only limited by acquisition length and STFT segmentation choice. Typical reasonable resolutions are in the range of 100 kHz to 10 MHz with a currently memory-limited maximum acquisition length of 4 ms. A key feature of the system consists in the unambiguity of frequency measurement: The system receives through two parallel channels, each using a harmonic mixer (h = 9 – 12 to convert the signal from RF millimeter wave frequencies (full D-Band, 110 – 170 GHz to IF (0 – 3 GHz. For each IF output signal of each individual mixer, injection side and receiving harmonic are initially not known. Using accordingly determined LO frequencies, this information is retrieved from the redundancy of the channels, yielding unambiguously reconstructed RF spectra with a total span of twice the usable receiver IF bandwidth, up to ≈ 6 GHz in our case. Using the system, which is still being improved continuously, various transient effects like cavity mode switching, parasitic oscillation frequency variation

  9. Multiple-input multiple-output based high density on-chip optical interconnect

    Science.gov (United States)

    Shen, Po-Kuan; Xu, Xiaochuan; Hosseini, Amir; Pan, Zeyu; Chen, Ray T.

    2015-03-01

    In on-chip optical interconnect, dielectric waveguide arrays are usually designed with pitches of a few wavelengths to avoid crosstalk, which greatly limits the integration density. In this paper, we for the first time propose to use multipleinput multiple-output (MIMO), a well-known technique in wireless communication, to recover the data from entangled signals and reduce the waveguide pitch to subwavelength range. In the proposed on-chip MIMO system, there is significant coupling among the adjacent waveguides in the high density waveguide region. In order to recover signals, the N×N transmission matrix of N high-density waveguides is calculated to describe the relation between each input ports and output ports. In the receiving part, homodyne coherent receivers are used to receive the transmitted signals, and obtain the signal in phase and ?/2 out of phase with local oscillator. In the electrical signal processing, the inverse transmission matrix is utilized to recover the signals in the electronic domain. To verify the proposed on-chip MIMO, we used the INTERCONNECT package in Lumerical software to simulate a 10x10 MIMO system. The cross section of each waveguide is 500 nm x 220 nm. The spacing is 250 nm. The simulation verifies the possibility of recovering 10 Gbps data from the heavily coupled 10 waveguides with a BER better than 10-12. The minimum input optical power for a BER of 10-12 is greater than -18.1 dBm, and the maximum phase shift between input laser and local oscillator can reach to 73.5˚.

  10. Lvad pump speed increase is associated with increased peak exercise cardiac output and vo2, postponed anaerobic threshold and improved ventilatory efficiency.

    Science.gov (United States)

    Vignati, Carlo; Apostolo, Anna; Cattadori, Gaia; Farina, Stefania; Del Torto, Alberico; Scuri, Silvia; Gerosa, Gino; Bottio, Tomaso; Tarzia, Vincenzo; Bejko, Jonida; Sisillo, Erminio; Nicoli, Flavia; Sciomer, Susanna; Alamanni, Francesco; Paolillo, Stefania; Agostoni, Piergiuseppe

    2017-03-01

    Peak exercise cardiac output (CO) increase is associated with an increase of peak oxygen uptake (VO2), provided that arteriovenous O2 difference [Δ(Ca-Cv)O2] does not decrease. At anaerobic threshold, VO2, is related to CO. We tested the hypothesis that, in heart failure (HF) patients with left ventricular assistance device (LVAD), an acute increase of CO obtained through changes in LVAD pump speed is associated with peak exercise and anaerobic threshold VO2 increase. Fifteen of 20 patients bearing LVAD (Jarvik 2000) enrolled in the study successfully performed peak exercise evaluation. All patients had severe HF as shown by clinical evaluation, laboratory tests, echocardiography, spirometry with alveolar-capillary diffusion, and maximal cardiopulmonary exercise testing (CPET). CPETs with non-invasive CO measurements at rest and peak exercise were done on 2days at LVAD pump speed set randomly at 2 and 4. Increasing LVAD pump speed from 2 to 4 increased CO from 3.4±0.9 to 3.8±1.0L/min (ΔCO 0.4±0.6L/min, p=0.04) and from 5.3±1.3 to 5.9±1.4L/min (ΔCO 0.6±0.7L/min, pincreased from 788±169 to 841±152mL/min (ΔVO2 52±76mL/min, p=0.01) and from 568±116 to 619±124mL/min (ΔVO2 69±96mL/min, p=0.02) at peak exercise and at anaerobic threshold, respectively. Δ(Ca-Cv)O2 did not change significantly, while ventilatory efficiency improved (VE/VCO2 slope from 39.9±5.4 to 34.9±8.3, ΔVE/VCO2 -5.0±6.4, pincrease in CO with a higher LVAD pump speed is associated with increased peak VO2, postponed anaerobic threshold, and improved ventilatory efficiency. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study.

    Science.gov (United States)

    Slagt, Cornelis; Helmi, Mochamat; Malagon, Ignacio; Groeneveld, A B Johan

    2015-01-01

    Cardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock. To compare calibrated arterial pressure waveform analysis-derived CO (COap, VolumeView/EV1000) and the uncalibrated form (COfv, FloTrac/Vigileo) with transpulmonary thermodilution derived CO (COtptd). A prospective, observational, single-centre study. ICU of a general teaching hospital. Twenty consecutive patients with severe sepsis or septic shock requiring haemodynamic monitoring by VolumeView/EV1000 and receiving mechanical ventilation. Connection of FloTrac/Vigileo to radial artery catheter already in situ. Radial (COfv) and femoral (COap) arterial waveform-derived CO measurements were compared with COtptd with respect to bias, precision, limits of agreement and percentage error, and the percentage error in the course of time since the last calibration of COap by COtptd. In comparing COap with COtptd (n = 267 paired measurements), the bias was 0.02 and limits of agreement were -2.49 to 2.52 l min, with a percentage error of 31%. The percentage error between COap and COtptd remained less than 30% until 8 h after calibration. In comparing COfv with COtptd (n = 301), the bias was -0.86 l min and limits of agreement were -4.48 to 2.77 l min, with a percentage error of 48%. The biases of COap and COfv correlated with systemic vascular resistance [r = 0.13 (P = 0.029) and r = 0.42 (P arterial waveform analysis technique. Compared with the uncalibrated COfv, the recently introduced calibrated arterial pressure waveform analysis-derived COap was more accurate and less dependent on vascular tone for up to 8 hours after callibation when monitoring CO in patients with severe sepsis and septic shock. The COap and COfv methods have poor to moderate CO-tracking abilities.

  12. A Simple MPPT Algorithm for Novel PV Power Generation System by High Output Voltage DC-DC Boost Converter

    DEFF Research Database (Denmark)

    Sanjeevikumar, Padmanaban; Grandi, Gabriele; Wheeler, Patrick

    2015-01-01

    This paper presents the novel topology of Photo Voltaic (PV) power generation system with simple Maximum Power Point Tracking (MPPT) algorithm in voltage operating mode. Power circuit consists of high output voltage DC-DC boost converter which maximizes the output of PV panel. Usually traditional...... of DC-DC converters for PV integration. Hence, to overcome these difficulties this paper investigates a DC-DC boost converter together with the additional parasitic component within the circuit to provide high output voltages for maximizing the PV power generation. The proposed power system circuit...... substantially improves the high output-voltage by a simple MPPT closed loop proportional-integral (P-I) controller, and requires only two sensor for feedback needs. The complete numerical model of the converter circuit along with PV MPPT algorithm is developed in numerical simulation (Matlab/Simulink) software...

  13. Performance of improved magnetostrictive vibrational power generator, simple and high power output for practical applications

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, Toshiyuki, E-mail: ueno@ec.t.kanazawa-u.ac.jp [Kanazawa University, Kakuma-machi, Kanazawa-city, Ishikawa 920-1192 (Japan)

    2015-05-07

    Vibration based power generation technology is utilized effectively in various fields. Author has invented novel vibrational power generation device using magnetostrictive material. The device is based on parallel beam structure consisting of a rod of iron-gallium alloy wound with coil and yoke accompanied with permanent magnet. When bending force is applied on the tip of the device, the magnetization inside the rod varies with induced stress due to the inverse magnetostrictive effect. In vibration, the time variation of the magnetization generates voltage on the wound coil. The magnetostrictive type is advantageous over conventional such using piezoelectric or moving magnet types in high efficiency and high robustness, and low electrical impedance. Here, author has established device configuration, simple, rigid, and high power output endurable for practical applications. In addition, the improved device is lower cost using less volume of Fe-Ga and permanent magnet compared to our conventional, and its assembly by soldering is easy and fast suitable for mass production. Average power of 3 mW/cm{sup 3} under resonant vibration of 212 Hz and 1.2 G was obtained in miniature prototype using Fe-Ga rod of 2 × 0.5× 7 mm{sup 3}. Furthermore, the damping effect was observed, which demonstrates high energy conversion of the generator.

  14. Predictive factors related to low cardiac output syndrome following aortic valve replacement%主动脉瓣置换术后发生低心排出量综合征的预测因素探讨

    Institute of Scientific and Technical Information of China (English)

    马红; 张其霞; 李晓静; 郑晓燕

    2014-01-01

    Objective To investigate the predictive factors related to postoperative low cardiac output syndrome in pa-tients after aortic valve replacement due to aortic stenosis or regurgitation. Methods Three hundred patients with aortic valve defect due to aortic stenosis (AS, n=150) or aortic incompetence (AI, n=150), who underwent isolated aortic valve replacement were included in the study. Low cardiac output syndrome(LOS) was defined as the need for high dosages of inotropic medication, and/or intra- aortic bal oon pumping to sustain adequate hemodynamic status. Results Postoperative low cardiac output syn-drome developed in 86 patients (28.6%), including 39 patients with AS (26.0%) and 47 patients with AI (31.3%). The development of postoperative LOS were associated with the fol owing factors (odds ratio in parentheses): for AS group: advanced age (OR=4.7), obesity (OR=1.8), history of heart failure (OR=1.7), end- systolic (OR=5.5) and end- diastolic intraventricular septum thickness (OR=4.2), left atrial diameter (OR=1.6), mitral and tricuspid regurgitation (OR=1.9, 1.5) before surgery, LVEF≤50.0%(OR=5.4), left ventricular end systolic diameter (OR=1.7), left ventricular end diastolic diameter (OR=1.9) and mitral regurgitation (OR=4.1) in early postoperative period; for AI group:advanced age (OR=1.9), obesity (OR=4.8), history of heart failure (OR=1.7), LVEF≤50.0%(OR=1.8), left ventricular end- systolic (OR=4.5), end- diastolic diameters (OR=6.4), left ventricular end systolic di-ameter (OR=1.5), left ventricular end diastolic diameter(OR=1.6), and tricuspid regurgitation (OR=1.5) in preoperative period and left ventricular end- systolic (OR=4.7) and end- diastolic diameters (OR=6.1), and LVEF≤50.0% (OR=7.2) in early postoperative period. Conclusion The patients at high risk for the development of low cardiac output syndrome should be the focus of trials of new techniques of myocardial protection to effectively resuscitate the ischemic myocardium and

  15. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review.

    Science.gov (United States)

    Cornette, J; Laker, S; Jeffery, B; Lombaard, H; Alberts, A; Rizopoulos, D; Roos-Hesselink, J W; Pattinson, R C

    2017-01-01

    Most severe pregnancy complications are characterized by profound hemodynamic disturbances, thus there is a need for validated hemodynamic monitoring systems for pregnant women. Pulmonary artery catheterization (PAC) using thermodilution is the clinical gold standard for the measurement of cardiac output (CO), however this reference method is rarely performed owing to its invasive nature. Transthoracic echocardiography (TTE) allows non-invasive determination of CO. We aimed to validate TTE against PAC for the determination of CO in severely ill pregnant women. This study consisted of a meta-analysis combining data from a prospective study and a systematic review. The prospective arm was conducted in Pretoria, South Africa, in 2003. Women with severe pregnancy complications requiring invasive monitoring with PAC according to contemporary guidelines were included. TTE was performed within 15 min of PAC and the investigator was blinded to the PAC measurements. Comparative measurements were extracted from similar studies retrieved from a systematic review of the literature and added to a database. Simultaneous CO measurements by TTE and PAC were compared. Agreement between methods was assessed using Bland-Altman statistics and intraclass correlation coefficients (ICC). Thirty-four comparative measurements were included in the meta-analysis. Mean CO values obtained by PAC and TTE were 7.39 L/min and 7.18 L/min, respectively. The bias was 0.21 L/min with lower and upper limits of agreement of -1.18 L/min and 1.60 L/min, percentage error was 19.1%, and ICC between the two methods was 0.94. CO measurements by TTE show excellent agreement with those obtained by PAC in pregnant women. Given its non-invasive nature and availability, TTE could be considered as a reference for the validation of other CO techniques in pregnant women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Las complicaciones del embarazo más graves se caracterizan por trastornos hemodin

  16. Integrated Differential Three-Level High-Voltage Pulser Output Stage for CMUTs

    DEFF Research Database (Denmark)

    Llimos Muntal, Pere; Larsen, Dennis Øland; Jørgensen, Ivan Harald Holger;

    2015-01-01

    A new integrated differential three-level highvoltage pulser output stage to drive capacitive micromachined ultrasonic transducers (CMUTs) is proposed in this paper. A topology comparison between the new differential output stage and the most commonly used single-ended topology is performed...

  17. Cardiovascular Ultrasound of Neonatal Long Evans Rats Exposed Prenatally to Trichloroacetic Acid: Effects on Heart Rate, Ejection Fraction, and Cardiac Output

    Science.gov (United States)

    This abstract describes the use of a relatively new technology, cardiovascular ultrasound (echocardiography) for evaluating developmental toxicity affecting heart development. The abstract describes the effects of two known cardiac teratogens, trichloroacetic acid and dimethadio...

  18. The Effect of High Intensity Intermittent Exercise on Power Output for the Upper Body

    Directory of Open Access Journals (Sweden)

    Leonie Harvey

    2015-06-01

    Full Text Available The aim of the present study was to examine and measure high intensity, intermittent upper body performance, in addition to identifying areas of the body that affect the variance in total work done during the 5 × 6 s sprint test. Fifteen males completed an upper body 5 × 6 s sprint test on a modified electro-magnetically braked cycle ergometer, which consisted of five maximal effort sprints, each 6 s in duration, separated by 24 s of passive recovery. A fly wheel braking force corresponding to 5% of the participants’ body weight was used as the implemented resistance level. Body composition was measured using dual-energy X-ray absorptiometry (DEXA. Percent (% decrement was calculated as 100 − (Total work/ideal work × 100. Significant (P < 0.05 differences were found between sprints for both absolute and relative (W, W·kg−1, W·kg−1 Lean body mass (LBM and W·kg−1 Upper body lean body mass (UBLBM peak (PP and mean (MP power. The % decrement in total work done over the five sprints was 11.4%. Stepwise multiple linear regression analysis revealed that UBLBM accounts for 87% of the variance in total work done during the upper body 5 × 6 s sprint test. These results provide a descriptive analysis of upper body, high intensity intermittent exercise, demonstrating that PP and MP output decreased significantly during the upper body 5 × 6 s sprint test.

  19. High prevalence of cardiac involvement in patients with myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Witting, Nanna; Ersbøll, Mads Kristian;

    2014-01-01

    .02). CONCLUSION: The cardiac phenotype of DM1 includes a high prevalence of conduction disorders, arrhythmias and risk factors of SCD. Systematic cardiac screening with ECG, Holter-monitoring and echocardiography is needed in order to make a proper characterization of cardiac involvement in DM1....... of controls. Thus, the optimal strategy for assessing cardiac involvement in DM1 is unclear. METHOD: In this large single-centre study, we evaluated 129 unselected DM1 patients (49.6% men), mean (SD) age 44 (14.7) years with family history, physical examination, electrocardiogram (ECG), echocardiography......, Holter-monitoring and muscle strength testing. RESULTS: Cardiac involvement was found in 71 patients (55%) and included: 1) Conduction abnormalities: atrio-ventricular block grade I (AVB grade I) (23.6%), AVB grade II (5.6%), right/left bundle branch block (5.5/3.2%) and prolonged QTc (7.2%); 2...

  20. High-Risk Cardiac Disease in Pregnancy Part I

    NARCIS (Netherlands)

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silverside, Candice K.

    2016-01-01

    The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated

  1. High-Risk Cardiac Disease in Pregnancy Part I

    NARCIS (Netherlands)

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silverside, Candice K.

    2016-01-01

    The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated

  2. Cardiac ablation by transesophageal high intensity focused ultrasound

    Institute of Scientific and Technical Information of China (English)

    JIANG Chen-xi; YU Rong-hui; MA Chang-sheng

    2010-01-01

    @@ Cardiac ablation is an important modality of invasive therapy in modern cardiology, especially in the treatment of arrhythmias, as well as other diseases such as hypertrophic obstructive cardiomyopathy (HOCM). Since Huang et al1 used radiofrequency (RF) to ablate canine atrial ventricular junction, RF has developed into the leading energy source in catheter ablation of arrhythmias.

  3. Semi-global robust output regulation of minimum-phase nonlinear systems based on high-gain nonlinear internal model

    Science.gov (United States)

    Wei, Xile; Lu, Meili; Wang, Jiang; Tsang, K. M.; Deng, Bin; Che, Yanqiu

    2010-05-01

    We consider the assumption of existence of the general nonlinear internal model that is introduced in the design of robust output regulators for a class of minimum-phase nonlinear systems with rth degree (r ≥ 2). The robust output regulation problem can be converted into a robust stabilisation problem of an augmented system consisting of the given plant and a high-gain nonlinear internal model, perfectly reproducing the bounded including not only periodic but also nonperiodic exogenous signal from a nonlinear system, which satisfies some general immersion assumption. The state feedback controller is designed to guarantee the asymptotic convergence of system errors to zero manifold. Furthermore, the proposed scheme makes use of output feedback dynamic controller that only processes information from the regulated output error by using high-gain observer to robustly estimate the derivatives of the regulated output error. The stabilisation analysis of the resulting closed-loop systems leads to regional as well as semi-global robust output regulation achieved for some appointed initial condition in the state space, for all possible values of the uncertain parameter vector and the exogenous signal, ranging over an arbitrary compact set.

  4. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, Stuart, E-mail: lyonsey@optusnet.com.au; Mott, Nigel, E-mail: nigelmott76@hotmail.com; Koukounaras, Jim; Shoobridge, Jen [Alfred Hospital, Department of Radiology (Australia); Hudson, Patricio Vargas [Clinica Alemana, Department of Radiology (Chile)

    2013-06-15

    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  5. PI and Fuzzy Control Strategies for High Voltage Output DC-DC Boost Power Converter - Hardware Implementation and Analysis

    DEFF Research Database (Denmark)

    Padmanaban, Sanjeevi Kumar; Blaabjerg, Frede; Siano, Pierluigi

    2016-01-01

    converter with inbuilt voltage-lift technique and overcome the aforementioned deficiencies. Further, the control strategy is adapted based on proportional-integral (P-I) and fuzzy logic, closed-loop controller to regulate the outputs and ensure the performances. Complete hardware prototype of EHV converter......This paper presents the control strategies by Proportional-Integral (P-I) and Fuzzy Logic (FL) for a DC-DC boost power converter for high output voltage configuration. Standard DC-DC converters are traditionally used for high voltage direct current (HVDC) power transmission systems. But, lack its...... performances in terms of efficiency, reduced transfer gain and increased cost with sensor units. Moreover, the internal self-parasitic components reduce the output voltage and efficiency of classical high voltage converters (HVC). This investigation focused on extra high-voltage (EHV) DC-DC boost power...

  6. Graphical user interface for input output characterization of single variable and multivariable highly nonlinear systems

    Directory of Open Access Journals (Sweden)

    Shahrukh Adnan Khan M. D.

    2017-01-01

    Full Text Available This paper presents a Graphical User Interface (GUI software utility for the input/output characterization of single variable and multivariable nonlinear systems by obtaining the sinusoidal input describing function (SIDF of the plant. The software utility is developed on MATLAB R2011a environment. The developed GUI holds no restriction on the nonlinearity type, arrangement and system order; provided that output(s of the system is obtainable either though simulation or experiments. An insight to the GUI and its features are presented in this paper and example problems from both single variable and multivariable cases are demonstrated. The formulation of input/output behavior of the system is discussed and the nucleus of the MATLAB command underlying the user interface has been outlined. Some of the industries that would benefit from this software utility includes but not limited to aerospace, defense technology, robotics and automotive.

  7. Studying gas emission rhythms based on data of mines with high gas output

    Energy Technology Data Exchange (ETDEWEB)

    Kovacs, F.

    1983-01-01

    Based on data of measuring ventilation of 21 cleaning faces, an analysis was made of the change in gas release in time. During the days of work and interruption in work, the gas output is practically the same. Based on analysis of the weekly rhythm of gas release, one can determine the order for danger in individual days of the week. The gas output essentially is independent of the day of the week. Collapse of the roof causes a spasmodic increase in gas output. Frequency of collapse is in a close relationship to the average rate of advance of the cleaning face. With an increase in the rate of advance of the face, one can decrease the average specific output of gas.

  8. An output amplitude configurable wideband automatic gain control with high gain step accuracy

    Institute of Scientific and Technical Information of China (English)

    何晓丰; 莫太山; 马成炎; 叶甜春

    2012-01-01

    An output amplitude configurable wideband automatic gain control (AGC) with high gain step accuracy for the GNSS receiver is presented.The amplitude of an AGC is configurable in order to cooperate with baseband chips to achieve interference suppression and be compatible with different full range ADCs.And what's more,the gain-boosting technology is introduced and the circuit is improved to increase the step accuracy.A zero,which is composed by the source feedback resistance and the source capacity,is introduced to compensate for the pole.The AGC is fabricated in a 0.18 μm CMOS process.The AGC shows a 62 dB gain control range by 1 dB each step with a gain error of less than 0.2 dB.The AGC provides 3 dB bandwidth larger than 80 MHz and the overall power consumption is less than 1.8 mA,and the die area is 800 × 300μm2.

  9. Continuous-wave high specific output power Ar-He-Xe laser with transverse RF excitation

    NARCIS (Netherlands)

    Udalov, Yu.B.; Peters, P.J.M.; Heeman-Ilieva, M.B.; Witteman, W.J.; Ochkin, V.N.

    1994-01-01

    A transverse RF excited gas discharge has been successfully used to produce a CW Ar-He-Xe laser. A maximum output power of 330 mW has been obtained from an experimental device with 37 cm active length and a 2.25 (DOT) 2.25 cm2 cross-section. This corresponds to a specific output power of about 175 m

  10. End-expiration Respiratory Gating for a High Resolution Stationary Cardiac SPECT system

    Science.gov (United States)

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

    2014-01-01

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

  11. End-expiration respiratory gating for a high-resolution stationary cardiac SPECT system

    Science.gov (United States)

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

    2014-10-01

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

  12. High brightness direct diode laser with kW output power

    Science.gov (United States)

    Fritsche, Haro; Kruschke, Bastian; Koch, Ralf; Ferrario, Fabio; Kern, Holger; Pahl, Ulrich; Pflueger, Silke; Gries, Wolfgang

    2014-03-01

    High power, high brightness diode lasers are beginning to challenge solid state lasers, i.e. disk and fiber lasers. The core technologies for brightness scaling of diode lasers are optical stacking and dense spectral combining (DSC), as well as improvements of the diode material. Diode lasers will have the lowest cost of ownership, highest efficiency and most compact design among all lasers. In our modular product design tens of single emitters are combined in a compact package and launched into a 200 μm fiber with 0.08 NA. Dense spectral combining enables power scaling from 80 W to kilowatts. Volume Bragg Gratings and dichroic filters yield high optical efficiencies of more than 80% at low cost. Each module emits up to 500 W with a beam quality of 5.5 mm*mrad and less than 20 nm linewidth. High speed switching power supplies are integrated into the module and rise times as short as 6 μs have been demonstrated. Fast control algorithms based on FPGA and embedded microcontroller ensure high wall plug efficiency with a unique control loop time of only 30 μs. Individual modules are spectrally combined to result in direct diode laser systems with kilowatts of output power at identical beam quality. For low loss fiber coupling a 200 μm fiber is used and the NA is limited to 0.08 corresponding to a beam quality of 7.5 mm*mrad. The controller architecture is fully scalable without sacrificing loop time. We leverage automated manufacturing for cost effective, high yield production. A precision robotic system handles and aligns the individual fast axis lenses and tracks all quality relevant data. Similar technologies are also deployed for dense spectral combining aligning the VBG and dichroic filters. Operating at wavelengths between 900 nm and 1100 nm, these systems are mainly used in cutting and welding, but the technology can also be adapted to other wavelength ranges, such as 793 nm and 1530 nm. Around 1.5 μm the diodes are already successfully used for resonant

  13. High Output Voltage Based Multiphase Step-Up DC-DC Converter Topology with Voltage Doubler Rectifiers

    Directory of Open Access Journals (Sweden)

    Liao Xiaozhong

    2013-02-01

    Full Text Available High Output Voltage Based Multiphase Step-Up DC-DC Converter topology with voltage doubler rectifiers is presented in this paper. High output voltage is obtained due to the series combination of voltage doubler rectifiers on the secondary side of high frequency transformers. This topology is useful in the application where the output voltage is greater than the input. The two loop control strategy has been developed in order to analyze the stable and effective working of the converter topology. Therefore the working mode analysis of the converter topology has been described in detail. The multiphase step-up DC-DC converter topology is first simulated on MATLAB and then a prototype has been designed in order to verify the simulation and experimental results. Finally the simulation and experimental results are found to be satisfactory.

  14. Application of model output statistics to the GEM-AQ high resolution air quality forecast

    Science.gov (United States)

    Struzewska, J.; Kaminski, J. W.; Jefimow, M.

    2016-11-01

    The aim of the presented work was to analyse the impact of data stratification on the efficiency of the Model Output Statistics (MOS) methodology as applied to a high-resolution deterministic air quality forecast carried out with the GEM-AQ model. The following parameters forecasted by the GEM-AQ model were selected as predictors for the MOS equation: pollutant concentration, air temperature in the lowest model layer, wind speed in the lowest model layer, temperature inversion and the precipitation rate. A representative 2-year series were used to construct regression functions. Data series were divided into two subsets. Approximately 75% of the data (first 3 weeks of each month) were used to estimate the regression function parameters. Remaining 25% (last week of each month) were used to test the method (control period). The subsequent 12 months were used for method verification (verification period). A linear model fitted the function based on forecasted parameters to the observations. We have assumed four different temperature-based data stratification methods (for each method, separate equations were constructed). For PM10 and PM2.5, SO2 and NO2 the best correction results were obtained with the application of temperature thresholds in the cold season and seasonal distribution combined with temperature thresholds in the warm season. For the PM10, PM2.5 and SO2 the best results were obtained using a combination of two stratification methods separately for cold and warm seasons. For CO, the systematic bias of the forecasted concentrations was partly corrected. For ozone more sophisticated methods of data stratification did not bring a significant improvement.

  15. A comparative verification of high resolution precipitation forecasts using model output statistics

    Science.gov (United States)

    van der Plas, Emiel; Schmeits, Maurice; Hooijman, Nicolien; Kok, Kees

    2017-04-01

    Verification of localized events such as precipitation has become even more challenging with the advent of high-resolution meso-scale numerical weather prediction (NWP). The realism of a forecast suggests that it should compare well against precipitation radar imagery with similar resolution, both spatially and temporally. Spatial verification methods solve some of the representativity issues that point verification gives rise to. In this study a verification strategy based on model output statistics is applied that aims to address both double penalty and resolution effects that are inherent to comparisons of NWP models with different resolutions. Using predictors based on spatial precipitation patterns around a set of stations, an extended logistic regression (ELR) equation is deduced, leading to a probability forecast distribution of precipitation for each NWP model, analysis and lead time. The ELR equations are derived for predictands based on areal calibrated radar precipitation and SYNOP observations. The aim is to extract maximum information from a series of precipitation forecasts, like a trained forecaster would. The method is applied to the non-hydrostatic model Harmonie (2.5 km resolution), Hirlam (11 km resolution) and the ECMWF model (16 km resolution), overall yielding similar Brier skill scores for the 3 post-processed models, but larger differences for individual lead times. Besides, the Fractions Skill Score is computed using the 3 deterministic forecasts, showing somewhat better skill for the Harmonie model. In other words, despite the realism of Harmonie precipitation forecasts, they only perform similarly or somewhat better than precipitation forecasts from the 2 lower resolution models, at least in the Netherlands.

  16. Transient downregulation of glomerular atrial natriuretic factor receptors in high output heart failure in the rat.

    Science.gov (United States)

    Gauquelin, G; Bonhomme, M C; Garcia, R

    1995-03-01

    The renal response to exogenous atrial natriuretic factor (ANF) is blunted in chronic heart failure. The aim of the present studies was to investigate whether renal ANF receptor regulation in chronic heart failure is a time related event. Glomerular ANF receptors were analysed in radioligand binding experiments at 0, 1, 2, 6, 12, 24, and 48 h, as well as at 1, 2, 4, and 8 weeks after the induction of an aortocaval shunt. Rats with aortocaval shunts had lower packed cell volume and body weight and higher relative heart weight than sham operated controls. Plasma ANF C and N terminal levels were increased in shunt rats as early as 5 min after establishment of the shunt. Right and left atrial ANF concentrations were decreased and ventricular ANF concentration was increased in shunt rats at 6 and 12 h respectively. Competitive inhibition of 125I-ANF binding showed that at 6 h the density (Bmax) of glomerular ANF receptors was significantly lower than in the controls [518(SEM 10) v 759(12) fmol.mg-1 protein] without differences in their affinity (Kd). The low Bmax in shunt animals persisted at 12, 24, and 48 h, even at 1 week [Bmax: 400(29) and 713(28) fmol.mg-1 protein; Kd: 80(2) and 70(4) pM, for AC rats and controls, respectively]. Bmax values were not significantly different at 2, 4, and 8 weeks. In 24 h animals, C-ANF displaced 65% of total binding, with both total and C ANF binding sites being 38% lower in shunt animals. Downregulation of glomerular ANF receptors is a transient event during the development of high output heart failure in the rat. Thus the blunted renal response to ANF during chronic heart failure is not likely to be due to a decrease in renal ANF receptor density or affinity.

  17. High-power Er:YAG laser with quasi-top-hat output beam.

    Science.gov (United States)

    Kim, J W; Mackenzie, J I; Hayes, J R; Clarkson, W A

    2012-05-01

    A simple method for simultaneously exciting the fundamental (TEM00) transverse mode and first order Laguerre-Gaussian (LG01) donut mode in an end-pumped solid-state laser to yield a quasi-top-hat output beam is reported. This approach has been applied to an Er:YAG laser, in-band pumped by an Er,Yb fiber laser, yielding 9.6 W of continuous-wave output at 1645 nm in a top-hat-like beam with beam propagation factor (M2)<2.1 for 24 W of incident pump power at 1532 nm. The corresponding slope efficiency with respect to incident pump power was 49%. The prospects of further scaling of output power and improved overall efficiency are considered.

  18. 16 W output power by high-efficient spectral beam combining of DBR-tapered diode lasers

    DEFF Research Database (Denmark)

    Müller, André; Vijayakumar, Deepak; Jensen, Ole Bjarlin;

    2011-01-01

    output power achieved by spectral beam combining of two single element tapered diode lasers. Since spectral beam combining does not affect beam propagation parameters, M2-values of 1.8 (fast axis) and 3.3 (slow axis) match the M2- values of the laser with lowest spatial coherence. The principle......Up to 16 W output power has been obtained using spectral beam combining of two 1063 nm DBR-tapered diode lasers. Using a reflecting volume Bragg grating, a combining efficiency as high as 93.7% is achieved, resulting in a single beam with high spatial coherence. The result represents the highest...... of spectral beam combining used in our experiments can be expanded to combine more than two tapered diode lasers and hence it is expected that the output power may be increased even further in the future....

  19. 16 W output power by high-efficient spectral beam combining of DBR-tapered diode lasers.

    Science.gov (United States)

    Müller, André; Vijayakumar, Deepak; Jensen, Ole Bjarlin; Hasler, Karl-Heinz; Sumpf, Bernd; Erbert, Götz; Andersen, Peter E; Petersen, Paul Michael

    2011-01-17

    Up to 16 W output power has been obtained using spectral beam combining of two 1063 nm DBR-tapered diode lasers. Using a reflecting volume Bragg grating, a combining efficiency as high as 93.7% is achieved, resulting in a single beam with high spatial coherence. The result represents the highest output power achieved by spectral beam combining of two single element tapered diode lasers. Since spectral beam combining does not affect beam propagation parameters, M2-values of 1.8 (fast axis) and 3.3 (slow axis) match the M2-values of the laser with lowest spatial coherence. The principle of spectral beam combining used in our experiments can be expanded to combine more than two tapered diode lasers and hence it is expected that the output power may be increased even further in the future.

  20. High-energy nanosecond radially polarized beam output from Nd:YAG amplifiers

    Science.gov (United States)

    Chang, Chengcheng; Chen, Xudong; Pu, Jixiong

    2017-04-01

    Radially polarized laser beam amplification up to the 772 mJ using flash-lamp-pumped Nd:YAG amplifiers was demonstrated. In the experiments, a nanosecond radially polarized seed beam was converted from a conventional Q-switched Nd:YAG laser output with a polarization converter and then amplified with two Nd:YAG amplifier stages. A maximum amplification output energy up to 772 mJ was achieved at 10 Hz with a 10-ns pulse, corresponding to an amplification factor of 323%. Excellent conservation of polarization was also obtained during the amplification.

  1. Research Update: Recent progress in the development of effective dielectrics for high-output triboelectric nanogenerator

    Directory of Open Access Journals (Sweden)

    Jae Won Lee

    2017-07-01

    Full Text Available A new energy generating device, triboelectric nanogenerator (TENG, was discovered in 2012 and thereafter, many applications such as portable power sources and self-powered, appropriate for portable electronic devices. So far, rapid development of device fabrication technologies and mechanical system designs significantly increased the instantaneous output power up to several tens of mW/cm2. This article provides a comprehensive review of effective dielectrics used so far in TENGs for further enhancement in output power, as well as the fundamental issues regarding the materials. Finally, we show some strategies for obtaining the properties that the materials should have as effective dielectrics.

  2. Research Update: Recent progress in the development of effective dielectrics for high-output triboelectric nanogenerator

    Science.gov (United States)

    Lee, Jae Won; Ye, Byeong Uk; Baik, Jeong Min

    2017-07-01

    A new energy generating device, triboelectric nanogenerator (TENG), was discovered in 2012 and thereafter, many applications such as portable power sources and self-powered, appropriate for portable electronic devices. So far, rapid development of device fabrication technologies and mechanical system designs significantly increased the instantaneous output power up to several tens of mW/cm2. This article provides a comprehensive review of effective dielectrics used so far in TENGs for further enhancement in output power, as well as the fundamental issues regarding the materials. Finally, we show some strategies for obtaining the properties that the materials should have as effective dielectrics.

  3. Administration of granulocyte-colony stimulating factor accompanied with a balanced diet improves cardiac function alterations induced by high fat diet in mice.

    Science.gov (United States)

    Daltro, Pâmela Santana; Alves, Paula Santana; Castro, Murilo Fagundes; Azevedo, Carine M; Vasconcelos, Juliana Fraga; Allahdadi, Kyan James; de Freitas, Luiz Antônio Rodrigues; de Freitas Souza, Bruno Solano; Dos Santos, Ricardo Ribeiro; Soares, Milena Botelho Pereira; Macambira, Simone Garcia

    2015-12-03

    High fat diet (HFD) is a major contributor to the development of obesity and cardiovascular diseases due to the induction of cardiac structural and hemodynamic abnormalities. We used a model of diabetic cardiomyopathy in C57Bl/6 mice fed with a HFD to investigate the effects of granulocyte-colony stimulating factor (G-CSF), a cytokine known for its beneficial effects in the heart, on cardiac anatomical and functional abnormalities associated with obesity and type 2 diabetes. Groups of C57Bl/6 mice were fed with standard diet (n = 8) or HFD (n = 16). After 36 weeks, HFD animals were divided into a group treated with G-CSF + standard diet (n = 8) and a vehicle control group + standard diet (n = 8). Cardiac structure and function were assessed by electrocardiography, echocardiography and treadmill tests, in addition to the evaluation of body weight, fasting glicemia, insulin and glucose tolerance at different time points. Histological analyses were performed in the heart tissue. HFD consumption induced metabolic alterations characteristic of type 2 diabetes and obesity, as well as cardiac fibrosis and reduced exercise capacity. Upon returning to a standard diet, obese mice body weight returned to non-obese levels. G-CSF administration accelerated the reduction in of body weight in obese mice. Additionally, G-CSF treatment reduced insulin levels, diminished heart fibrosis, increased exercise capacity and reversed cardiac alterations, including bradycardia, elevated QRS amplitude, augmented P amplitude, increased septal wall thickness, left ventricular posterior thickening and cardiac output reduction. Our results indicate that G-CSF administration caused beneficial effects on obesity-associated cardiac impairment.

  4. Towards high power output of scaled-up benthic microbial fuel cells (BMFCs) using multiple electron collectors.

    Science.gov (United States)

    Liu, Bingchuan; Williams, Isaiah; Li, Yan; Wang, Lei; Bagtzoglou, Amvrossios; McCutcheon, Jeffrey; Li, Baikun

    2016-05-15

    This study aimed at achieving high power output of benthic microbial fuel cells (BMFCs) with novel geometric anode setups (inverted tube granular activated charcoal (IT-GAC) and carbon cloth roll (CCR)) and multiple anodes/electron collectors. The lab-scale tests showed the power density of IT-GAC and CCR anodes achieved at 2.92 and 2.55 W m(-2), the highest value ever reported in BMFCs. The power density of BMFCs substantially increased with electron collector number (titanium rods) in anodes. The connection of multiple electron collectors with multiple cathodes had much higher total voltage/current output than that with single cathode. The possibility of maintaining high power density at scaled-up BMFCs was explored by arranging multiple anodes in sediment. The compact configuration of multiple CCR anodes contacting each other did not deteriorate the performance of individual anodes, showing the feasibility of maximizing anode numbers per sediment footprint and achieving high power output. Multiple IT-GAC and CCR anodes with multiple collectors effectively utilized sediment at both horizontal and vertical directions and enhanced electron collection efficiency. This study demonstrated that bacterial adhesion and electron collection should be optimized on small anodes in order to maintain high power density and achieve high power output in the scaled-up BMFCs.

  5. Effect of high laser output on the central bronchi and pulmonary artery.

    Science.gov (United States)

    Kirschbaum, A; Rexin, P; Bartsch, D K; Quint, K

    2017-05-01

    A diode-pump Nd:YAG high-power laser (wavelength 1320 nm, power 100 W) is routinely used to surgically remove lung metastases. Even pulmonary lesions in central locations are resectable via this method, yet it also carries a potential risk of damaging the larger bronchi and vessels in the vicinity. Studies investigating the safety of using high-power lasers are lacking. We therefore aimed to examine the direct effects of a 100-watt laser on the bronchi and pulmonary artery at a standard working velocity. From freshly slaughtered pigs, we isolated cylindrical specimens of the trachea, the main and lobar bronchi, and the central pulmonary artery from the both lungs. These specimens were fixed consecutively in rows behind each other on a Styrofoam surface in the laboratory. The laser's handle was clamped into a hydraulic feed unit so that the laser was focused at constant distance perpendicular to the tissue and would move at 10 mm/s over the specimens. The Nd:YAG Laser LIMAX® 120 functioned at a consistent power of 100 W during all the experiments. The lasered specimens were examined macroscopically and histologically for tissue damage. None of the trachea or bronchial walls were perforated. Compared to the pulmonary parenchyma, we observed no vaporization effects-only minor superficial coagulation (with a mean depth of 2.1 ± 0.8 mm). This finding was histologically confirmed in each specimen, which revealed mild superficial coagulation and no damage to the cartilage. In the presence of a residual peribronchial fatty tissue, the laser effect was even attenuated. The pulmonary arteries presented no lumen openings whatsoever, merely a discrete trace of coagulation. The vessel wall revealed increased vacuolization without alteration of the remaining vessel wall. In conclusion, laser resection at 100 W of the central lung areas is safe with respect to airways and blood vessels and the laser output does not need to be reduced when treating these areas.

  6. Aortic and Hepatic Contrast Enhancement During Hepatic-Arterial and Portal Venous Phase Computed Tomography Scanning: Multivariate Linear Regression Analysis Using Age, Sex, Total Body Weight, Height, and Cardiac Output.

    Science.gov (United States)

    Masuda, Takanori; Nakaura, Takeshi; Funama, Yoshinori; Higaki, Toru; Kiguchi, Masao; Imada, Naoyuki; Sato, Tomoyasu; Awai, Kazuo

    We evaluated the effect of the age, sex, total body weight (TBW), height (HT) and cardiac output (CO) of patients on aortic and hepatic contrast enhancement during hepatic-arterial phase (HAP) and portal venous phase (PVP) computed tomography (CT) scanning. This prospective study received institutional review board approval; prior informed consent to participate was obtained from all 168 patients. All were examined using our routine protocol; the contrast material was 600 mg/kg iodine. Cardiac output was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. We calculated contrast enhancement (per gram of iodine: [INCREMENT]HU/gI) of the abdominal aorta during the HAP and of the liver parenchyma during the PVP. We performed univariate and multivariate linear regression analysis between all patient characteristics and the [INCREMENT]HU/gI of aortic- and liver parenchymal enhancement. Univariate linear regression analysis demonstrated statistically significant correlations between the [INCREMENT]HU/gI and the age, sex, TBW, HT, and CO (all P linear regression analysis showed that only the TBW and CO were of independent predictive value (P linear regression analysis only the TBW and CO were significantly correlated with aortic and liver parenchymal enhancement; the age, sex, and HT were not. The CO was the only independent factor affecting aortic and liver parenchymal enhancement at hepatic CT when the protocol was adjusted for the TBW.

  7. Ranking Hearing Aid Input-Output Functions for Understanding Low-, Conversational-, and High-Level Speech in Multitalker Babble

    Science.gov (United States)

    Chung, King; Killion, Mead C.; Christensen, Laurel A.

    2007-01-01

    Purpose: To determine the rankings of 6 input-output functions for understanding low-level, conversational, and high-level speech in multitalker babble without manipulating volume control for listeners with normal hearing, flat sensorineural hearing loss, and mildly sloping sensorineural hearing loss. Method: Peak clipping, compression limiting,…

  8. Low Power Very High Frequency Switch-Mode Power Supply with 50 V Input and 5 V Output

    DEFF Research Database (Denmark)

    Madsen, Mickey Pierre; Knott, Arnold; Andersen, Michael A. E.

    2014-01-01

    This paper presents the design of a resonant converter with a switching frequency in the very high frequencyrange (30-300 MHz), a large step down ratio (10 times) and low output power (1 W). Several different invertersand rectifiers are analyzed and compared. The class E inverter and rectifier ar...

  9. A comprehensive analysis and hardware implementation of control strategies for high output voltage DC-DC boost power converter

    DEFF Research Database (Denmark)

    Padmanaban, Sanjeevikumar; Grandi, Gabriele; Blaabjerg, Frede

    2017-01-01

    Classical DC-DC converters used in high voltage direct current (HVDC) power transmission systems, lack in terms of efficiency, reduced transfer gain and increased cost with sensor (voltage/current) numbers. Besides, the internal self-parasitic behavior of the power components reduces the output v...

  10. Frequency of cardiac arrhythmias in high and low- yielding dairy cows

    Directory of Open Access Journals (Sweden)

    Afshin Jafari Dehkordi

    2014-06-01

    Full Text Available Electrocardiography (ECG may be used to recognize cardiac disorders. Levels of milk production may change the serum electrolytes which its imbalance has a role in cardiac arrhythmia. Fifty high yielding and fifty low yielding Holstein dairy cows were used in this study. Electrocardiography was recorded by base-apex lead and blood samples were collected from jugular vein for measurement of serum elements such as sodium, potassium, calcium, phosphorous, iron and magnesium. Cardiac dysrhythmias were detected more frequent in low yielding Holstein cows (62.00% compared to high yielding Holstein cows (46.00%. The cardiac dysrhythmias that were observed in low yielding Holstein cows included sinus arrhythmia (34.70%, wandering pacemaker (22.45 %, bradycardia (18.37%, tachycardia (10.20%, atrial premature beat (2.04%, sinoatrial block (2.04%, atrial fibrillation (8.16% and atrial tachycardia (2.04%. The cardiac dysrhythmias were observed in high yielding Holstein cows including, sinus arrhythmia (86.95% and wandering pacemaker (13.05%. Also, notched P wave was observed to be 30% and 14% in high- and low- yielding Holstein cows respectively. The serum calcium concentration of low yielding Holstein cows was significantly lower than that of high yielding Holstein cows. There was not any detectable significant difference in other serum elements between high- and low- yielding Holstein cows. Based on the result of present study, could be concluded that low serum concentration of calcium results to more frequent dysrhythmias in low yielding Holstein cows.

  11. Negative impacts of a vertebrate predator on insect pollinator visitation and seed output in Chuquiraga oppositifolia, a high Andean shrub.

    Science.gov (United States)

    Muñoz, Alejandro A; Arroyo, Mary T K

    2004-01-01

    Studies on plant-pollinator interactions have largely neglected the potential negative effects of the predators of pollinators on seed output, even though anti-predatory behaviour of pollinators may affect visitation patterns, pollen transfer, and therefore potentially, plant reproductive output. We tested the hypothesis that the presence of lizards and insectivorous birds, by reducing pollinator visitation, can have significant negative effects on seed output in the insect-pollinated, genetically self-incompatible lower alpine Andean shrub, Chuquiraga oppositifolia (Asteraceae). The lower alpine belt supports a high density of territorial Liolaemus (Tropiduridae) lizards and low shrubs interspersed among rocks of varying sizes, the latter inhabited by lizards and commonly used by flycatchers Muscisaxicola (Tyrannidae) as perching sites. In a 2x2 factorial predator-exclusion experiment, visitation rates of the most frequent pollinators of C. oppositifolia (the satyrid butterfly Cosmosatyrus chilensis and the syrphid fly Scaeva melanostoma), the duration of pollinator visits, and seed output, were 2-4 times greater when lizards were excluded, while birds had no effect. In a natural experiment, visits by S. melanostoma were 9 times shorter, and pollinator visitation rates of C. chilensis and S. melanostoma, and C. oppositifolia seed output were 2-3 times lower on shrubs growing adjacent to lizard-occupied rocks compared to those growing distant from rocks. Our results, verified for additional Andean sites, suggest that lizard predators can alter the behaviour of pollinators and elicit strong top-down indirect negative effects on seed output. Such effects may be especially important in high alpine plant communities, where pollinator activity can be low and erratic, and pollen limitation has been reported.

  12. Activation of the Cardiac Renin-Angiotensin System in High Oxygen-Exposed Newborn Rats: Angiotensin Receptor Blockade Prevents the Developmental Programming of Cardiac Dysfunction.

    Science.gov (United States)

    Bertagnolli, Mariane; Dios, Anne; Béland-Bonenfant, Sarah; Gascon, Gabrielle; Sutherland, Megan; Lukaszewski, Marie-Amélie; Cloutier, Anik; Paradis, Pierre; Schiffrin, Ernesto L; Nuyt, Anne Monique

    2016-04-01

    Newborn rats exposed to high oxygen (O2), mimicking preterm birth-related neonatal stress, develop later in life cardiac hypertrophy, dysfunction, fibrosis, and activation of the renin-angiotensin system. Cardiac renin-angiotensin system activation in O2-exposed adult rats is characterized by an imbalance in angiotensin (Ang) receptors type 1/2 (AT1/2), with prevailing AT1 expression. To study the role of renin-angiotensin system in the developmental programming of cardiac dysfunction, we assessed Ang receptor expression during neonatal high O2 exposure and whether AT1 receptor blockade prevents cardiac alterations in early adulthood. Sprague-Dawley newborn rats were kept with their mother in 80% O2 or room air (control) from days 3 to 10 (P3-P10) of life. Losartan or water was administered by gavage from P8 to P10 (n=9/group). Rats were studied at P3 (before O2 exposure), P5, P10 (end of O2), and P28. Losartan treatment had no impact on growth or kidney development. AT1 and Ang type 2 receptors were upregulated in the left ventricle by high O2 exposure (P5 and P10), which was prevented by Losartan treatment at P10. Losartan prevented the cardiac AT1/2 imbalance at P28. Losartan decreased cardiac hypertrophy and fibrosis and improved left ventricle fraction of shortening in P28 O2-exposed rats, which was associated with decreased oxidation of calcium/calmodulin-dependent protein kinase II, inhibition of the transforming growth factor-β/SMAD3 pathway, and upregulation of cardiac angiotensin-converting enzyme 2. In conclusion, short-term Ang II blockade during neonatal high O2 prevents the development of cardiac alterations later in life in rats. These findings highlight the key role of neonatal renin-angiotensin system activation in the developmental programming of cardiac dysfunction induced by deleterious neonatal conditions.

  13. Feasibility Study on Cardiac Arrhythmia Ablation Using High-Energy Heavy Ion Beams

    Science.gov (United States)

    Lehmann, H. Immo; Graeff, Christian; Simoniello, Palma; Constantinescu, Anna; Takami, Mitsuru; Lugenbiel, Patrick; Richter, Daniel; Eichhorn, Anna; Prall, Matthias; Kaderka, Robert; Fiedler, Fine; Helmbrecht, Stephan; Fournier, Claudia; Erbeldinger, Nadine; Rahm, Ann-Kathrin; Rivinius, Rasmus; Thomas, Dierk; Katus, Hugo A.; Johnson, Susan B.; Parker, Kay D.; Debus, Jürgen; Asirvatham, Samuel J.; Bert, Christoph; Durante, Marco; Packer, Douglas L.

    2016-12-01

    High-energy ion beams are successfully used in cancer therapy and precisely deliver high doses of ionizing radiation to small deep-seated target volumes. A similar noninvasive treatment modality for cardiac arrhythmias was tested here. This study used high-energy carbon ions for ablation of cardiac tissue in pigs. Doses of 25, 40, and 55 Gy were applied in forced-breath-hold to the atrioventricular junction, left atrial pulmonary vein junction, and freewall left ventricle of intact animals. Procedural success was tracked by (1.) in-beam positron-emission tomography (PET) imaging; (2.) intracardiac voltage mapping with visible lesion on ultrasound; (3.) lesion outcomes in pathohistolgy. High doses (40–55 Gy) caused slowing and interruption of cardiac impulse propagation. Target fibrosis was the main mediator of the ablation effect. In irradiated tissue, apoptosis was present after 3, but not 6 months. Our study shows feasibility to use high-energy ion beams for creation of cardiac lesions that chronically interrupt cardiac conduction.

  14. Mapping cardiac fiber orientations from high-resolution DTI to high-frequency 3D ultrasound

    Science.gov (United States)

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

    2014-03-01

    The orientation of cardiac fibers affects the anatomical, mechanical, and electrophysiological properties of the heart. Although echocardiography is the most common imaging modality in clinical cardiac examination, it can only provide the cardiac geometry or motion information without cardiac fiber orientations. If the patient's cardiac fiber orientations can be mapped to his/her echocardiography images in clinical examinations, it may provide quantitative measures for diagnosis, personalized modeling, and image-guided cardiac therapies. Therefore, this project addresses the feasibility of mapping personalized cardiac fiber orientations to three-dimensional (3D) ultrasound image volumes. First, the geometry of the heart extracted from the MRI is translated to 3D ultrasound by rigid and deformable registration. Deformation fields between both geometries from MRI and ultrasound are obtained after registration. Three different deformable registration methods were utilized for the MRI-ultrasound registration. Finally, the cardiac fiber orientations imaged by DTI are mapped to ultrasound volumes based on the extracted deformation fields. Moreover, this study also demonstrated the ability to simulate electricity activations during the cardiac resynchronization therapy (CRT) process. The proposed method has been validated in two rat hearts and three canine hearts. After MRI/ultrasound image registration, the Dice similarity scores were more than 90% and the corresponding target errors were less than 0.25 mm. This proposed approach can provide cardiac fiber orientations to ultrasound images and can have a variety of potential applications in cardiac imaging.

  15. High-output tri-magnetic terminal-based non-local spin valves

    Science.gov (United States)

    Shirotori, Satoshi; Hashimoto, Susumu; Takagishi, Masayuki; Kamiguchi, Yuzo; Iwasaki, Hitoshi

    2015-12-01

    We propose tri-magnetic terminal-based non-local spin valves (TM-NLSVs) for lateral structures. A lateral structure has dual spin injector terminals with an anti-parallel spin configuration. The accumulated spin is detected as the voltage between the free layer and one side of the spin injector. Numerical investigation revealed that the output voltage of the TM-NLSV is 2.4-fold higher than that of the conventional four-terminal structure. A further 3.7-fold increase is expected by increasing the injector area by a factor of 9. These results indicate the possibility of obtaining an output voltage that is almost the same as that of conventional (non-lateral) spin valves.

  16. High resolution 3-Dimensional imaging of the human cardiac conduction system from microanatomy to mathematical modeling.

    Science.gov (United States)

    Stephenson, Robert S; Atkinson, Andrew; Kottas, Petros; Perde, Filip; Jafarzadeh, Fatemeh; Bateman, Mike; Iaizzo, Paul A; Zhao, Jichao; Zhang, Henggui; Anderson, Robert H; Jarvis, Jonathan C; Dobrzynski, Halina

    2017-08-03

    Cardiac arrhythmias and conduction disturbances are accompanied by structural remodelling of the specialised cardiomyocytes known collectively as the cardiac conduction system. Here, using contrast enhanced micro-computed tomography, we present, in attitudinally appropriate fashion, the first 3-dimensional representations of the cardiac conduction system within the intact human heart. We show that cardiomyocyte orientation can be extracted from these datasets at spatial resolutions approaching the single cell. These data show that commonly accepted anatomical representations are oversimplified. We have incorporated the high-resolution anatomical data into mathematical simulations of cardiac electrical depolarisation. The data presented should have multidisciplinary impact. Since the rate of depolarisation is dictated by cardiac microstructure, and the precise orientation of the cardiomyocytes, our data should improve the fidelity of mathematical models. By showing the precise 3-dimensional relationships between the cardiac conduction system and surrounding structures, we provide new insights relevant to valvar replacement surgery and ablation therapies. We also offer a practical method for investigation of remodelling in disease, and thus, virtual pathology and archiving. Such data presented as 3D images or 3D printed models, will inform discussions between medical teams and their patients, and aid the education of medical and surgical trainees.

  17. Parallel input parallel output high voltage bi-directional converters for driving dielectric electro active polymer actuators

    DEFF Research Database (Denmark)

    Thummala, Prasanth; Zhang, Zhe; Andersen, Michael A. E.;

    2014-01-01

    is to design and implement driving circuits for the DEAP actuators for their use in various applications. This paper presents implementation of parallel input, parallel output, high voltage (~2.5 kV) bi-directional DC-DC converters for driving the DEAP actuators. The topology is a bidirectional flyback DC......-DC converter incorporating commercially available high voltage MOSFETs (4 kV) and high voltage diodes (5 kV). Although the average current of the aforementioned devices is limited to 300 mA and 150 mA, respectively, connecting the outputs of multiple converters in parallel can provide a scalable design....... This enables operating the DEAP actuators in various static and dynamic applications e.g. positioning, vibration generation or damping, and pumps. The proposed idea is experimentally verified by connecting three high voltage converters in parallel to operate a single DEAP actuator. The experimental results...

  18. Overcoming x-ray tube small focal spot output limitations for high resolution region of interest imaging

    Science.gov (United States)

    Gupta, Sandesh K.; Jain, Amit; Bednarek, Daniel R.; Rudin, Stephen

    2012-03-01

    We investigate methods to increase x-ray tube output to enable improved quantum image quality with a higher generalized-NEQ (GNEQ) while maintaining a small focal-spot size for the new high-resolution Micro-angiographic Fluoroscope (MAF) Region of Interest (ROI) imaging system. Rather than using a larger focal spot to increase tubeloading capacity with degraded resolution, we evaluated separately or in combination three methods to increase tube output: 1) reducing the anode angle and lengthening the filament to maintain a constant effective small focal-spot size, 2) using the standard medium focal spot viewed from a direction on the anode side of the field and 3) increasing the frame rate (frames/second) in combination with temporal filter. The GNEQ was compared for the MAF for the small focal-spot at the central axis, and for the medium focal-spot with a higher output on the anode side as well as for the small focal spot with different temporal recursive filtering weights. A net output increase of about 4.0 times could be achieved with a 2-degree anode angle (without the added filtration) and a 4 times longer filament compared to that of the standard 8-degree target. The GNEQ was also increased for the medium focal-spot due to its higher output capacity and for the temporally filtered higher frame rate. Thus higher tube output, while maintaining a small effective focal-spot, should be achievable using one or more of the three methods described with only small modifications of standard x-ray tube geometry.

  19. Transmission of laser pulses with high output beam quality using step-index fibers having large cladding

    Science.gov (United States)

    Yalin, Azer P; Joshi, Sachin

    2014-06-03

    An apparatus and method for transmission of laser pulses with high output beam quality using large core step-index silica optical fibers having thick cladding, are described. The thick cladding suppresses diffusion of modal power to higher order modes at the core-cladding interface, thereby enabling higher beam quality, M.sup.2, than are observed for large core, thin cladding optical fibers. For a given NA and core size, the thicker the cladding, the better the output beam quality. Mode coupling coefficients, D, has been found to scale approximately as the inverse square of the cladding dimension and the inverse square root of the wavelength. Output from a 2 m long silica optical fiber having a 100 .mu.m core and a 660 .mu.m cladding was found to be close to single mode, with an M.sup.2=1.6. Another thick cladding fiber (400 .mu.m core and 720 .mu.m clad) was used to transmit 1064 nm pulses of nanosecond duration with high beam quality to form gas sparks at the focused output (focused intensity of >100 GW/cm.sup.2), wherein the energy in the core was 20 mJ delivered for 50 ns pulses) without damaging the silica fiber.

  20. High Glucose Causes Human Cardiac Progenitor Cell Dysfunction by Promoting Mitochondrial Fission: Role of a GLUT1 Blocker.

    Science.gov (United States)

    Choi, He Yun; Park, Ji Hye; Jang, Woong Bi; Ji, Seung Taek; Jung, Seok Yun; Kim, Da Yeon; Kang, Songhwa; Kim, Yeon Ju; Yun, Jisoo; Kim, Jae Ho; Baek, Sang Hong; Kwon, Sang-Mo

    2016-07-01

    Cardiovascular disease is the most common cause of death in diabetic patients. Hyperglycemia is the primary characteristic of diabetes and is associated with many complications. The role of hyperglycemia in the dysfunction of human cardiac progenitor cells that can regenerate damaged cardiac tissue has been investigated, but the exact mechanism underlying this association is not clear. Thus, we examined whether hyperglycemia could regulate mitochondrial dynamics and lead to cardiac progenitor cell dysfunction, and whether blocking glucose uptake could rescue this dysfunction. High glucose in cardiac progenitor cells results in reduced cell viability and decreased expression of cell cycle-related molecules, including CDK2 and cyclin E. A tube formation assay revealed that hyperglycemia led to a significant decrease in the tube-forming ability of cardiac progenitor cells. Fluorescent labeling of cardiac progenitor cell mitochondria revealed that hyperglycemia alters mitochondrial dynamics and increases expression of fission-related proteins, including Fis1 and Drp1. Moreover, we showed that specific blockage of GLUT1 improved cell viability, tube formation, and regulation of mitochondrial dynamics in cardiac progenitor cells. To our knowledge, this study is the first to demonstrate that high glucose leads to cardiac progenitor cell dysfunction through an increase in mitochondrial fission, and that a GLUT1 blocker can rescue cardiac progenitor cell dysfunction and downregulation of mitochondrial fission. Combined therapy with cardiac progenitor cells and a GLUT1 blocker may provide a novel strategy for cardiac progenitor cell therapy in cardiovascular disease patients with diabetes.

  1. Zinc oxide integrated area efficient high output low power wavy channel thin film transistor

    KAUST Repository

    Hanna, A. N.

    2013-11-26

    We report an atomic layer deposition based zinc oxide channel material integrated thin film transistor using wavy channel architecture allowing expansion of the transistor width in the vertical direction using the fin type features. The experimental devices show area efficiency, higher normalized output current, and relatively lower power consumption compared to the planar architecture. This performance gain is attributed to the increased device width and an enhanced applied electric field due to the architecture when compared to a back gated planar device with the same process conditions.

  2. Dark Matter annihilation energy output and its effects on the high-z IGM

    CERN Document Server

    Araya, Ignacio J

    2013-01-01

    We study the case of DM self annihilation, in order to asses its importance as an energy injection mechanism, to the IGM in general, and to the medium within particular DM haloes. We consider two well motivated WIMP candidates, the SUSY neutralino and the first KK excited state of the B electroweak boson. We explicitly compute the energy output (or luminosity) of DM haloes due to annihilations, and compare the obtained luminosities with the standard AGN feedback process, concluding that DM annihilation does not provide the necessary output as to constitute an important feedback mechanism. We then compute the energy injection rate per baryon of annihilations on the IGM, in order to calculate the effects that it has on its temperature and ionization fraction. We find significant deviations in the evolutions of the temperature and ionization fraction of the IGM, in scenarios that take into account the clustering of DM at all levels, such that a 1TeV WIMP may, for example, maintain the temperature of the IGM on t...

  3. Metabolic and cardiac changes in high cholesterol-fructose-fed rats

    DEFF Research Database (Denmark)

    Axelsen, Lene N; Pedersen, Henrik D; Petersen, Jørgen S

    2010-01-01

    function was examined by in vivo pressure-volume measurements in the left ventricle. Finally, protein and glucose content in the urine was measured and all organs were weighed at the end of the study. Results: Rats fed a HCF diet showed increased cholesterol and decreased high-density lipoprotein (HDL......Introduction: High cholesterol-fructose (HCF) fed rats have previously been described as an animal model of impaired cardiac insulin signaling and decreased contractile performance. In this study, we evaluated the metabolic and cardiac effects of a HCF diet in rats. Methods: Male Sprague......-Dawley rats received a HCF diet for 16 to 17weeks. Body weight was measured weekly and mean arterial blood pressure, fasting blood glucose, fasting plasma insulin, glucose tolerance, and blood lipid levels were measured following 15weeks of feeding. One to 2weeks later, while still on the HCF diet, cardiac...

  4. A high output voltage flexible piezoelectric nanogenerator using porous lead-free KNbO3 nanofibers

    Science.gov (United States)

    Ganeshkumar, Rajasekaran; Cheah, Chin Wei; Xu, Ruize; Kim, Sang-Gook; Zhao, Rong

    2017-07-01

    Self-powered nanodevices for applications such as sensor networks and IoTs are among the emerging technologies in electronics. Piezoelectric nanogenerators (P-NGs) that harvest energy from mechanical stimuli are highly valuable in the development of self-sufficient nanosystems. Despite progress in the development of P-NGs, the use of porous perovskite ferroelectric nanofibers was barely considered or discussed. In this letter, a flexible high output nanogenerator is fabricated using a nanocomposite comprising porous potassium niobate (KNbO3) nanofibers and polydimethylsiloxane. When a compressive force was applied to as-fabricated P-NG, a peak-to-peak output voltage of ˜16 V and a maximum closed circuit current of 230 nA were obtained, which are high enough to realize self-powered nanodevices. In addition, due to their porosity and non-toxic nature, KNbO3 nanofibers may be used as an alternative to the dominant lead-based piezoelectric devices. Besides the high output performance of the device, multifunctional capability, flexible design, and cost-effective construction of the as-fabricated P-NG can be crucial to large-scale deployment of autonomous devices.

  5. GaAs-based superluminescent diodes with window-like facet structure for low spectral modulation at high output powers

    Science.gov (United States)

    Ghazal, O. M. S.; Childs, D. T.; Stevens, B. J.; Babazadeh, N.; Hogg, R. A.; Groom, K. M.

    2016-04-01

    We demonstrate a GaAs-based superluminescent diode (SLD) based on the incorporation of a window-like back facet into a self-aligned stripe structure in order to reduce the effective facet reflectivity. This allows the realisation of SLDs with low spectral modulation depth (SMD) at high power spectral density (PSD), without the application of anti-reflection coatings to either facet. This approach is therefore compatible with ultra-broadband gain active elements. We show that 30 mW output power can be attained in a narrow bandwidth, corresponding to 2.2 mW nm-1 PSD with only 5% SMD, centred about 990 nm. We discuss the design criteria for high power and low SMD and the deviation from a linear dependence of SMD on output power, resulting from Joule heating in the self-aligned stripe.

  6. Multiple-input multiple-output synthetic aperture ladar system for wide-range swath with high azimuth resolution.

    Science.gov (United States)

    Tang, Yu; Qin, Bao; Yan, Yun; Xing, Mengdao

    2016-02-20

    For the trade-off between the high azimuth resolution and the wide-range swath in the single-input single-output synthetic aperture ladar (SAL) system, the range swath of the SAL system is restricted to a narrow range, this paper proposes a multiple-input multiple-output (MIMO) synthetic aperture ladar system. The MIMO system adopts a low pulse repetition frequency (PRF) to avoid a range ambiguity for the wide-range swath and in azimuth adopts the multi-channel method to achieve azimuth high resolution from the unambiguous azimuth wide-spectrum signal, processed through adaptive digital beam-forming technology. Simulations and analytical results are presented.

  7. Kv3-Like Potassium Channels Are Required for Sustained High-Frequency Firing in Basal Ganglia Output Neurons

    OpenAIRE

    Ding, Shengyuan; Matta, Shannon G.; Zhou, Fu-Ming

    2010-01-01

    The GABA projection neurons in the substantial nigra pars reticulata (SNr) are key output neurons of the basal ganglia motor control circuit. These neurons fire sustained high-frequency, short-duration spikes that provide a tonic inhibition to their targets and are critical to movement control. We hypothesized that a robust voltage-activated K+ conductance that activates quickly and resists inactivation is essential to the remarkable fast-spiking capability in these neurons. Semi-quantitative...

  8. Low spectral modulation high-power output from a new AlGaAs superluminescent diode/optical amplifier structure

    Energy Technology Data Exchange (ETDEWEB)

    Alphonse, G.A.; Connolly, J.C.; Dinkel, N.A.; Palfrey, S.L.; Gilbert, D.B. (David Sarnoff Research Center, Princeton, New Jersey 08543-5300 (US))

    1989-11-27

    A double-heterojunction angled stripe AlGaAs device consisting of an index-guided ridge waveguide with gain-guided facet regions has produced cw output powers of 20 mW with less than 1% spectral modulation from a 300-{mu}m-long diode. These properties enable these devices to have important use in high-sensitivity fiber optic gyroscopes and as broadband traveling-wave optical amplifiers.

  9. Design of spherical electron gun for ultra high frequency, CW power inductive output tube

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Meenu, E-mail: mkceeri@gmail.com; Joshi, L. M., E-mail: lmj1953@gmail.com [Microwave Tubes Division, CSIR-Central Electronics Engineering Research Institute (CEERI), Pilani, Rajasthan (India); Academy of Scientific and Innovative Research (AcSIR), New Delhi (India)

    2016-03-09

    Inductive Output Tube (IOT) is an amplifier that usually operates in UHF range. It is an electron tube whose basic structure is similar to conventional vacuum devices. This device is widely used in broadcast applications but is now being explored for scientific applications also specifically, particle accelerators and fusion plasma heating purposes. The paper describes the design approach of a spherical gridded electron gun of a 500 MHz, 100 kW CW power IOT. The electron gun structure has been simulated and optimized for operating voltage and current of 40kV and 3.5 A respectively. The electromagnetic analysis of this spherical electron gun has been carried out in CST and TRAK codes.

  10. Beam quality of InGaAs ridge lasers at high output power.

    Science.gov (United States)

    Hunziker, G; Harder, C

    1995-09-20

    The nonlinear behavior of the light-current characteristic of single quantum well, graded-index-separateheterostructure ridge laser diodes emitting at 980 nm is investigated. We have measured the beam-quality factor |M|(2) as a function of the output power, under continuous-wave and transient conditions.The time constant associated with beam degradation under the transient condition suggests that the temperature profile in the cavity plays a significant role in the lateral guiding of the lasing modes. The two-dimensional heat equation is solved for the device, and the time-resolved thermally induced refractive-index profile is computed. There is excellent agreement between the time required to reach a steady index profile and that required to degrade the beam. The small beam astigmatism (typically 2 µm) measured under CW operating conditions in the linear regime indicates that the mode is essentially index guided, which permits simple quantitative modeling of the waveguide.

  11. Design of spherical electron gun for ultra high frequency, CW power inductive output tube

    Science.gov (United States)

    Kaushik, Meenu; Joshi, L. M.

    2016-03-01

    Inductive Output Tube (IOT) is an amplifier that usually operates in UHF range. It is an electron tube whose basic structure is similar to conventional vacuum devices. This device is widely used in broadcast applications but is now being explored for scientific applications also specifically, particle accelerators and fusion plasma heating purposes. The paper describes the design approach of a spherical gridded electron gun of a 500 MHz, 100 kW CW power IOT. The electron gun structure has been simulated and optimized for operating voltage and current of 40kV and 3.5 A respectively. The electromagnetic analysis of this spherical electron gun has been carried out in CST and TRAK codes.

  12. Ferroelectric-ferromagnetic multilayers: A magnetoelectric heterostructure with high output charge signal

    Energy Technology Data Exchange (ETDEWEB)

    Prokhorenko, S. [Laboratoire Structures, Propriétés et Modélisation des Solides, UMR CNRS—École Centrale Paris, 92295 Châtenay-Malabry (France); Kohlstedt, H. [Nanoelektronik, Technische Fakultät, Christian-Albrechts-Universität zu Kiel, D-24143 Kiel (Germany); Pertsev, N. A., E-mail: pertsev.domain@mail.ioffe.ru [A. F. Ioffe Physical-Technical Institute and St. Petersburg State Polytechnical University, St. Petersburg, 194021 and 195251 (Russian Federation)

    2014-09-21

    Multiferroic composites and heterostructures comprising ferroelectric and ferromagnetic materials exhibit room-temperature magnetoelectric (ME) effects greatly exceeding those of single-phase magnetoelectrics known to date. Since these effects are mediated by the interfacial coupling between ferroic constituents, the ME responses may be enhanced by increasing the density of interfaces and improving their quality. A promising material system providing these features is a ferroelectric-ferromagnetic multilayer with epitaxial interfaces. In this paper, we describe theoretically the strain-mediated direct ME effect exhibited by free-standing multilayers composed of single-crystalline ferroelectric nanolayers interleaved by conducting ferromagnetic slabs. Using a nonlinear thermodynamic approach allowing for specific mechanical boundary conditions of the problem, we first calculate the polarization states and dielectric properties of ferroelectric nanolayers in dependence on the lattice mismatch between ferroic constituents and their volume fractions. In these calculations, the ferromagnetic component is described by a model which combines linear elastic behavior with magnetic-field-dependent lattice parameters. Then the quasistatic ME polarization and voltage coefficients are evaluated using the theoretical strain sensitivity of ferroelectric polarization and measured effective piezomagnetic coefficients of ferromagnets. For Pb(Zr₀.₅Ti₀.₅)O₃-FeGaB and BaTiO₃-FeGaB multilayers, the ME coefficients are calculated numerically as a function of the FeGaB volume fraction and used to evaluate the output charge and voltage signals. It is shown that the multilayer geometry of a ferroelectric-ferromagnetic nanocomposite opens the way for a drastic enhancement of the output charge signal. This feature makes biferroic multilayers advantageous for the development of ultrasensitive magnetic-field sensors for technical and biomedical applications.

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

    Directory of Open Access Journals (Sweden)

    Kapoor Poonam

    2008-01-01

    Full Text Available Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE ≥3 undergoing coronary artery bypass surgery under cardiopulmonary bypass. The patients were randomly divided into two groups, namely, control and early goal-directed therapy (EGDT groups. All the subjects received standardized care; arterial pressure was monitored through radial artery, central venous pressure through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour and frequent arterial blood gas analysis. In addition, cardiac index monitoring using FloTrac™ and continuous central venous oxygen saturation using PreSep™ was used in patients in the EGTD group. Our aim was to maintain the cardiac index at 2.5-4.2 l/min/m 2 , stroke volume index 30-65 ml/beat/m 2 , systemic vascular resistance index 1500-2500 dynes/s/cm 5 /m 2 , oxygen delivery index 450-600 ml/min/m 2 , continuous central venous oximetry more than 70%, stroke volume variation less than 10%; in addition to the control group parameters such as central venous pressure 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal arterial blood gas analysis values, pulse oximetry, hematocrit value above 30% and urine output more than 1 ml/kg/h. The aims were achieved by altering the administration of intravenous fluids and doses of inotropic or vasodilator agents. Three patients were excluded from the study and the data of 27 patients analyzed. The extra volume used (330 ± 160 v/s 80 ± 80 ml, P = 0.043 number of adjustments of inotropic agents (3

  14. High-frequency oscillatory ventilation and pediatric cardiac surgery : Yes, we can!

    NARCIS (Netherlands)

    Kneyber, Martin C. J.

    2011-01-01

    In the previous issue of Critical Care, Bojan and colleagues reported their experiences with high-frequency oscillatory ventilation (HFOV) after pediatric cardiac surgery. A total of 120 patients were treated with HFOV on the day of surgery, thus excluding rescue HFOV use. The main finding of the

  15. Edge-facet pumped, multi-aperture, thin-disk laser geometry for very high average power output scaling

    Energy Technology Data Exchange (ETDEWEB)

    Zapata, Luis E.

    2004-12-21

    The average power output of a laser is scaled, to first order, by increasing the transverse dimension of the gain medium while increasing the thickness of an index matched light guide proportionately. Strategic facets cut at the edges of the laminated gain medium provide a method by which the pump light introduced through edges of the composite structure is trapped and passes through the gain medium repeatedly. Spontaneous emission escapes the laser volume via these facets. A multi-faceted disk geometry with grooves cut into the thickness of the gain medium is optimized to passively reject spontaneous emission generated within the laser material, which would otherwise be trapped and amplified within the high index composite disk. Such geometry allows the useful size of the laser aperture to be increased, enabling the average laser output power to be scaled.

  16. High-Power Er3+/Yb3+ Codoped Double-Cladding Fibre Amplifier with More Than 2 W Output Power

    Institute of Scientific and Technical Information of China (English)

    LIU Yan-Ge; FENG Xin-Huan; LI Li-Jun; LI Yao; YUAN Shu-Zhong; KAI Gui-Yun; LI Yi-Gang; DONG Xiao-Yi

    2005-01-01

    @@ A high-power Er3+/Yb3+-codoped double-cladding all-fibre amplifier was successfully demonstrated and experimentally investigated. The amplifier could be operated with a maximum output power of 2.18 W and 2.11 W at 1541nm and 1550nm wavelengths, respectively, when the maximum pump power was 6.07W. The power conversion efficiency was up to 35.6% and 34.4% at the two wavelengths, respectively. The output power and the gain were greater than 2.00 W and 20.0dB, respectively, in the wavelength range from 1539nm to 1565nm for 20.0mW input signal power. The gain fluctuation and the noise figure around 1550nm wavelength were less than 0.3 dB and 6.0 dB, respectively.

  17. Flexible, transparent and exceptionally high power output nanogenerators based on ultrathin ZnO nanoflakes

    Science.gov (United States)

    van Ngoc, Huynh; Kang, Dae Joon

    2016-02-01

    Novel nanogenerator structures composed of ZnO nanoflakes of less than 10 nm thickness were fabricated using a novel method involving a facile synthetic route and a rational design. The fabricated nanogenerators exhibited a short-circuit current density of 67 μA cm-2, a peak-to-peak open-circuit voltage of 110 V, and an overall output power density exceeding 1.2 mW cm-2, and to the best of our knowledge, these are the best values that have been reported so far in the literature on ZnO-based nanogenerators. We demonstrated that our nanogenerator design could instantaneously power 20 commercial green light-emitting diodes without any additional energy storage processes. Both the facile synthetic route for the ZnO nanoflakes and the straightforward device fabrication process present great scaling potential in order to power mobile and personal electronics that can be used in smart wearable systems, transparent and flexible devices, implantable telemetric energy receivers, electronic emergency equipment, and other self-powered nano/micro devices.Novel nanogenerator structures composed of ZnO nanoflakes of less than 10 nm thickness were fabricated using a novel method involving a facile synthetic route and a rational design. The fabricated nanogenerators exhibited a short-circuit current density of 67 μA cm-2, a peak-to-peak open-circuit voltage of 110 V, and an overall output power density exceeding 1.2 mW cm-2, and to the best of our knowledge, these are the best values that have been reported so far in the literature on ZnO-based nanogenerators. We demonstrated that our nanogenerator design could instantaneously power 20 commercial green light-emitting diodes without any additional energy storage processes. Both the facile synthetic route for the ZnO nanoflakes and the straightforward device fabrication process present great scaling potential in order to power mobile and personal electronics that can be used in smart wearable systems, transparent and flexible

  18. Serial measurements of high-sensitivity cardiac troponin T after exercise stress test in stable coronary artery disease

    DEFF Research Database (Denmark)

    Axelsson, Anna; Ruwald, Martin Huth; Dalsgaard, Morten;

    2013-01-01

    The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD).......The aim was to assess serial measurements of high-sensitivity cardiac troponin T (hs-cTNT) post-exercise in patients with stable coronary artery disease (CAD)....

  19. Mechanical ventilation with high tidal volumes attenuates myocardial dysfunction by decreasing cardiac edema in a rat model of LPS-induced peritonitis

    Directory of Open Access Journals (Sweden)

    Smeding Lonneke

    2012-03-01

    Full Text Available Abstract Background Injurious mechanical ventilation (MV may augment organ injury remote from the lungs. During sepsis, myocardial dysfunction is common and increased endothelial activation and permeability can cause myocardial edema, which may, among other factors, hamper myocardial function. We investigated the effects of MV with injuriously high tidal volumes on the myocardium in an animal model of sepsis. Methods Normal rats and intraperitoneal (i.p. lipopolysaccharide (LPS-treated rats were ventilated with low (6 ml/kg and high (19 ml/kg tidal volumes (Vt under general anesthesia. Non-ventilated animals served as controls. Mean arterial pressure (MAP, central venous pressure (CVP, cardiac output (CO and pulmonary plateau pressure (Pplat were measured. Ex vivo myocardial function was measured in isolated Langendorff-perfused hearts. Cardiac expression of endothelial vascular cell adhesion molecule (VCAM-1 and edema were measured to evaluate endothelial inflammation and leakage. Results MAP decreased after LPS-treatment and Vt-dependently, both independent of each other and with interaction. MV Vt-dependently increased CVP and Pplat and decreased CO. LPS-induced peritonitis decreased myocardial function ex vivo but MV attenuated systolic dysfunction Vt-dependently. Cardiac endothelial VCAM-1 expression was increased by LPS treatment independent of MV. Cardiac edema was lowered Vt-dependently by MV, particularly after LPS, and correlated inversely with systolic myocardial function parameters ex vivo. Conclusion MV attenuated LPS-induced systolic myocardial dysfunction in a Vt-dependent manner. This was associated with a reduction in cardiac edema following a lower transmural coronary venous outflow pressure during LPS-induced coronary inflammation.

  20. Frequency-multiplication high-output triboelectric nanogenerator for sustainably powering biomedical microsystems.

    Science.gov (United States)

    Zhang, Xiao-Sheng; Han, Meng-Di; Wang, Ren-Xin; Zhu, Fu-Yun; Li, Zhi-Hong; Wang, Wei; Zhang, Hai-Xia

    2013-03-13

    An attractive method to response the current energy crisis and produce sustainable nonpolluting power source is harvesting energy from our living environment. However, the energy in our living environment always exists in low-frequency form, which is very difficult to be utilized directly. Here, we demonstrated a novel sandwich-shape triboelectric nanogenerator to convert low-frequency mechanical energy to electric energy with double frequency. An aluminum film was placed between two polydimethylsiloxane (PDMS) membranes to realize frequency multiplication by twice contact electrifications within one cycle of external force. The working mechanism was studied by finite element simulation. Additionally, the well-designed micro/nano dual-scale structures (i.e., pyramids and V-shape grooves) fabricated atop PDMS surface was employed to enhance the device performance. The output peak voltage, current density, and energy volume density achieved 465 V, 13.4 μA/cm(2), and 53.4 mW/cm(3), respectively. This novel nanogenerator was systematically investigated and also demonstrated as a reliable power source, which can be directly used to not only lighten five commercial light-emitting diodes (LEDs) but also drive an implantable 3-D microelectrode array for neural prosthesis without any energy storage unit or rectification circuit. This is the first demonstration of the nanogenerator for directly driving biomedical microsystems, which extends the application fields of the nanogenerator and drives it closer to practical applications.

  1. FloTrac/Vigileo系统在单肺通气心输出量监测中应用的探讨%Investigation of FloTrac/Vigileo in monitoring cardiac output during one lung ventilation

    Institute of Scientific and Technical Information of China (English)

    王宏宇; 苏中宏; 史宏伟; 鲍红光

    2011-01-01

    观察FloTrac/Vigileo系统在单肺通气心输出量(CO)监测中的应用效果.方法择期单肺通气手术患者17例,ASAⅡ或Ⅲ级,使用FloTrac/Vigileo系统观察CO变化,记录诱导后(T0)、单肺通气5 min(T1)、10 min(T2)、30min(T3)以及双腔管双肺通气时(T4)、关胸时(T5)的HR、MAP、心脏指数(CI)、每搏量变异度(SVV)和气道峰压(Pmax).结果 与T0时比较,T1、T5时CI明显增加(P<0.05);T1~T5时SVV均明显下降(P<0.05);T1~T3时Pmax显著增加(P<0.05).结论 FloTrac/Vigileo系统能快速、持续地监测单肺通气时CO的变化.%Objective To investigate the efficacy of FloTrac/Vigileo in monitoring cardiac output during one lung ventilatioa Methods Seventeen ASA Ⅱ or Ⅲ patients requiring one lung ventilation (OLV) were enrolled in the study. Cardiac index (CD and stroke volume variation (SVV) were recorded using FloTrac/Vigileo after anesthesia induction (T0), 5 min after (T1), 10 min after (T2), 30 min after (T3) OLV, during double-lumen-endobronchial-tube ventilation (T4) and at closing thorax (T5). HR, MAP and airway pressure were also recorded at these time points. Results Compared with T0, CI increased significantly at T1 and T5 (P<0. 05); SW decreased significantly from T1 to T5 (P<0. 05); and Pmax increased significantly from T1 to T3 (P<0. 05). Conclusion FloTrac/Vigileo can be used to rapidly and continuously monitor cardiac output during one lung ventilation continuously.

  2. Cardiac size of high-volume resistance trained female athletes: shaping the body but not the heart.

    Science.gov (United States)

    Venckunas, T; Simonavicius, J; Marcinkeviciene, J E

    2016-03-01

    Introduction Exercise training, besides many health benefits, may result in cardiac remodelling which is dependent on the type and amount of exercise performed. It is not clear, however, whether significant adaptation in cardiac structure is possible in females undergoing resistance type of exercise training. Rigorous high volume training of most muscle groups emphasising resistance exercises are being undertaken by athletes of some aesthetic sports such as female fitness (light bodybuilding). The impact of this type of training on cardiac adaptation has not been investigated until now. The aim of the current study was to disclose the effect of high volume resistance training on cardiac structure and function. Methods 11 top-level female fitness athletes and 20 sedentary age-matched controls were recruited to undergo two-dimensional echocardiography. Results Cardiac structure did not differ between elite female fitness athletes and controls (p > 0.05), and fitness athletes had a tendency for a smaller (p = 0.07) left ventricular (LV) mass indexed to lean body mass. Doppler diastolic function index (E/A ratio) and LV ejection fraction were similar between the groups (p > 0.05). Conclusions Elite female fitness athletes have normal cardiac size and function that do not differ from matched sedentary controls. Consequently, as high volume resistance training has no easily observable effect on adaptation of cardiac structure, when cardiac hypertrophy is present in young resistance-trained lean female, other reasons such as inherited cardiac disease are to be considered carefully.

  3. Exercise Ameliorates High Fat Diet Induced Cardiac Dysfunction by Increasing Interleukin 10

    Directory of Open Access Journals (Sweden)

    Varun eKesherwani

    2015-04-01

    Full Text Available Increasing evidence suggests that a sedentary lifestyle and a high fat diet (HFD leads to cardiomyopathy. Moderate exercise ameliorates cardiac dysfunction, however underlying molecular mechanisms are poorly understood. Increased inflammation due to induction of pro-inflammatory cytokine such as tumor necrosis factor-alpha (TNF-α and attenuation of anti-inflammatory cytokine such as interleukin10 (IL-10 contributes to cardiac dysfunction in obese and diabetics. We hypothesized that exercise training ameliorates HFD- induced cardiac dysfunction by mitigating obesity and inflammation through upregulation of IL-10 and downregulation of TNF-α. To test this hypothesis, eight week old, female C57BL/6J mice were fed with HFD and exercised (swimming 1hr/day for 5 days/week for eight weeks. The four treatment groups: normal diet (ND, HFD, HFD + exercise (HFD + Ex and ND + Ex were analyzed for mean body weight, blood glucose level, TNF-α, IL-10, cardiac fibrosis by Masson Trichrome, and cardiac dysfunction by echocardiography. Mean body weights were increased in HFD but comparatively less in HFD + Ex. The level of TNF-α was elevated and IL-10 was downregulated in HFD but ameliorated in HFD + Ex. Cardiac fibrosis increased in HFD and was attenuated by exercise in the HFD + Ex group. The percentage ejection fraction and fractional shortening were decreased in HFD but comparatively increased in HFD + Ex. There was no difference between ND and ND + Ex for the above parameters except an increase in IL-10 level following exercise. Based on these results, we conclude that exercise mitigates HFD- induced cardiomyopathy by decreasing obesity, inducing IL-10, and reducing TNF-α in mice.

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

    Science.gov (United States)

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

    2016-03-01

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

  5. Is High Temporal Resolution Achievable for Paediatric Cardiac Acquisitions during Several Heart Beats? Illustration with Cardiac Phase Contrast Cine-MRI.

    Science.gov (United States)

    Bonnemains, Laurent; Odille, Freddy; Meyer, Christophe; Hossu, Gabriella; Felblinger, Jacques; Vuissoz, Pierre-André

    2015-01-01

    During paediatric cardiac Cine-MRI, data acquired during cycles of different lengths must be combined. Most of the time, Feinstein's model is used to project multiple cardiac cycles of variable lengths into a mean cycle. To assess the effect of Feinstein projection on temporal resolution of Cine-MRI. 1/The temporal errors during Feinstein's projection were computed in 306 cardiac cycles fully characterized by tissue Doppler imaging with 6-phase analysis (from a population of 7 children and young adults). 2/The effects of these temporal errors on tissue velocities were assessed by simulating typical tissue phase mapping acquisitions and reconstructions. 3/Myocardial velocities curves, extracted from high-resolution phase-contrast cine images, were compared for the 6 volunteers with lowest and highest heart rate variability, within a population of 36 young adults. 1/The mean of temporal misalignments was 30 ms over the cardiac cycle but reached 60 ms during early diastole. 2/During phase contrast MRI simulation, early diastole velocity peaks were diminished by 6.1 cm/s leading to virtual disappearance of isovolumic relaxation peaks. 3/The smoothing and erasing of isovolumic relaxation peaks was confirmed on tissue phase mapping velocity curves, between subjects with low and high heart rate variability (p = 0.05). Feinstein cardiac model creates temporal misalignments that impair high temporal resolution phase contrast cine imaging when beat-to-beat heart rate is changing.

  6. Prognostic value of high-sensitivity cardiac troponin T in patients with en-domyocardial-biopsy proven cardiac amyloidosis

    Institute of Scientific and Technical Information of China (English)

    Geng QIAN; Chen WU; Yang ZHANG; Yun-Dai CHEN; Wei DONG; Yi-Hong REN

    2014-01-01

    Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.

  7. A utility piezoelectric energy harvester with low frequency and high-output voltage: Theoretical model, experimental verification and energy storage

    Science.gov (United States)

    Zhang, Guangyi; Gao, Shiqiao; Liu, Haipeng

    2016-09-01

    In this paper, a utility piezoelectric energy harvester with low frequency and high-output voltage is presented. Firstly, the harvester's three theoretical models are presented, namely the static model, the quasi static model and the dynamic vibration model. By analyzing the influence of the mass ratio of the mass block to the beam on output characteristics of the harvester, we compare the quasi static model and the dynamic vibration model and then define their applicable ranges. Secondly, simulation and experiments are done to verify the models, using the harvester with PZT-5H piezoelectric material, which are proved to be consistent with each other. The experimental results show that the output open-circuit voltage and the output power can reach up to 86.36V and 27.5mW respectively. The experiments are conducted when this harvester system is excited by the first modal frequency (58.90Hz) with the acceleration 10m/s2. In this low frequency vibration case, it is easy to capture the energy in the daily environment. In addition, LTC 3588-1 chip (Linear Technology Corporation) is used as the medium energy circuit to transfer charges from the PZT-5H electrode to the 0.22F 5V super capacitor and ML621 rechargeable button battery. For this super-capacitor, it takes about 100min for the capacitor voltage to rise from 0V to 3.6V. For this button battery, it takes about 200min to increase the battery voltage from 2.5V to 3.48V.

  8. A utility piezoelectric energy harvester with low frequency and high-output voltage: Theoretical model, experimental verification and energy storage

    Directory of Open Access Journals (Sweden)

    Guangyi Zhang

    2016-09-01

    Full Text Available In this paper, a utility piezoelectric energy harvester with low frequency and high-output voltage is presented. Firstly, the harvester’s three theoretical models are presented, namely the static model, the quasi static model and the dynamic vibration model. By analyzing the influence of the mass ratio of the mass block to the beam on output characteristics of the harvester, we compare the quasi static model and the dynamic vibration model and then define their applicable ranges. Secondly, simulation and experiments are done to verify the models, using the harvester with PZT-5H piezoelectric material, which are proved to be consistent with each other. The experimental results show that the output open-circuit voltage and the output power can reach up to 86.36V and 27.5mW respectively. The experiments are conducted when this harvester system is excited by the first modal frequency (58.90Hz with the acceleration 10m/s2. In this low frequency vibration case, it is easy to capture the energy in the daily environment. In addition, LTC 3588-1 chip (Linear Technology Corporation is used as the medium energy circuit to transfer charges from the PZT-5H electrode to the 0.22F 5V super capacitor and ML621 rechargeable button battery. For this super-capacitor, it takes about 100min for the capacitor voltage to rise from 0V to 3.6V. For this button battery, it takes about 200min to increase the battery voltage from 2.5V to 3.48V.

  9. Design and Implementation of a High-Voltage Generator with Output Voltage Control for Vehicle ER Shock-Absorber Applications

    Directory of Open Access Journals (Sweden)

    Chih-Lung Shen

    2013-01-01

    Full Text Available A self-oscillating high-voltage generator is proposed to supply voltage for a suspension system in order to control the damping force of an electrorheological (ER fluid shock absorber. By controlling the output voltage level of the generator, the damping force in the ER fluid shock absorber can be adjusted immediately. The shock absorber is part of the suspension system. The high-voltage generator drives a power transistor based on self-excited oscillation, which converts dc to ac. A high-frequency transformer with high turns ratio is used to increase the voltage. In addition, the system uses the car battery as dc power supply. By regulating the duty cycle of the main switch in the buck converter, the output voltage of the buck converter can be linearly adjusted so as to obtain a specific high voltage for ER. The driving system is self-excited; that is, no additional external driving circuit is required. Thus, it reduces cost and simplifies system structure. A prototype version of the actual product is studied to measure and evaluate the key waveforms. The feasibility of the proposed system is verified based on experimental results.

  10. Simple Design Approach for Low Torque Ripple and High Output Torque Synchronous Reluctance Motors

    Directory of Open Access Journals (Sweden)

    Mohamed Nabil Fathy Ibrahim

    2016-11-01

    Full Text Available The rotor design of Synchronous Reluctance Motors (SynRMs has a large effect on their efficiency, torque density and torque ripple. In order to achieve a good compromise between these three goals, an optimized rotor geometry is necessary. A finite element method (FEM is a good tool for the optimization. However, the computation time is an obstacle as there are many geometrical parameters to be optimized. The flux-barrier widths and angles are the two most crucial parameters for the SynRM output torque and torque ripple. This paper proposes an easy-to-use set of parametrized equations to select appropriate values for these two rotor parameters. With these equations, the reader can design a SynRM of distributed windings with a low torque ripple and with a better average torque. The methodology is valid for a wide range of SynRMs. To check the validity of the proposed equations, the sensitivity analysis for the variation of these two parameters on the SynRM torque and torque ripple is carried out. In addition, the analysis in this paper gives insight into the behavior of the machine as a function of these two parameters. Furthermore, the torque and torque ripple of SynRMs having a rotor with three, four and five flux-barriers are compared with three literature approaches. The comparison shows that the proposed equations are effective in choosing the flux-barrier angles and widths for low torque ripple and better average torque. Experimental results have been obtained to confirm the FEM results and to validate the methodology for choosing the rotor parameters.

  11. A High-Voltage class-D power amplifier with switching frequency regulation for improved high-efficiency output power range

    NARCIS (Netherlands)

    Ma, Haifeng; Zee, van der Ronan; Nauta, Bram

    2015-01-01

    This paper describes the power dissipation analysis and the design of an efficiency-improved high-voltage class-D power amplifier. The amplifier adaptively regulates its switching frequency for optimal power efficiency across the full output power range. This is based on detecting the switching outp

  12. High Density Sphere Culture of Adult Cardiac Cells Increases the Levels of Cardiac and Progenitor Markers and Shows Signs of Vasculogenesis

    Directory of Open Access Journals (Sweden)

    Kristina Vukusic

    2013-01-01

    Full Text Available 3D environment and high cell density play an important role in restoring and supporting the phenotypes of cells represented in cardiac tissues. The aim of this study was therefore to investigate the suitability of high density sphere (HDS cultures for studies of cardiomyocyte-, endothelial-, and stem-cell biology. Primary adult cardiac cells from nine human biopsies were cultured using different media for up to 9 weeks. The possibilities to favor a certain cell phenotype and induce production of extra cellular matrix (ECM were studied by histology, immunohistochemistry, and quantitative real-time PCR. Defined media gave significant increase in both cardiac- and progenitor-specific markers and also an intraluminal position of endothelial cells over time. Cardiac media showed indication of differentiation and maturity of HDS considering the ECM production and activities within NOTCH regulation but no additional cardiac differentiation. Endothelial media gave no positive effects on endothelial phenotype but increased proliferation without fibroblast overgrowth. In addition, indications for early vasculogenesis were found. It was also possible to affect the Wnt signaling in HDS by addition of a glycogen synthase kinase 3 (GSK3 inhibitor. In conclusion, these findings show the suitability of HDS as in vitro model for studies of cardiomyocyte-, endothelial-, and stem-cell biology.

  13. High-Risk Cardiac Disease in Pregnancy Part II

    NARCIS (Netherlands)

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silverside, Candice K.

    2016-01-01

    Heart disease continues to be the leading cause of nonobstetric maternal morbidity and mortality. Early diagnosis and appropriate care can lead to prevention of complications and improvement of pregnancy outcome. This paper continues the review and provides recommendations for the approach to high-r

  14. Analysis of Possible Application of High-Temperature Nuclear Reactors to Contemporary Large-Output Steam Power Plants on Ships

    Directory of Open Access Journals (Sweden)

    Kowalczyk T.

    2016-04-01

    Full Text Available This paper is aimed at analysis of possible application of helium to cooling high-temperature nuclear reactor to be used for generating steam in contemporary ship steam-turbine power plants of a large output with taking into account in particular variable operational parameters. In the first part of the paper types of contemporary ship power plants are presented. Features of today applied PWR reactors and proposed HTR reactors are discussed. Next, issues of load variability of the ship nuclear power plants, features of the proposed thermal cycles and results of their thermodynamic calculations in variable operational conditions, are presented.

  15. Battery powered high output voltage bidirectional flyback converter for cylindrical DEAP actuator

    DEFF Research Database (Denmark)

    Huang, Lina; Thummala, Prasanth; Zhang, Zhe;

    2012-01-01

    DEAP (Dielectric Electro Active Polymer) actuator is essentially a capacitive load and can be applied in various actuation occasions. However, high voltage is needed to actuate it. In this paper, a high voltage bidirectional flyback converter with low input voltage is presented. The fundamental....... The design parameters for flyback transformer and snubber circuits are illustrated. Moreover, the experimental waveforms are provided....

  16. Quick-Change Ceramic Flame Holder for High-Output Torches

    Science.gov (United States)

    Haskin, Henry

    2010-01-01

    Researchers at NASA's Langley Research Center have developed a new ceramic design flame holder with a service temperature of 4,000 F (2,204 C). The combination of high strength and high temperature capability, as well as a twist-lock mounting method to the steel burner, sets this flame holder apart from existing technology.

  17. Biphasic contrast medium injection in cardiac CT: moderate versus high concentration contrast material at identical iodine flux and iodine dose.

    NARCIS (Netherlands)

    Rutten, A.; Meijs, M.F.; Vos, A.M.C.; Seidensticker, P.R.; Prokop, M.

    2010-01-01

    OBJECTIVE: To prospectively investigate the influence of contrast material concentration on enhancement in cardiac CT by using a biphasic single-injection protocol. METHODS: Sixty-four-row multidetector cardiac CT angiography was performed in 159 patients randomised to a moderate or high contrast me

  18. Cardiac dysfunction in the diabetic rat: quantitative evaluation using high resolution magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Alenezy Mohammed D

    2006-04-01

    Full Text Available Abstract Background Diabetes is a major risk factor for cardiovascular disease. In particular, type 1 diabetes compromises the cardiac function of individuals at a relatively early age due to the protracted course of abnormal glucose homeostasis. The functional abnormalities of diabetic myocardium have been attributed to the pathological changes of diabetic cardiomyopathy. Methods In this study, we used high field magnetic resonance imaging (MRI to evaluate the left ventricular functional characteristics of streptozotocin treated diabetic Sprague-Dawley rats (8 weeks disease duration in comparison with age/sex matched controls. Results Our analyses of EKG gated cardiac MRI scans of the left ventricle showed a 28% decrease in the end-diastolic volume and 10% increase in the end-systolic volume of diabetic hearts compared to controls. Mean stroke volume and ejection fraction in diabetic rats were decreased (48% and 28%, respectively compared to controls. Further, dV/dt changes were suggestive of phase sensitive differences in left ventricular kinetics across the cardiac cycle between diabetic and control rats. Conclusion Thus, the MRI analyses of diabetic left ventricle suggest impairment of diastolic and systolic hemodynamics in this rat model of diabetic cardiomyopathy. Our studies also show that in vivo MRI could be used in the evaluation of cardiac dysfunction in this rat model of type 1 diabetes.

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

    Science.gov (United States)

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

    2013-06-12

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

  20. High-Sensitivity Cardiac Troponin T in Prediction and Diagnosis of Myocardial Infarction and Long-Term Mortality after Non-Cardiac Surgery

    Science.gov (United States)

    Nagele, Peter; Brown, Frank; Gage, Brian F.; Gibson, David W.; Miller, J. Philip; Jaffe, Allan S.; Apple, Fred S.; Scott, Mitchell G.

    2013-01-01

    Background Perioperative myocardial infarction is a serious complication after non-cardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk of acute myocardial infarction (AMI) and long-term mortality after major non-cardiac surgery. Methods This was a prospective cohort study within the Vitamins in Nitrous Oxide (VINO) trial (n=608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major non-cardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay), and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative day 1, 2 and 3. Results At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration and 247 (41%) were above 14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median Δhs-cTnT +2.7 ng/L [IQR 0.7, 6.8]). During the first three postoperative days, 9 patients (2.5%) with a preoperative hs-cTnT 14 ng/L (odds ratio, 3.67; 95% CI 1.65 – 8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11% in patients with a preoperative hs-cTnT concentration 14 ng/L (adjusted hazard ratio, 2.17; 95% CI 1.19 – 3.96). Conclusions In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative myocardial infarction and long-term mortality after non-cardiac surgery. PMID:23895816

  1. OptoDyCE: Automated system for high-throughput all-optical dynamic cardiac electrophysiology

    Science.gov (United States)

    Klimas, Aleksandra; Yu, Jinzhu; Ambrosi, Christina M.; Williams, John C.; Bien, Harold; Entcheva, Emilia

    2016-02-01

    In the last two decades, drugs withdrawals from the market were due to cardiac toxicity, where unintended interactions with ion channels disrupt the heart's normal electrical function. Consequently, all new drugs must undergo preclinical testing for cardiac liability, adding to an already expensive and lengthy process. Recognition that proarrhythmic effects often result from drug action on multiple ion channels demonstrates a need for integrative and comprehensive measurements. Additionally, patient-specific therapies relying on emerging technologies employing stem-cell derived cardiomyocytes (e.g. induced pluripotent stem-cell-derived cardiomyocytes, iPSC-CMs) require better screening methods to become practical. However, a high-throughput, cost-effective approach for cellular cardiac electrophysiology has not been feasible. Optical techniques for manipulation and recording provide a contactless means of dynamic, high-throughput testing of cells and tissues. Here, we consider the requirements for all-optical electrophysiology for drug testing, and we implement and validate OptoDyCE, a fully automated system for all-optical cardiac electrophysiology. We demonstrate the high-throughput capabilities using multicellular samples in 96-well format by combining optogenetic actuation with simultaneous fast high-resolution optical sensing of voltage or intracellular calcium. The system can also be implemented using iPSC-CMs and other cell-types by delivery of optogenetic drivers, or through the modular use of dedicated light-sensitive somatic cells in conjunction with non-modified cells. OptoDyCE provides a truly modular and dynamic screening system, capable of fully-automated acquisition of high-content information integral for improved discovery and development of new drugs and biologics, as well as providing a means of better understanding of electrical disturbances in the heart.

  2. Regulation of pyruvate dehydrogenase activity and citric acid cycle intermediates during high cardiac power generation.

    Science.gov (United States)

    Sharma, Naveen; Okere, Isidore C; Brunengraber, Daniel Z; McElfresh, Tracy A; King, Kristen L; Sterk, Joseph P; Huang, Hazel; Chandler, Margaret P; Stanley, William C

    2005-01-15

    A high rate of cardiac work increases citric acid cycle (CAC) turnover and flux through pyruvate dehydrogenase (PDH); however, the mechanisms for these effects are poorly understood. We tested the hypotheses that an increase in cardiac energy expenditure: (1) activates PDH and reduces the product/substrate ratios ([NADH]/[NAD(+)] and [acetyl-CoA]/[CoA-SH]); and (2) increases the content of CAC intermediates. Measurements were made in anaesthetized pigs under control conditions and during 15 min of a high cardiac workload induced by dobutamine (Dob). A third group was made hyperglycaemic (14 mm) to stimulate flux through PDH during the high work state (Dob + Glu). Glucose and fatty acid oxidation were measured with (14)C-glucose and (3)H-oleate. Compared with control, the high workload groups had a similar increase in myocardial oxygen consumption ( and cardiac power. Dob increased PDH activity and glucose oxidation above control, but did not reduce the [NADH]/[NAD(+)] and [acetyl-CoA]/[CoA-SH] ratios, and there were no differences between the Dob and Dob + Glu groups. An additional group was treated with Dob + Glu and oxfenicine (Oxf) to inhibit fatty acid oxidation: this increased [CoA-SH] and glucose oxidation compared with Dob; however, there was no further activation of PDH or decrease in the [NADH]/[NAD(+)] ratio. Content of the 4-carbon CAC intermediates succinate, fumarate and malate increased 3-fold with Dob, but there was no change in citrate content, and the Dob + Glu and Dob + Glu + Oxf groups were not different from Dob. In conclusion, compared with normal conditions, at high myocardial energy expenditure (1) the increase in flux through PDH is regulated by activation of the enzyme complex and continues to be partially controlled through inhibition by fatty acid oxidation, and (2) there is expansion of the CAC pool size at the level of 4-carbon intermediates that is largely independent of myocardial fatty acid oxidation.

  3. 超声心动图对中晚孕正常胎儿心排血量及主动脉峡部血流量的研究%Research on cardiac output and blood flow of aortic isthmus of normal fetus in middle and late pregnancy by echocardiography

    Institute of Scientific and Technical Information of China (English)

    陈桂红; 张燕宏; 米杰; 张晓云; 李伟娟; 孙聪欣; 梁丽华; 刘涛; 王玮婧

    2014-01-01

    Objective To explore the changes of cardiac output and distribution with the increasing of pregnancy week in normal fetuses of middle and late pregnancy and establish the normal reference range.Methods Three hundred and thirteen normal fetuses in 20-40 pregnancy weeks underwent fetal echocardiography.The largest diameters of aortic valve,pulmonary valve,ductus arteriosus,aortic isthmus were measured respectively in the left ventricular outflow view,right ventricular outflow view,three vessels view and aortic arch longitudinal view.The blood flow spectrums of these parts were acquired and its velocity time integral (VTI) and heart rate (HR) were got by automatic envelope model.According to the formula of Q =(diameter/2)2 × 3.14 × VTI × HR,the cardiac output of left and right ventricle,the blood flow of aortic isthmus and ductus arteriosus were calculated.Results The cardiac outputs of left and right ventricle,combined cardiac output and the blood flow of aortic isthmus and ductus arteriosus of normal fetuses in middle and late pregnancy gradually increased with the increasing of gestational age and there were linear positive correlation between them.The blood flow of aortic isthmus increased with fetal weight,and there was significant correlation between them.The ratio of blood flow of aortic isthmus and ductus arteriosus decreased gradually with the increasing pregnancy week,and there was linear negative relationship between them.The ratio of blood flow of aortic isthmus and output of left ventricle and the ratio of blood flow of aortic isthmus and cardiac output were relatively constant,and there was poor correlation with gestational age.Conclusions Quantification of cardiac output and blood flow of AI can improve understanding about fetal circulation system physiology and help to identify abnormal pathological conditions,especially prompt the late morphological changes because of early abnormal flow of aortic isthmus.There was high clinical value for

  4. Bidirectional Flyback Converter with Multiple Series Connected Outputs for High Voltage Capacitive Charge and Discharge Applications

    DEFF Research Database (Denmark)

    Thummala, Prasanth; Schneider, Henrik; Zhang, Zhe;

    2015-01-01

    This paper evaluates two different implementations of a bidirectional flyback converter for driving a capacitive electro active actuator, which must be charged and discharged from 0 V to 2.5 kV DC and vice versa, supplied from a 24 V battery. In one implementation, a high voltage MOSFET (4 kV) in...

  5. Clinical value of high-sensitivity cardiac troponin assays after acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Yi-rui CAO

    2016-11-01

    Full Text Available In view of a variety of cardiovascular events complicated by acute ischemic stroke, the importance of monitoring myocardial ischemic symptoms and signs, electrocardiogram, echocardiogram and myocardial injury markers has been gradually recognized by clinicians. Cardiac troponin (cTn by conventional assay has been a unique marker of myocardial injury for its extremely high specificity. However, with the utilization of high-sensitivity cardiac troponin (hs-cTn, cTn is no longer exclusive of a disease, but was given more significance in the diagnosis and application value. Therefore, we described the clinical significance of alterations of serum hs-cTn concentration after ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2016.11.015

  6. Comprehensive biocompatibility of nontoxic and high-output flexible energy harvester using lead-free piezoceramic thin film

    Science.gov (United States)

    Jeong, Chang Kyu; Han, Jae Hyun; Palneedi, Haribabu; Park, Hyewon; Hwang, Geon-Tae; Joung, Boyoung; Kim, Seong-Gon; Shin, Hong Ju; Kang, Il-Suk; Ryu, Jungho; Lee, Keon Jae

    2017-07-01

    Flexible piezoelectric energy harvesters have been regarded as an overarching candidate for achieving self-powered electronic systems for environmental sensors and biomedical devices using the self-sufficient electrical energy. In this research, we realize a flexible high-output and lead-free piezoelectric energy harvester by using the aerosol deposition method and the laser lift-off process. We also investigated the comprehensive biocompatibility of the lead-free piezoceramic device using ex-vivo ionic elusion and in vivo bioimplantation, as well as in vitro cell proliferation and histologic inspection. The fabricated LiNbO3-doped (K,Na)NbO3 (KNN) thin film-based flexible energy harvester exhibited an outstanding piezoresponse, and average output performance of an open-circuit voltage of ˜130 V and a short-circuit current of ˜1.3 μ A under normal bending and release deformation, which is the best record among previously reported flexible lead-free piezoelectric energy harvesters. Although both the KNN and Pb(Zr,Ti)O3 (PZT) devices showed short-term biocompatibility in cellular and histological studies, excessive Pb toxic ions were eluted from the PZT in human serum and tap water. Moreover, the KNN-based flexible energy harvester was implanted into a porcine chest and generated up to ˜5 V and 700 nA from the heartbeat motion, comparable to the output of previously reported lead-based flexible energy harvesters. This work can compellingly serve to advance the development of piezoelectric energy harvesting for actual and practical biocompatible self-powered biomedical applications beyond restrictions of lead-based materials in long-term physiological and clinical aspects.

  7. Early assessment of post-operative cardiac output and causes of death in the neonates with congenital heart diseases%新生儿先天性心脏病术后早期心排血量评估及死亡原因分析

    Institute of Scientific and Technical Information of China (English)

    仇黎生; 刘锦纷; 徐志伟; 朱丽敏; 徐卓明

    2010-01-01

    analysis and calculated with the PiCCO plus system. Meanwhile, serum cardiac troponin I ( cTnl), mixed venous oxygen saturation ( SvO_2 ) and cardiopulmonary bypass (CPB) time were measured. Finally, the risk factors for surgical treatment in survivors and that associated with an increased mortality were analyzed. The association between post-operative cardiac output and the death after surgery was examined. Results Four neonates died after surgery, with a surgical mortality of 8.5%. CIvalue in the neonates [ (2.0±0.3 ) liters per minute per square meter of body surface was less than normal 2.5±0. 3. CI was associated inversely with CPB time but had a positive correlation with SvO_2. No significant difference association between CI and cTnI was observed. The value of cTnl was associated with the type of surgical procedures. Cases for which DHCA and low flow cerebral pefusion technique were used were free from neurological complications, ischemia in the lower extremities and oli-guria. The duration of cardiopulmonary bypass, urgent state of the operation and the abnormal coronary artery were associated with high mortality in the neonates after cardiac surgery. Conclusion The cardiac output of the neonates in whom cardiac pro-cedures were performed is adequate for the the oxygen supply required by the whole body though it is slightly lower than nomad after cardiac surgery. Higher mortality in the neonates during early postoperative period may be due to the complexity of the primary diseases, prolonged cardiopulmonary bypass time, residual abnormalities and severe acidosis before operation. Various techniques for CPB and that for the myocardial protection are safe and can provide an appropriate operative field.

  8. Anomalies of Siberian High Intensity and Their Precursors in Climatic Models Output

    Science.gov (United States)

    Martynova, Yuliya; Krupchatnikov, Vladimir

    2016-04-01

    The Siberian High (SH) is a powerful pressure system that determines the weather regime during the wintertime for the huge part of Asia [Sazonov B.I., 1991]. Particularly, SH regulates an intensity and duration of frosts in Siberia. Moreover, this pressure system has a strong connection with another atmospheric centers of action of the Northern Hemisphere such as Arctic High, Icelandic Low, the Azores High [Morozova S.V., 2013]. SH variation is closely related to atmospheric dynamics processes and air temperature variations between surface and middle troposphere. The maintaining of SH mainly depends on downward through the troposphere airflow which variation is strongly affected by the Arctic oscillation (AO). Positive (negative) AO phase causes the remarkably weakening (strengthening) of the downward airflow that has strong effect on the SH behavior [Gong G. et al., 2002; Krupchatnikov V. N. et al., 2009; Martynova Yu.V. and V.N. Krupchatnikov, 2010]. SH is highly exposed to global climate change that increases standard deviation of SH intensity [Fei L.I. and G. A. O. Yong-Qi, 2015]. The changes of SH characteristics result from not only direct climate change effect (such as global temperature rise) but also feedback effect of another climate system parameters variation. Thus, these parameters can serve as precursors of the extremely SH intensity. It's important to remember that the changes of the just one component of this High-Low interaction system could affect whole system. This study is devoted to determination of the precursors of the anomaly SH behavior and estimation of changes of the determined connection in the climate change conditions. The research was provided on a base of climate system models and reanalysis data. Acknowledgements This work is partially supported by SB RAS project VIII.80.2.1, RFBR grants 14-05-00502, 16-35-00301, 16-05-00558. References Fei L.I. and G. A. O. Yong-Qi The Project Siberian High in CMIP5 Models // Atmospheric and

  9. 静脉输注氨茶碱治疗严重脓毒症的可行性%Effects of aminophylline on cardiac index,oxygenation index, urine output and APACHEⅡ in patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    代冬梅; 王飞; 许汪斌; 杨磊; 谢翠英

    2013-01-01

    Objective To investigate the effects of aminophylline on cardiac index, oxygenation index and urine output in patients with sepsis. Methods Sixty APACHE Ⅱ score > 16 points patients with spesis of both sexes, aged 22 -76yr, were randomly divided into 2 groups( n = 30 each ) : aminophylline group ( group A ) and control group( group C ). Mechanical ventilation, antibiotics according to susceptibility or the sites of infection, early goal - directed therapy and low - dose steroids were administered for septic shock in both groups. Aminophylline 3mg/kg was infused iv over 30 min and followed by an infusion at 0. 4 mg/( kg·h ) for 4 days. Cardiac index, stroke volume variation and invasive arterial blood pressure were continuously monitored. Blood samples were drawn for blood gas analysis calculating oxygenation index and for determination of aminophylline serum concentration before aminophylline infusion( T0) and at 24h( T1), 48h( T2 ) and 72 h( T3 ) following aminophylline infusion. Urine output and total daily infusion were recorded at T0- T3. Results There were no significant differences in age, gender ratios, height, weight, APACHE Ⅱ scores, and total daily infusion between two groups ( P>0. 05 ). Compared with group C, there were no significant differences in the total daily infusion, cardiac index, oxygenation index and urine output before intravenous infusion of aminophylline ( P >0. 05 ). Compared with the values before intravenous infusion of aminophylline ( T0), oxygenation index and urine output increased in two groups ( P 0. 05 ), but it increased at T1 and T3( P 0. 05 ). Conclusion Intravenous infusion of aminophylline can increase urine output, oxygenation index and cardiac index in patients with sepsis.%目的 观察静脉输注氨茶碱对严重脓毒症患者氧合指数、尿量、心脏指数和APACHEII评分的影响,探讨静脉输注氨茶碱治疗脓毒症的可行性.方法 将60例APACHE 评分>16分的脓毒症患者随机分为氨茶

  10. Bidirectional Flyback Converter with Multiple Series Connected Outputs for High Voltage Capacitive Charge and Discharge Applications

    DEFF Research Database (Denmark)

    Thummala, Prasanth; Schneider, Henrik; Zhang, Zhe

    2015-01-01

    This paper evaluates two different implementations of a bidirectional flyback converter for driving a capacitive electro active actuator, which must be charged and discharged from 0 V to 2.5 kV DC and vice versa, supplied from a 24 V battery. In one implementation, a high voltage MOSFET (4 k...... by lower voltage rating MOSFETs driven by a gate drive transformer. Simulation results to compare the operation of conventional and proposed converters are provided. The advantages of proposed implementation are improved energy efficiency and lower cost. Experimental results with two series connected...

  11. Pretreatment solution recycling and high-concentration output for economical production of bioethanol.

    Science.gov (United States)

    Han, Minhee; Moon, Se-Kwon; Choi, Gi-Wook

    2014-11-01

    The purpose of this study was to enhance the economic efficiency of producing bioethanol. Pretreatment solution recycling is expected to increase economic efficiency by reducing the cost of pretreatment and the amount of wastewater. In addition, the production of high-concentration bioethanol could increase economic efficiency by reducing the energy cost of distillation. The pretreatment conditions were 95 °C, 0.72 M NaOH, 80 rpm twin-screw speed, and flow rate of 90 mL/min at 18 g/min of raw biomass feeding for pretreatment solution recycling. The pretreatment with NaOH solution recycling was conducted five times. All of the components and the pretreatment efficiency were similar, despite reuse. In addition, we developed a continuous biomass feeding system for production of high-concentration bioethanol. Using this reactor, the bioethanol productivity was investigated using various pretreated biomass feeding rates in a simultaneous saccharification and fermentation (SSF) process. The maximum ethanol concentration, yield, and productivity were 74.5 g/L, 89.5%, and 1.4 g/L h, respectively, at a pretreated biomass loading of approximately 25% (w/v) with an enzyme dosage of 30 FPU g/cellulose. The results presented here constitute an important contribution toward the production of bioethanol from Miscanthus.

  12. Facile Fabrication of Micro-Nano Structured Triboelectric Nanogenerator with High Electric Output

    Science.gov (United States)

    Zhang, Feifei; Li, Baozhang; Zheng, Jianming; Xu, Chunye

    2015-07-01

    In this article, a new method is used to fabricate a high-performance triboelectric nanogenerator (TENG), which is convenient and cost-effective. A polyformaldehyde (POM) film with novel structures is prepared through electrospinning and is combined with a polytetrafluoroethylene (PTFE) film to assemble micro-nano structured TENG. The short-circuit current ( I s) and open-circuit voltage ( V o) of the TENG are up to 0.4343 mA and 236.8 V, respectively, and no significant change is observed by applying different frequencies of external impact forces from 1 to 10 Hz. Finally, we successfully drive an electrochromic device (ECD) directly using TENG within just 2 min for the first time.

  13. Innovative electronic exams with voice in- and output questions in medical terminology on a high taxonomic level.

    Science.gov (United States)

    Baumann, Martin; Steinmetzer, Jan; Karami, Mazdak; Schäfer, Gereon

    2009-10-01

    Computer-based assessments can improve quality and economy of university exams. Using the 'Online Examination System' (OES), for the first time questions can be implemented which are specifically designed to test the examinees' voice-related knowledge and skills in electronic exams of History, Theory and Ethics of Medicine on all taxonomy levels. To meet the specific learning objectives and to increase exam quality and economy with regard to testing student pronunciation and listening skills, the OES was to be prepared to handle sound output and vocal input. The usage of headsets reduces the inevitably occurring acoustical disturbances caused by sound file replay. Problems of acoustic disturbances during vocal recordings can be overcome by introducing synchronized micro-exams at the beginning of the assessments. The majority of participating students accept these types of electronic exams. Evaluation procedures of the respective items still require human intervention, but are increased in objectivity due to anonymity. Accelerated exam compilation, less staff interaction and assessments on a high taxonomic level increase the exam efficiency and quality. The integration of sound in- and output facilities in electronic assessment systems is capable of increasing both test economy and objectivity.

  14. Development of a High Output Fluorescent Light Module for the Commercial Plant Biotechnology Facility

    Science.gov (United States)

    Turner, Mark; Zhou, Wei-Jia; Doty, Laura (Technical Monitor)

    2000-01-01

    To maximize the use of available resources provided onboard the International Space Station, the development of an efficient lighting 1 system is critical to the overall performance of the CPBF. Not only is it important to efficiently generate photon energy, but thermal loads on the CPBF Temperature and Humidity Control System must be minimized. By utilizing optical coatings designed to produce highly diffuse reflectance in the visible wavelengths while minimizing reflectance in the infrared region, the design of the fluorescent light module for the CPBF is optimized for maximum photon flux, spatial uniformity and energy efficiency. Since the Fluorescent Light Module must be fully enclosed to meet (ISS) requirements for containment of particulates and toxic materials, heat removal from the lights presented some unique design challenges. By using the Express Rack moderate C, temperature-cooling loop, heat is rejected by means of a liquid/air coolant manifold. Heat transfer to the manifold is performed by conduction using copper fins, by forced air convection using miniature fans, and by radiation using optically selective coatings that absorb in the infrared wavelengths. Using this combination of heat transfer mechanisms builds in redundancy to prevent thermal build up and premature bulb failure.

  15. Real-time observation of cardiac movement and structures in congenital and acquired heart diseases employing high-speed ultrasonocardiotomography.

    Science.gov (United States)

    Nishimura, K; Hibi, N; Kato, T; Fukui, Y; Arakawa, T

    1976-09-01

    Echocardiography has proved useful for cardiac diagnosis during the past several years; however, the conventional one-dimensional ultrasound pulse echo method cannot easily visualize the anatomical relationships of the various cardiac structures. To overcome the limitation, the authors attempted a real-time observation of cardiac structures and introduced high-speed ultrasonocardiotomography with a Sonolayergraph Model SSL-51H (Toshiba) having a logarithmic amplifier. Thirty sector images are produced per second by a mechanically operated, single flat or 75 mm. focus transducer measuring 10 mm. in diameter. The angle of a sector image composed of about 120 scanning lines is arbitrarily changeable from null to 65 degrees. The fast succession of images produced enables clear observation of the movement of cardiac structures in real time. Study of 230 patients by means of the proposed system suggests that it is advantageous as a quick method to provide two-dimensional echocardiograms for cardiac diagnosis and assessment, especially in noninvasive diagnosis.

  16. Cardiac autonomic function and high-intensity interval training in middle-age men.

    Science.gov (United States)

    Kiviniemi, Antti M; Tulppo, Mikko P; Eskelinen, Joonas J; Savolainen, Anna M; Kapanen, Jukka; Heinonen, Ilkka H A; Huikuri, Heikki V; Hannukainen, Jarna C; Kalliokoski, Kari K

    2014-10-01

    The effects of short-term high-intensity interval training (HIT) on cardiac autonomic function are unclear. The present study assessed cardiac autonomic adaptations to short-term HIT in comparison with aerobic endurance training (AET). Twenty-six healthy middle-age sedentary men were randomized into HIT (n = 13, 4-6 × 30 s of all-out cycling efforts with 4-min recovery) and AET (n = 13, 40-60 min at 60% of peak workload) groups, performing six sessions within 2 wk. The participants underwent a 24-h ECG recording before and after the intervention and, additionally, recorded R-R interval data in supine position (5 min) at home every morning during the intervention. Mean HR and low-frequency (LF) and high-frequency (HF) power of R-R interval oscillation were analyzed from these recordings. Peak oxygen consumption (V˙O2peak) increased in both groups (P training, most probably by inducing larger increases in cardiac vagal activity. The acute autonomic responses to the single HIT session were not modified by short-term training.

  17. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

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

    1979-06-15

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

  18. Nonlinear SVM-DTC for induction motor drive using input-output feedback linearization and high order sliding mode control.

    Science.gov (United States)

    Ammar, Abdelkarim; Bourek, Amor; Benakcha, Abdelhamid

    2017-03-01

    This paper presents a nonlinear Direct Torque Control (DTC) strategy with Space Vector Modulation (SVM) for an induction motor. A nonlinear input-output feedback linearization (IOFL) is implemented to achieve a decoupled torque and flux control and the SVM is employed to reduce high torque and flux ripples. Furthermore, the control scheme performance is improved by inserting a super twisting speed controller in the outer loop and a load torque observer to enhance the speed regulation. The combining of dual nonlinear strategies ensures a good dynamic and robustness against parameters variation and disturbance. The system stability has been analyzed using Lyapunov stability theory. The effectiveness of the control algorithm is investigated by simulation and experimental validation using Matlab/Simulink software with real-time interface based on dSpace 1104.

  19. Numerical simulations of output pulse extraction from a high-power microwave compressor with a plasma switch

    Energy Technology Data Exchange (ETDEWEB)

    Shlapakovski, Anatoli; Beilin, Leonid; Bliokh, Yuri; Donskoy, Moshe; Krasik, Yakov E. [Physics Department, Technion, Haifa 32000 (Israel); Hadas, Yoav [Department of Applied Physics, Rafael, PO Box 2250, Haifa 31021 (Israel); Schamiloglu, Edl [Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131 (United States)

    2014-05-07

    Numerical simulations of the process of electromagnetic energy release from a high-power microwave pulse compressor comprising a gas-filled cavity and interference switch were carried out. A microwave plasma discharge in a rectangular waveguide H-plane tee was modeled with the use of the fully electromagnetic particle-in-cell code MAGIC. The gas ionization, plasma evolution, and interaction with RF fields accumulated within the compressor were simulated using different approaches provided by the MAGIC code: particle-in-cell approach accounting for electron-neutral collisions, gas conductivity model based on the concept of mobility, and hybrid modeling. The dependences of the microwave output pulse peak power and waveform on parameters that can be controlled in experiments, such as an external ionization rate, RF field amplitude, and background gas pressure, were investigated.

  20. Modeling and output tracking of transverse flux permanent magnet machines using high gain observer and RBF neural network.

    Science.gov (United States)

    Karimi, H R; Babazadeh, A

    2005-10-01

    This paper deals with modeling and adaptive output tracking of a transverse flux permanent magnet machine as a nonlinear system with unknown nonlinearities by utilizing high gain observer and radial basis function networks. The proposed model is developed based on computing the permeance between rotor and stator using quasiflux tubes. Based on this model, the techniques of feedback linearization and Hinfinity control are used to design an adaptive control law for compensating the unknown nonlinear parts, such as the effect of cogging torque, as a disturbance is decreased onto the rotor angle and angular velocity tracking performances. Finally, the capability of the proposed method in tracking both the angle and the angular velocity is shown in the simulation results.

  1. High output efficiency in a one wavelength microcavity OLED with emitter layer positioned at an anti-node

    CERN Document Server

    Nelson, Mitchell C

    2015-01-01

    A novel OLED architecture is described in which a thin emitter layer is located at the anti-node of a resonant microcavity. In two realizations, the mode space is constrained by either multi-layer mirrors or by an emitter with transition dipole moments oriented normal to the vertical mode of the device. The multi-layer mirror device achieves 315 lm/W and shows linear light output versus current with a small offset. The symmetrized emitter device demonstrates a luminous efficiency of 340 lm/W. Rate equation analysis predicts the observed linear behavior with constant loss term for stimulated emission devices. For spontaneous emission devices a coefficient is obtained that is analogous to the out-coupling factor and goes to 1 for high finesse cavities. Both types of devices can approach unit efficiency, the stimulated emission device should be less susceptible to roll-off and may be easier to manufacture.

  2. VLSI Implementation of a Fixed-Complexity Soft-Output MIMO Detector for High-Speed Wireless

    Directory of Open Access Journals (Sweden)

    Di Wu

    2010-01-01

    Full Text Available This paper presents a low-complexity MIMO symbol detector with close-Maximum a posteriori performance for the emerging multiantenna enhanced high-speed wireless communications. The VLSI implementation is based on a novel MIMO detection algorithm called Modified Fixed-Complexity Soft-Output (MFCSO detection, which achieves a good trade-off between performance and implementation cost compared to the referenced prior art. By including a microcode-controlled channel preprocessing unit and a pipelined detection unit, it is flexible enough to cover several different standards and transmission schemes. The flexibility allows adaptive detection to minimize power consumption without degradation in throughput. The VLSI implementation of the detector is presented to show that real-time MIMO symbol detection of 20 MHz bandwidth 3GPP LTE and 10 MHz WiMAX downlink physical channel is achievable at reasonable silicon cost.

  3. Synthesis, Tunable Multicolor Output, and High Pure Red Upconversion Emission of Lanthanide-Doped Lu2O3 Nanosheets

    Directory of Open Access Journals (Sweden)

    Lingzhen Yin

    2013-01-01

    Full Text Available Yb3+ and Ln3+ (Ln = Er, Ho codoped Lu2O3 square nanocubic sheets were successfully synthesized via a facile hydrothermal method followed by a subsequent dehydration process. The crystal phase, morphology, and composition of hydroxide precursors and target oxides were characterized by X-ray diffraction (XRD, field emission scanning electron microscope (FE-SEM, and energy-dispersive X-ray spectroscope (EDS. Results present the as-prepared Lu2O3 crystallized in cubic phase, and the monodispersed square nanosheets were maintained both in hydroxide and oxides. Moreover, under 980 nm laser diode (LD excitation, multicolor output from red to yellow was realized by codoped different lanthanide ions in Lu2O3. It is noteworthy that high pure strong red upconversion emission with red to green ratio of 443.3 of Er-containing nanocrystals was obtained, which is beneficial for in vivo optical bioimaging.

  4. An Efficient Framework for Compressed Sensing Reconstruction of Highly Accelerated Dynamic Cardiac MRI

    Science.gov (United States)

    Ting, Samuel T.

    The research presented in this work seeks to develop, validate, and deploy practical techniques for improving diagnosis of cardiovascular disease. In the philosophy of biomedical engineering, we seek to identify an existing medical problem having significant societal and economic effects and address this problem using engineering approaches. Cardiovascular disease is the leading cause of mortality in the United States, accounting for more deaths than any other major cause of death in every year since 1900 with the exception of the year 1918. Cardiovascular disease is estimated to account for almost one-third of all deaths in the United States, with more than 2150 deaths each day, or roughly 1 death every 40 seconds. In the past several decades, a growing array of imaging modalities have proven useful in aiding the diagnosis and evaluation of cardiovascular disease, including computed tomography, single photon emission computed tomography, and echocardiography. In particular, cardiac magnetic resonance imaging is an excellent diagnostic tool that can provide within a single exam a high quality evaluation of cardiac function, blood flow, perfusion, viability, and edema without the use of ionizing radiation. The scope of this work focuses on the application of engineering techniques for improving imaging using cardiac magnetic resonance with the goal of improving the utility of this powerful imaging modality. Dynamic cine imaging, or the capturing of movies of a single slice or volume within the heart or great vessel region, is used in nearly every cardiac magnetic resonance imaging exam, and adequate evaluation of cardiac function and morphology for diagnosis and evaluation of cardiovascular disease depends heavily on both the spatial and temporal resolution as well as the image quality of the reconstruction cine images. This work focuses primarily on image reconstruction techniques utilized in cine imaging; however, the techniques discussed are also relevant to

  5. Saturated Adaptive Output-Feedback Power-Level Control for Modular High Temperature Gas-Cooled Reactors

    Directory of Open Access Journals (Sweden)

    Zhe Dong

    2014-11-01

    Full Text Available Small modular reactors (SMRs are those nuclear fission reactors with electrical output powers of less than 300 MWe. Due to its inherent safety features, the modular high temperature gas-cooled reactor (MHTGR has been seen as one of the best candidates for building SMR-based nuclear plants with high safety-level and economical competitive power. Power-level control is crucial in providing grid-appropriation for all types of SMRs. Usually, there exists nonlinearity, parameter uncertainty and control input saturation in the SMR-based plant dynamics. Motivated by this, a novel saturated adaptive output-feedback power-level control of the MHTGR is proposed in this paper. This newly-built control law has the virtues of having relatively neat form, of being strong adaptive to parameter uncertainty and of being able to compensate control input saturation, which are given by constructing Lyapunov functions based upon the shifted-ectropies of neutron kinetics and reactor thermal-hydraulics, giving an online tuning algorithm for the controller parameters and proposing a control input saturation compensator respectively. It is proved theoretically that input-to-state stability (ISS can be guaranteed for the corresponding closed-loop system. In order to verify the theoretical results, this new control strategy is then applied to the large-range power maneuvering control for the MHTGR of the HTR-PM plant. Numerical simulation results show not only the relationship between regulating performance and control input saturation bound but also the feasibility of applying this saturated adaptive control law practically.

  6. The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses.

    Science.gov (United States)

    McRae, Marion E; Chan, Alice; Hulett, Renee; Lee, Ai Jin; Coleman, Bernice

    2017-06-01

    There are few reports of the effectiveness or satisfaction with simulation to learn cardiac surgical resuscitation skills. To test the effect of simulation on the self-confidence of nurses to perform cardiac surgical resuscitation simulation and nurses' satisfaction with the simulation experience. A convenience sample of sixty nurses rated their self-confidence to perform cardiac surgical resuscitation skills before and after two simulations. Simulation performance was assessed. Subjects completed the Satisfaction with Simulation Experience scale and demographics. Self-confidence scores to perform all cardiac surgical skills as measured by paired t-tests were significantly increased after the simulation (d=-0.50 to 1.78). Self-confidence and cardiac surgical work experience were not correlated with time to performance. Total satisfaction scores were high (mean 80.2, SD 1.06) indicating satisfaction with the simulation. There was no correlation of the satisfaction scores with cardiac surgical work experience (τ=-0.05, ns). Self-confidence scores to perform cardiac surgical resuscitation procedures were higher after the simulation. Nurses were highly satisfied with the simulation experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. A universal system for highly efficient cardiac differentiation of human induced pluripotent stem cells that eliminates interline variability.

    Directory of Open Access Journals (Sweden)

    Paul W Burridge

    Full Text Available BACKGROUND: The production of cardiomyocytes from human induced pluripotent stem cells (hiPSC holds great promise for patient-specific cardiotoxicity drug testing, disease modeling, and cardiac regeneration. However, existing protocols for the differentiation of hiPSC to the cardiac lineage are inefficient and highly variable. We describe a highly efficient system for differentiation of human embryonic stem cells (hESC and hiPSC to the cardiac lineage. This system eliminated the variability in cardiac differentiation capacity of a variety of human pluripotent stem cells (hPSC, including hiPSC generated from CD34(+ cord blood using non-viral, non-integrating methods. METHODOLOGY/PRINCIPAL FINDINGS: We systematically and rigorously optimized >45 experimental variables to develop a universal cardiac differentiation system that produced contracting human embryoid bodies (hEB with an improved efficiency of 94.7±2.4% in an accelerated nine days from four hESC and seven hiPSC lines tested, including hiPSC derived from neonatal CD34(+ cord blood and adult fibroblasts using non-integrating episomal plasmids. This cost-effective differentiation method employed forced aggregation hEB formation in a chemically defined medium, along with staged exposure to physiological (5% oxygen, and optimized concentrations of mesodermal morphogens BMP4 and FGF2, polyvinyl alcohol, serum, and insulin. The contracting hEB derived using these methods were composed of high percentages (64-89% of cardiac troponin I(+ cells that displayed ultrastructural properties of functional cardiomyocytes and uniform electrophysiological profiles responsive to cardioactive drugs. CONCLUSION/SIGNIFICANCE: This efficient and cost-effective universal system for cardiac differentiation of hiPSC allows a potentially unlimited production of functional cardiomyocytes suitable for application to hPSC-based drug development, cardiac disease modeling, and the future generation of clinically

  8. Peak power tunable mid-infrared oscillator pumped by a high power picosecond pulsed fiber amplifier with bunch output

    Science.gov (United States)

    Wei, Kaihua; Guo, Yan; Lai, Xiaomin; Fan, Shanhui

    2016-07-01

    A high power mid-infrared optical parametric oscillator (OPO) with picosecond pulse bunch output is experimentally demonstrated. The pump source was a high power master oscillation power amplifier (MOPA) picosecond pulsed fiber amplifier. The seed of the MOPA was a gain-switched distributed Bragg reflector (DBR) laser diode (LD) with picosecond pulse operation at a high repetition rate. The seed laser was amplified to 50 W by two-stage pre-amplifiers and a large mode area (LMA) Yb fiber based power-amplifier. A fiber-pigtailed acousto-optic modulator with the first order diffraction transmission was inserted into the second pre-amplifier to form a picosecond pulse bunch train and to change the peak power simultaneously. The power-amplified pulse bunches were focused to pump a wavelength-tunable OPO for emitting high power mid-infrared laser. By adjusting the OPO cavity length, the maximum average idler powers obtained at 3.1, 3.3 and 3.5 μm were 7, 6.6 and 6.4 W respectively.

  9. An Artificial Neural Network Compensated Output Feedback Power-Level Control for Modular High Temperature Gas-Cooled Reactors

    Directory of Open Access Journals (Sweden)

    Zhe Dong

    2014-02-01

    Full Text Available Small modular reactors (SMRs could be beneficial in providing electricity power safely and also be viable for applications such as seawater desalination and heat production. Due to its inherent safety features, the modular high temperature gas-cooled reactor (MHTGR has been seen as one of the best candidates for building SMR-based nuclear power plants. Since the MHTGR dynamics display high nonlinearity and parameter uncertainty, it is necessary to develop a nonlinear adaptive power-level control law which is not only beneficial to the safe, stable, efficient and autonomous operation of the MHTGR, but also easy to implement practically. In this paper, based on the concept of shifted-ectropy and the physically-based control design approach, it is proved theoretically that the simple proportional-differential (PD output-feedback power-level control can provide asymptotic closed-loop stability. Then, based on the strong approximation capability of the multi-layer perceptron (MLP artificial neural network (ANN, a compensator is established to suppress the negative influence caused by system parameter uncertainty. It is also proved that the MLP-compensated PD power-level control law constituted by an experientially-tuned PD regulator and this MLP-based compensator can guarantee bounded closed-loop stability. Numerical simulation results not only verify the theoretical results, but also illustrate the high performance of this MLP-compensated PD power-level controller in suppressing the oscillation of process variables caused by system parameter uncertainty.

  10. Improving electromechanical output of IPMC by high surface area Pd-Pt electrodes and tailored ionomer membrane thickness

    Directory of Open Access Journals (Sweden)

    Viljar Palmre

    2014-04-01

    Full Text Available In this study, we attempt to improve the electromechanical performance of ionic polymer–metal composites (IPMCs by developing high surface area Pd-Pt electrodes and tailoring the ionomer membrane thickness. With proper electroless plating techniques, a high dispersion of palladium particles is achieved deep in the ionomer membrane, thereby increasing notably the interfacial surface area of electrodes. The membrane thickness is increased using 0.5 and 1 mm thick ionomer films. For comparison, IPMCs with the same ionomer membranes, but conventional Pt electrodes, are also prepared and studied. The electromechanical, mechanoelectrical, electrochemical and mechanical properties of different IPMCs are characterized and discussed. Scanning electron microscopy-energy dispersive X-ray (SEM-EDS is used to investigate the distribution of deposited electrode metals in the cross section of Pd-Pt IPMCs. Our experiments demonstrate that IPMCs assembled with millimeter thick ionomer membranes and newly developed Pd-Pt electrodes are superior in mechanoelectrical transduction, and show significantly higher blocking force compared to conventional type of IPMCs. The blocking forces of more than 0.3 N were measured at 4V DC input, exceeding the force output of typical Nafion® 117-based Pt IPMCs more than two orders of magnitude. The newly designed Pd-Pt IPMCs can be useful in more demanding applications, e.g., in biomimetic underwater robotics, where high stress and drag forces are encountered.

  11. Functional high-resolution time-course expression analysis of human embryonic stem cells undergoing cardiac induction

    Directory of Open Access Journals (Sweden)

    Ilaria Piccini

    2016-12-01

    Full Text Available Cardiac induction of human embryonic stem cells (hESCs is a process bearing increasing medical relevance, yet it is poorly understood from a developmental biology perspective. Anticipated technological progress in deriving stably expandable cardiac precursor cells or in advancing cardiac subtype specification protocols will likely require deeper insights into this fascinating system. Recent improvements in controlling hESC differentiation now enable a near-homogeneous induction of the cardiac lineage. This is based on an optimized initial stimulation of mesoderm-inducing signaling pathways such as Activin and/or FGF, BMP, and WNT, followed by WNT inhibition as a secondary requirement. Here, we describe a comprehensive data set based on varying hESC differentiation conditions in a systematic manner and recording high-resolution differentiation time-courses analyzed by genome-wide expression profiling (GEO accession number GSE67154. As a baseline, hESCs were differentiated into cardiomyocytes under optimal conditions. Moreover, in additional time-series, individual signaling factors were withdrawn from the initial stimulation cocktail to reveal their specific roles via comparison to the standard condition. Hence, this data set presents a rich resource for hypothesis generation in studying human cardiac induction, as we reveal numbers of known as well as uncharacterized genes prominently marking distinct intermediate stages in the process. These data will also be useful for identifying putative cardiac master regulators in the human system as well as for characterizing expandable cardiac stem cells.

  12. High-fat Diet Promotes Cardiac Remodeling in an Experimental Model of Obesity

    Directory of Open Access Journals (Sweden)

    Fernando Martins

    2015-01-01

    Full Text Available AbstractBackground:Although nutritional, metabolic and cardiovascular abnormalities are commonly seen in experimental studies of obesity, it is uncertain whether these effects result from the treatment or from body adiposity.Objective:To evaluate the influence of treatment and body composition on metabolic and cardiovascular aspects in rats receiving high saturated fat diet.Methods:Sixteen Wistar rats were used, distributed into two groups, the control (C group, treated with isocaloric diet (2.93 kcal/g and an obese (OB group, treated with high-fat diet (3.64 kcal/g. The study period was 20 weeks. Analyses of nutritional behavior, body composition, glycemia, cholesterolemia, lipemia, systolic arterial pressure, echocardiography, and cardiac histology were performed.Results:High-fat diet associates with manifestations of obesity, accompanied by changes in glycemia, cardiomyocyte hypertrophy, and myocardial interstitial fibrosis. After adjusting for adiposity, the metabolic effects were normalized, whereas differences in morphometric changes between groups were maintained.Conclusion:It was concluded that adiposity body composition has a stronger association with metabolic disturbances in obese rodents, whereas the high-fat dietary intervention is found to be more related to cardiac morphological changes in experimental models of diet-induced obesity.

  13. High-fat Diet Promotes Cardiac Remodeling in an Experimental Model of Obesity.

    Science.gov (United States)

    Martins, Fernando; Campos, Dijon Henrique Salomé; Pagan, Luana Urbano; Martinez, Paula Felippe; Okoshi, Katashi; Okoshi, Marina Politi; Padovani, Carlos Roberto; Souza, Albert Schiaveto de; Cicogna, Antonio Carlos; Oliveira-Junior, Silvio Assis de

    2015-11-01

    Although nutritional, metabolic and cardiovascular abnormalities are commonly seen in experimental studies of obesity, it is uncertain whether these effects result from the treatment or from body adiposity. To evaluate the influence of treatment and body composition on metabolic and cardiovascular aspects in rats receiving high saturated fat diet. Sixteen Wistar rats were used, distributed into two groups, the control (C) group, treated with isocaloric diet (2.93 kcal/g) and an obese (OB) group, treated with high-fat diet (3.64 kcal/g). The study period was 20 weeks. Analyses of nutritional behavior, body composition, glycemia, cholesterolemia, lipemia, systolic arterial pressure, echocardiography, and cardiac histology were performed. High-fat diet associates with manifestations of obesity, accompanied by changes in glycemia, cardiomyocyte hypertrophy, and myocardial interstitial fibrosis. After adjusting for adiposity, the metabolic effects were normalized, whereas differences in morphometric changes between groups were maintained. It was concluded that adiposity body composition has a stronger association with metabolic disturbances in obese rodents, whereas the high-fat dietary intervention is found to be more related to cardiac morphological changes in experimental models of diet-induced obesity.

  14. High Resolution Data Assimilation of Cardiac Mechanics Applied to a Dyssynchronous Ventricle.

    Science.gov (United States)

    Balaban, Gabriel; Finsberg, Henrik; Odland, Hans Henrik; Rognes, Marie; Ross, Stian; Sundnes, Joakim; Wall, Samuel

    2016-12-31

    Computational models of cardiac mechanics, personalized to a patient, offer access to mechanical information above and beyond direct medical imaging. Additionally, such models can be used to optimize and plan therapies in-silico, thereby reducing risks and improving patient outcome. Model personalization has traditionally been achieved by data assimilation, which is the tuning or optimization of model parameters to match patient observations. Current data assimilation procedures for cardiac mechanics are limited in their ability to efficiently handle high dimensional parameters. This restricts parameter spatial resolution, and thereby the ability of a personalized model to account for heterogeneities that are often present in a diseased or injured heart. In this paper we address this limitation by proposing an adjoint-gradient based data assimilation method that can efficiently handle high-dimensional parameters. We test this procedure on a synthetic data set, and provide a clinical example with a dyssynchronous left ventricle with highly irregular motion. Our results show that the method efficiently handles a high dimensional optimization parameter, and produces an excellent agreement for personalized models to both synthetic and clinical data. This article is protected by copyright. All rights reserved.

  15. High-dose hydroxocobalamin administered after H2S exposure counteracts sulfide-poisoning-induced cardiac depression in sheep.

    Science.gov (United States)

    Haouzi, Philippe; Chenuel, Bruno; Sonobe, Takashi

    2015-01-01

    Severe H2S poisoning leads to death by rapid respiratory and cardiac arrest, the latter can occur within seconds or minutes in severe forms of intoxication. To determine the time course and the nature of H2S-induced cardiac arrest and the effects of high-dose hydroxocobalamin administered after the end of sulfide exposure. NaHS was infused in 16 sedated mechanically ventilated sheep to reach concentrations of H2S in the blood, which was previously found to lead to cardiac arrest within minutes following the cessation of H2S exposure. High-dose hydroxocobalamin (5 g) or saline solution was administered intravenously, 1 min after the cessation of NaHS infusion. All animals were still alive at the cessation of H2S exposure. Three animals (18%) presented a cardiac arrest within 90 s and were unable to receive any antidote or vehicle. In the animals that survived long enough to receive either hydroxocobalamin or saline, 71% (5/7) died in the control group by cardiac arrest within 10 min. In all instances, cardiac arrest was the result of a pulseless electrical activity (PEA). In the group that received the antidote, intravenous injection of 5 g of hydroxocobalamin provoked an abrupt increase in blood pressure and blood flow; PEA was prevented in all instances. However, we could not find any evidence for a recovery in oxidative metabolism in the group receiving hydroxocobalamin, as blood lactate remained elevated and even continued to rise after 1 h, despite restored hemodynamics. This, along with an unaltered recovery of H2S kinetics, suggests that hydroxocobalamin did not act through a mechanism of H2S trapping. In this sheep model, there was a high risk for cardiac arrest, by PEA, persisting up to 10 min after H2S exposure. Very high dose of hydroxocobalamin (5 g), injected very early after the cessation of H2S exposure, improved cardiac contractility and prevented PEA.

  16. Monolithically interconnected GaAs solar cells: A new interconnection technology for high voltage solar cell output

    Science.gov (United States)

    Dinetta, L. C.; Hannon, M. H.

    1995-01-01

    Photovoltaic linear concentrator arrays can benefit from high performance solar cell technologies being developed at AstroPower. Specifically, these are the integration of thin GaAs solar cell and epitaxial lateral overgrowth technologies with the application of monolithically interconnected solar cell (MISC) techniques. This MISC array has several advantages which make it ideal for space concentrator systems. These are high system voltage, reliable low cost monolithically formed interconnections, design flexibility, costs that are independent of array voltage, and low power loss from shorts, opens, and impact damage. This concentrator solar cell will incorporate the benefits of light trapping by growing the device active layers over a low-cost, simple, PECVD deposited silicon/silicon dioxide Bragg reflector. The high voltage-low current output results in minimal 12R losses while properly designing the device allows for minimal shading and resistance losses. It is possible to obtain open circuit voltages as high as 67 volts/cm of solar cell length with existing technology. The projected power density for the high performance device is 5 kW/m for an AMO efficiency of 26% at 1 5X. Concentrator solar cell arrays are necessary to meet the power requirements of specific mission platforms and can supply high voltage power for electric propulsion systems. It is anticipated that the high efficiency, GaAs monolithically interconnected linear concentrator solar cell array will enjoy widespread application for space based solar power needs. Additional applications include remote man-portable or ultra-light unmanned air vehicle (UAV) power supplies where high power per area, high radiation hardness and a high bus voltage or low bus current are important. The monolithic approach has a number of inherent advantages, including reduced cost per interconnect and increased reliability of array connections. There is also a high potential for a large number of consumer products. Dual

  17. Governmentally amplified output volatility

    Science.gov (United States)

    Funashima, Yoshito

    2016-11-01

    Predominant government behavior is decomposed by frequency into several periodic components: updating cycles of infrastructure, Kuznets cycles, fiscal policy over business cycles, and election cycles. Little is known, however, about the theoretical impact of such cyclical behavior in public finance on output fluctuations. Based on a standard neoclassical growth model, this study intends to examine the frequency at which public investment cycles are relevant to output fluctuations. We find an inverted U-shaped relationship between output volatility and length of cycle in public investment. This implies that periodic behavior in public investment at a certain frequency range can cause aggravated output resonance. Moreover, we present an empirical analysis to test the theoretical implication, using the U.S. data in the period from 1968 to 2015. The empirical results suggest that such resonance phenomena change from low to high frequency.

  18. Haemodynamics and oxygenation improvement induced by high frequency percussive ventilation in a patient with hypoxia following cardiac surgery: a case report

    Directory of Open Access Journals (Sweden)

    Persi Bruno

    2010-10-01

    Full Text Available Abstract Introduction High frequency percussive ventilation is a ventilatory technique that delivers small bursts of high flow respiratory gas into the lungs at high rates. It is classified as a pneumatically powered, pressure-regulated, time-cycled, high-frequency flow interrupter modality of ventilation. High frequency percussive ventilation improves the arterial partial pressure of oxygen with the same positive end expiratory pressure and fractional inspiratory oxygen level as conventional ventilation using a minor mean airway pressure in an open circuit. It reduces the barotraumatic events in a hypoxic patient who has low lung-compliance. To the best of our knowledge, there have been no papers published about this ventilation modality in patients with severe hypoxaemia after cardiac surgery. Case presentation A 75-year-old Caucasian man with an ejection fraction of 27 percent, developed a lung infection with severe hypoxaemia [partial pressure of oxygen/fractional inspiratory oxygen of 90] ten days after cardiac surgery. Conventional ventilation did not improve the gas exchange. He was treated with high frequency percussive ventilation for 12 hours with a low conventional respiratory rate (five per minute. His cardiac output and systemic and pulmonary pressures were monitored. Compared to conventional ventilation, high frequency percussive ventilation gives an improvement of the partial pressure of oxygen from 90 to 190 mmHg with the same fractional inspiratory oxygen and positive end expiratory pressure level. His right ventricular stroke work index was lowered from 19 to seven g-m/m2/beat; his pulmonary vascular resistance index from 267 to 190 dynes•seconds/cm5/m2; left ventricular stroke work index from 28 to 16 gm-m/m2/beat; and his pulmonary arterial wedge pressure was lowered from 32 to 24 mmHg with a lower mean airway pressure compared to conventional ventilation. His cardiac index (2.7 L/min/m2 and ejection fraction (27 percent

  19. The Design of Drive Circuit with High-power Output for Two-phase Hybrid Stepping Motor Based on BY-5064

    Institute of Scientific and Technical Information of China (English)

    MA Xiao-jiao; LI Cheng-gui; CAI Zheng; ZHAO Li-guo

    2011-01-01

    A kind of drive circuit which high-power output for stepping motor, based two-phase hybrid stepping motor are designed, achieved. is low power consumption, high-performance and on BY-5064, and a kind of dedicated circuit for drive control for stepping motor with high-power is

  20. EVALUACIÓN ECOCARDIOGRÁFICA DEL GASTO CARDÍACO SISTÉMICO EN LA ATRESIA PULMONAR CON SEPTO INTERVENTRICULAR INTACTO / Echocardiographic evaluation of cardiac output in pulmonary atresia with intact ventricular septum

    Directory of Open Access Journals (Sweden)

    Giselle Serrano Ricardo

    2013-07-01

    hemodynamic performance, influencing cardiac output and generating potential conditions for short-term prognosis. Method: A descriptive, prospective and applied study was conducted. It included 43 patients who were referred to the William Soler Pediatric Cardiology Hospital from January 1992 to November 2011 with a diagnosis of the disease. In each subject, the profiles of eight echocardiographic variables were assessed, as well as the heart rate profile. Their level of association and mutual dependence were statistically assessed by simple regression models. Results: There are considerable variations in heart rate, in the volume index and in the ejection fraction of the patients´ left ventricle compared with those in the reference control group. Conclusions: The increased size of the atrial septal defect and the prolongation of transmitral diastasis favor left ventricular volume increment. Heart rate, the restrictive nature of the left ventricular myocardium and its ejection fraction are regulatory factors of cardiac output in this disease.

  1. High salt intake damages the heart through activation of cardiac (pro renin receptors even at an early stage of hypertension.

    Directory of Open Access Journals (Sweden)

    Yuka Hayakawa

    Full Text Available It has not yet been fully elucidated whether cardiac tissue levels of prorenin, renin and (PRR are activated in hypertension with a high salt intake. We hypothesized that a high salt intake activates the cardiac tissue renin angiotensin system and prorenin-(prorenin receptor system, and damages the heart at an early stage of hypertension.Wistar Kyoto rats (WKY and spontaneously hypertensive rats (SHR received regular (normal-salt diet, 0.9% and high-salt (8.9% chow for 6 weeks from 6 to 12 weeks of age. The systolic blood pressure, plasma renin activity (PRA and plasma angiotensin II concentration were measured, and the protein expressions of prorenin, (prorenin receptor, angiotensinogen, angiotensin II AT1 receptor, ERK1/2, TGF-β, p38MAPK and HSP27 in the myocardium were investigated. The cardiac function was assessed by echocardiography, and histological analysis of the myocardium was performed.The high-salt diet significantly increased the systolic blood pressure, and significantly reduced the PRA and plasma angiotensin II concentration both in the WKYs and SHRs. Cardiac expressions of prorenin, renin, (PRR, angiotensinogen, angiotensin II AT1 receptor, phosphorylated (p-ERK1/2, p-p38MAPK, TGF-β and p-HSP27 were significantly increased by the high salt diet both in the WKYs and SHRs. The high-salt diet significantly increased the interventricular septum thickness and cardiomyocyte size, and accelerated cardiac interstitial and perivascular fibrosis both in the WKYs and SHRs. On the other hand, dilatation of left ventricular end-diastolic dimension and impairment of left ventricular fractional shortening was shown only in salt loaded SHRs.The high-salt diet markedly accelerated cardiac damage through the stimulation of cardiac (PRR and angiotensin II AT1 receptor by increasing tissue prorenin, renin and angiotensinogen and the activation of ERK1/2, TGF-β, p38MAPK and HSP27 under higher blood pressure.

  2. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Jan M.; Nathoe, Hendrik M.; Boasson, Marc P.; Kluin, Jolanda; Bunge, Jeroen J. H.; Nierich, Arno P.; Rosseel, Peter M.; Maaten, van der Joost; Hofland, Jan; Diephuis, Jan C.; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    Background. Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  3. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Stefan; Nathoe, HM; Boasson, Marc P; Kluin, Jolanda; Bunge, Jeroen J H; Nierich, Arno P; Rosseel, Peter M; van der Maaten, Joost M; Hofland, Jan; Diephuis, Jan C; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    BACKGROUND: Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  4. Kv3-like potassium channels are required for sustained high-frequency firing in basal ganglia output neurons.

    Science.gov (United States)

    Ding, Shengyuan; Matta, Shannon G; Zhou, Fu-Ming

    2011-02-01

    The GABA projection neurons in the substantial nigra pars reticulata (SNr) are key output neurons of the basal ganglia motor control circuit. These neurons fire sustained high-frequency, short-duration spikes that provide a tonic inhibition to their targets and are critical to movement control. We hypothesized that a robust voltage-activated K(+) conductance that activates quickly and resists inactivation is essential to the remarkable fast-spiking capability in these neurons. Semi-quantitative RT-PCR (qRT-PCR) analysis on laser capture-microdissected nigral neurons indicated that mRNAs for Kv3.1 and Kv3.4, two key subunits for forming high activation threshold, fast-activating, slow-inactivating, 1 mM tetraethylammonium (TEA)-sensitive, fast delayed rectifier (I(DR-fast)) type Kv channels, are more abundant in fast-spiking SNr GABA neurons than in slow-spiking nigral dopamine neurons. Nucleated patch clamp recordings showed that SNr GABA neurons have a strong Kv3-like I(DR-fast) current sensitive to 1 mM TEA that activates quickly at depolarized membrane potentials and is resistant to inactivation. I(DR-fast) is smaller in nigral dopamine neurons. Pharmacological blockade of I(DR-fast) by 1 mM TEA impaired the high-frequency firing capability in SNr GABA neurons. Taken together, these results indicate that Kv3-like channels mediating fast-activating, inactivation-resistant I(DR-fast) current are critical to the sustained high-frequency firing in SNr GABA projection neurons and hence movement control.

  5. Application of peritoneal dialysis in the treatment of children with low cardiac output after cardiosurgery%腹膜透析在小儿先天性心脏病术后低心排的应用

    Institute of Scientific and Technical Information of China (English)

    王风

    2014-01-01

    Objective To investigate the effect of peritoneal dialysis in the treatment of children with low cardiac output after cardiosurgery .Methods A retrospective analysis was performed on the therapeutic effect of 12 children with low cardiac output after surgery of congenital heart disease by the early peritoneal dialysis in our hospital , 2.5%low calcium peritoneal dialysis solution was selected .The single amount of peritoneal dialysis was 15~20 ml/kg, and dialysis fluid retention time was 20~30 min.After 30 min reservation, dialysis fluid was drained for about 20 min according to the blood pressure .Peritoneal dialysis interval time was extended gradually after the urine occurred .Re-tention time of peritoneal dialysis was extended if patients were suffered from hyperlactacidemia .The frequency of di-alysis was adjusted according to the the level of serum creatinine and lactate .The blood glucose , electrolytes as well as arterial and venous blood gas was monitored , and the colloid was supplied when necessary .The peritoneal dialysis start, duration and the urine recovery time was recorded .Results The urine recovery time was 5~22 h.The appli-cation time of ventilator was 70~128 h, and the time in ICU was 5~18 d.The complications of peritoneal dialysis included catheter blockage (3 cases), hypoglycemia(3 cases), hyperglycemia(1 case) and hypokalemia (2 cases). No patients suffered from peritonitis and intestinal perforation .Two cases of tetralogy of fallot were died of severe low cardiac output and multiple organ dysfunction .Conclusion Early application of peritoneal dialysis can reduce the burden of heart , lung and kidney , maintain the stability of internal environment , and reduce mortality .%目的观察腹膜透析对小儿先天性心脏病术后的低心排治疗效果。方法回顾性分析该院12例先天性心脏病术后低心排早期治疗使用腹膜透析效果。腹透液选择百特公司2.5%低钙腹膜透析液。单次腹膜透析量15

  6. Infliximab reduces cardiac output in rheumatoid arthritis patients without heart failure Infliximabe reduz débito cardíaco em pacientes com artrite reumatoide sem insuficiência cardíaca

    Directory of Open Access Journals (Sweden)

    Rodrigo Cardoso Santos

    2012-12-01

    Full Text Available OBJECTIVE: Human anti-tumor necrosis factor (TNF-α monoclonal antibody (infliximab is used to treat autoimmune diseases such as rheumatoid arthritis (RA. Although the risk of worsening heart failure has been described in patients under chronic treatment, the acute cardiovascular effects of this drug are unknown in RA patients without heart failure. METHODS: 14 RA patients with normal echocardiography and no history of heart failure were evaluated during the 2-hour infliximab (3-5 mg/kg infusion period, using a noninvasive hemodynamic beat-to-beat system (Portapres. Stroke volume (SV; systolic, diastolic and mean blood pressures (SBP, DBP and MBP, respectively; cardiac output (CO; heart rate (HR; and total peripheral vascular resistance (PVR were recorded. All patients also received saline infusion instead of infliximab as a control. Significant differences in hemodynamic parameters were determined using Tuckey's test. All values were expressed as mean ± standard deviation (SD. RESULTS: Fourteen RA patients (6M/8F with mean age of 47.2 ± 8.8 years were evaluated. A significant decrease was found in cardiac output and stroke volume (7.04 ± 2.3 to 6.12 ± 2.1 l/min and 91 ± 29.0 to 83 ± 28.8 mL/beat, respectively after infliximab infusion. Although not statistically significant, a progressive increase was detected in SBP, DBP and total PVR during infusion. Saline infusion did not cause significant hemodynamic changes in the same group of RA patients. No adverse effects were observed during the infusion period. CONCLUSION: Acute infliximab administration decreased cardiac output due to low stroke volume in RA patients without heart disease. The results also demonstrated that, in spite of its negative inotropic effect, infliximab enhanced BP, probably by increasing PVR.OBJETIVO: O inibidor de fator de necrose tumoral (TNF-α infliximabe é usado no tratamento de doenças autoimunes como a artrite reumatoide (AR. Embora o risco de piora de

  7. The effectiveness of a high output/short duration radiofrequency current application technique in segmental pulmonary vein isolation for atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen;

    2006-01-01

    AIMS: Segmental pulmonary vein (PV) isolation by radiofrequency (RF) catheter ablation has become a curative therapy for atrial fibrillation (AF). However, the long procedure time limits the wide application of this procedure. The aim of the current study was to compare a novel ablation technique...... with a high power output and short application time vs. a conventional technique using a low power output and long application time. METHODS AND RESULTS: The study included 90 consecutive patients (age 53+/-10 years; 66 men). Segmental PV isolation was performed by irrigated RF catheter ablation in both...... groups. In the conventional group (Group 1, 45 patients), the power output was limited to 30 W with a target temperature of 50 degrees C and an RF preset duration of 120 s. In the novel group (Group 2, 45 patients), the maximum power output was preset to 45 W, with a target temperature of 55 degrees C...

  8. High-sensitivity cardiac troponin assays: answers to frequently asked questions.

    Science.gov (United States)

    Chenevier-Gobeaux, Camille; Bonnefoy-Cudraz, Éric; Charpentier, Sandrine; Dehoux, Monique; Lefevre, Guillaume; Meune, Christophe; Ray, Patrick

    2015-02-01

    Cardiac troponin (cTn) assays have quickly gained in analytical sensitivity to become what are termed 'high-sensitivity cardiac troponin' (hs-cTn) assays, bringing a flurry of dense yet incomplete literature data. The net result is that cTn assays are not yet standardized and there are still no consensus-built data on how to use and interpret cTn assay results. To address these issues, the authors take cues and clues from multiple disciplines to bring responses to frequently asked questions. In brief, the effective use of hs-cTn hinges on knowing: specific assay characteristics, particularly precision at the 99th percentile of a reference population; factors of variation at the 99th percentile value; and the high-individuality of hs-cTn assays, for which the notion of individual kinetics is more informative than straight reference to 'normal' values. The significance of patterns of change between two assay measurements has not yet been documented for every hs-cTn assay. Clinicians need to work hand-in-hand with medical biologists to better understand how to use hs-cTn assays in routine practice.

  9. Troponin not just a simple cardiac marker: prognostic significance of cardiac troponin

    Institute of Scientific and Technical Information of China (English)

    Benny Mulyanto Setiadi; LEI Han; CHANG Jing

    2009-01-01

    Objective The object of this study was to review the role of cardiac troponin as a prognostic factor in acute coronary syndrome patients of varying circumstances.Data sources The data used in this review were obtained mainly from the studies of cardiac troponin reported in pubmed from 1981 to 2006.Study selection Relevant articles on studies of cardiac troponin were selected.Results Elevated cardiac troponin in patients with ST elevation and non ST elevation myocardial infarction was associated with adverse outcomes, including a higher incidence of congestive heart failure, shock, and death. Patients with elevated cardiac troponin value seemed to benefit more from invasive strategies including a percutaneous coronary intervention and bypass surgery, but elevated cardiac troponin was also correlated with adverse outcomes, including a higher degree of failure, shock, and mortality in patients undergoing percutaneous coronary intervention; a higher degree of perioperative myocardial infarction, low cardiac output syndrome, cardiopulmonary resuscitation, and new-onset ventricular arrhythmia in patients undergoing bypass surgery were also observed. Elevated troponin after a percutaneous coronary intervention seemed to be associated with short-term adverse outcomes rather than long-term adverse outcomes, unless the elevation of the troponin post percutaneous coronary intervention was quite high (about 5 times above normal). On the contrary, elevated cardiac troponin after bypass surgery was more confusing to analyze since it happened in almost all patients. Furthermore, differences in cutoff values and time measurements in some studies add more confusion; thus, further research is warranted.Conclusions The prognostic value of cardiac troponin is demonstrated in almost all acute coronary syndrome patients. In addition to its high sensitivity and specificity, the prognostic value of cardiac troponin is another reason to make it the "golden cardiac marker' of this time.

  10. Fetal cardiac cine imaging using highly accelerated dynamic MRI with retrospective motion correction and outlier rejection.

    Science.gov (United States)

    van Amerom, Joshua F P; Lloyd, David F A; Price, Anthony N; Kuklisova Murgasova, Maria; Aljabar, Paul; Malik, Shaihan J; Lohezic, Maelene; Rutherford, Mary A; Pushparajah, Kuberan; Razavi, Reza; Hajnal, Joseph V

    2017-04-03

    Development of a MRI acquisition and reconstruction strategy to depict fetal cardiac anatomy in the presence of maternal and fetal motion. The proposed strategy involves i) acquisition and reconstruction of highly accelerated dynamic MRI, followed by image-based ii) cardiac synchronization, iii) motion correction, iv) outlier rejection, and finally v) cardiac cine reconstruction. Postprocessing entirely was automated, aside from a user-defined region of interest delineating the fetal heart. The method was evaluated in 30 mid- to late gestational age singleton pregnancies scanned without maternal breath-hold. The combination of complementary acquisition/reconstruction and correction/rejection steps in the pipeline served to improve the quality of the reconstructed 2D cine images, resulting in increased visibility of small, dynamic anatomical features. Artifact-free cine images successfully were produced in 36 of 39 acquired data sets; prolonged general fetal movements precluded processing of the remaining three data sets. The proposed method shows promise as a motion-tolerant framework to enable further detail in MRI studies of the fetal heart and great vessels. Processing data in image-space allowed for spatial and temporal operations to be applied to the fetal heart in isolation, separate from extraneous changes elsewhere in the field of view. Magn Reson Med, 2017. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.

  11. NEWBORNS OF HIGH RISK GROUPS AND ELECTROPHYSIOLOGICAL CARDIAC ACTIVITY DURING THE PERIOD OF EARLY ADAPTATION

    Directory of Open Access Journals (Sweden)

    T. S. Tumaeva

    2014-01-01

    Full Text Available Aim: to study characteristics of electrophysiological cardiac activity in children of risk groups and to assess possibilities of Holter-electrocardiography (H-ECG in revealing of cardiac dysfunction during the period of early adaptation. Patients and methods: 250 newborns were examined. The main group consisted of 200 children with cerebral ischemia (CI. This group was divided into 2 subgroups: 100 full-term and 100 premature (at various gestation age infants. Control group contained 50 children born at 38–40th weeks of gestation with physiological course of pregnancy and delivery, APGAR score of 8–9 points. Complex examination included H-ECG according the standard technic with evaluation of the hearth rate (HR during sleep and wakefulness; HRmin, HRmax; arrhythmias, conductivity disorders, duration of the intervals; rhythm variability. Results: according to the ECG children with CI, especially premature ones, and children delivered via Cesarean section more often had ST-T disturbances, arrhythmias (sinus tachycardia, less often — sinus bradycardia and conductivity disorders, Q-Tc prolongation. H-EGC revealed decrease of sleep HR, HRmin and HRmax in children with CI especially in delivered via Cesarean section. The most common arrhythmia was supraventricular extrasystole.  Pauses in rhythms and variability were the highest in premature children delivered via Cesarean section. Conclusions: hypoxia/ischemia is a trigger for development of cardiovascular dysfuncion in newborns. Premature and children delivered via Cesarean section form a group of high risk. H-ECG widens possibilities of revealing of symptoms of cardiac dysfunction (disturbances at the basal level of functioning, of adaptation resources of the sinus node, electric instability of the myocardium and heart rate variability in children of risk group for development of cardiovascular disorders. 

  12. Cardiac Characterization of sgca-Null Mice Using High Resolution Echocardiography.

    Science.gov (United States)

    Fayssoil, Abdallah; Renault, Gilles; Guerchet, Nicolas; Marchiol-Fournigault, Carmen; Fougerousse, Françoise; Richard, Isabelle

    2013-01-01

    Limb-girdle muscular dystrophy 2D (LGMD2D) is an inherited myogenic disorder belonging to the group of muscular dystrophies. Sgca-null mouse is a knock-out model of LGMD2D. Little is known about cardiac phenotype characterization in this model at different ages. We conducted a prospective study to characterize cardiac sgca-null mice phenotype using high resolution Doppler echocardiography at different ages. Conventional echocardiography was performed on anesthetised mice using a Vevo 770 (Visualsonics) with 30 MHz cardiac probe. Wild Type (WT) and sgca-null mice were scanned at 13, 15 and 17 months. From M-mode, we measured interventricular septal (IVS) wall thickness, posterior wall (PW) thickness, and end-left ventricular diameter in systolic and diastolic. From the above parameters, we calculated left ventricular (LV) shortening fraction (SF), LV ejection fraction (EF) and LV mass. At age 13 months, PW diastolic thickness was increased in sgca-null mice (0.89±0.14 mm vs 0.73±0.2 mm; P=0.020) and LV mass was higher in sgca-null mice (LV mass 205.2 mg vs 143 mg; P=0.001). We found also dilation of the LV (LVEDD: 4.84 mm vs 4.29 mm; P=0.019) in sgca-null mice. At age 15 months, dilation of the LV (LVEDD: 4.86 mm vs 4 mm; P=0.05) with an increase of the LV mass (165.7 mg vs 127.12; P=0.03) are found in sgca-null mice. At age 17 months, we found a decrease of the PW thickening (17% vs 30%; P=0.036). This work provides echocardiographic insights for the assessment of pharmaceutical therapies in sgca-null mice.

  13. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Science.gov (United States)

    Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder; Mehta, Yatin

    2016-01-01

    Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP) through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2) using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025), hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025), and Intensive Care Unit (ICU) stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012) was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  14. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2016-01-01

    Full Text Available Goal-directed therapy (GDT encompasses guidance of intravenous (IV fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG analysis. In addition, cardiac index (CI monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2 using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation 30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025, hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025, and Intensive Care Unit (ICU stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012 was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were

  15. High levels of maternally transferred mercury do not affect reproductive output or embryonic survival of northern watersnakes (Nerodia sipedon).

    Science.gov (United States)

    Chin, Stephanie Y; Willson, John D; Cristol, Daniel A; Drewett, David V V; Hopkins, William A

    2013-03-01

    Maternal transfer is an important exposure pathway for contaminants because it can directly influence offspring development. Few studies have examined maternal transfer of contaminants, such as mercury (Hg), in snakes, despite their abundance and high trophic position in many ecosystems where Hg is prevalent. The objectives of the present study were to determine if Hg is maternally transferred in northern watersnakes (Nerodia sipedon) and to evaluate the effects of maternal Hg on reproduction. The authors captured gravid female watersnakes (n = 31) along the South River in Waynesboro, Virginia, USA, where an extensive Hg-contamination gradient exists. The authors measured maternal tissue and litter Hg concentrations and, following birth, assessed (1) reproductive parameters (i.e., litter size and mass, neonate mass); (2) rates of infertility, death during development, stillbirths, malformations, and runts; and (3) the overall viability of offspring. Mercury concentrations in females were strongly and positively correlated with concentrations in litters, suggesting that N. sipedon maternally transfer Hg in proportion to their tissue residues. Maternal transfer resulted in high concentrations (up to 10.10 mg/kg dry wt total Hg) of Hg in offspring. The authors found little evidence of adverse effects of Hg on these measures of reproductive output and embryonic survival, suggesting that N. sipedon may be more tolerant of Hg than other vertebrate species. Given that this is the first study to examine the effects of maternally transferred contaminants in snakes and that the authors did not measure all reproductive endpoints, further research is needed to better understand factors that influence maternal transfer and associated sublethal effects on offspring.

  16. Design of Low-Noise Output Amplifiers for P-channel Charge-Coupled Devices Fabricated on High-Resistivity Silicon

    Energy Technology Data Exchange (ETDEWEB)

    Haque, S; Frost, F Dion R.; Groulx, R; Holland, S E; Karcher, A; Kolbe, W F; Roe, N A; Wang, G; Yu, Y

    2011-12-22

    We describe the design and optimization of low-noise, single-stage output amplifiers for p-channel charge-coupled devices (CCDs) used for scientific applications in astronomy and other fields. The CCDs are fabricated on high-resistivity, 4000–5000 -cm, n-type silicon substrates. Single-stage amplifiers with different output structure designs and technologies have been characterized. The standard output amplifier is designed with an n{sup +} polysilicon gate that has a metal connection to the sense node. In an effort to lower the output amplifier readout noise by minimizing the capacitance seen at the sense node, buried-contact technology has been investigated. In this case, the output transistor has a p{sup +} polysilicon gate that connects directly to the p{sup +} sense node. Output structures with buried-contact areas as small as 2 μm × 2 μm are characterized. In addition, the geometry of the source-follower transistor was varied, and we report test results on the conversion gain and noise of the various amplifier structures. By use of buried-contact technology, better amplifier geometry, optimization of the amplifier biases and improvements in the test electronics design, we obtain a 45% reduction in noise, corresponding to 1.7 e{sup -} rms at 70 kpixels/sec.

  17. A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease

    Directory of Open Access Journals (Sweden)

    Clement Fiona M

    2011-11-01

    Full Text Available Abstract Background There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1 To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2 to explore whether the linear relationship exists in other jurisdictions. Methods Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection. Results In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006 than in time period 1(1995-2001, there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population. Conclusions Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding

  18. Cardiac motion estimation by using high-dimensional features and K-means clustering method

    Science.gov (United States)

    Oubel, Estanislao; Hero, Alfred O.; Frangi, Alejandro F.

    2006-03-01

    Tagged Magnetic Resonance Imaging (MRI) is currently the reference modality for myocardial motion and strain analysis. Mutual Information (MI) based non rigid registration has proven to be an accurate method to retrieve cardiac motion and overcome many drawbacks present on previous approaches. In a previous work1, we used Wavelet-based Attribute Vectors (WAVs) instead of pixel intensity to measure similarity between frames. Since the curse of dimensionality forbids the use of histograms to estimate MI of high dimensional features, k-Nearest Neighbors Graphs (kNNG) were applied to calculate α-MI. Results showed that cardiac motion estimation was feasible with that approach. In this paper, K-Means clustering method is applied to compute MI from the same set of WAVs. The proposed method was applied to four tagging MRI sequences, and the resulting displacements were compared with respect to manual measurements made by two observers. Results show that more accurate motion estimation is obtained with respect to the use of pixel intensity.

  19. Developing high resolution AOD imaging compatible with weather forecast model outputs for PM2.5 estimation

    Science.gov (United States)

    Vidal, D.; Gross, B.; Cordero, L.

    2013-12-01

    This project evaluates the potential of the Aerosol Optical Depth (AOD) measurements derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) at a wavelength of 0.55μm from both the Terra and Aqua satellites to estimate ground-level concentrations of fine particulate matter (PM2.5) in the Northeast. Since the PM25 product should be a daily average product to conform to EPA requirements, multiple AOD measurements need to be blended to obtain the best daily mosaic. In order for the mosaic AOD maps to be useful, the output needs to maximize resolution as well as its coverage which are in general contradictory requirements. For example, to account for clouds, the daily products from MODIS DAAC are forced to average the 10km resolution granules over large spatial domains (1 deg x 1 deg) to reduce the effects of cloud blockage. In our research, we attempt to combine the advantages of single granule resolution with 1 deg coverage. In particular, an algorithm was created to take each granule and project each data point at a 0.1 degree resolution using Inverse Distance Weighting (IDW); then, the projected granules are averaged to generate the high resolution 24-hour product. To improve spatial coverage, we adopt an iterative scheme to estimate cloud covered scenes by gradually reducing the resolution for those sectors, creating a hybrid map which maximizes resolution and coverage. After the blending product is achieved, for only grid points missing data (due to cloud coverage), we use Inverse distance Weighting to get a value that best represents the AOD at those points. By using a linear approach, we produce PM2.5 maps based on the AOD data obtained.

  20. Adaptive controller design based on input-output signal selection for voltage source converter high voltage direct current systems to improve power system stability

    Institute of Scientific and Technical Information of China (English)

    Abdolkhalegh Hamidi; Jamal Beiza; Ebrahim Babaei; Sohrab Khanmohammadi

    2016-01-01

    An input-output signal selection based on Phillips-Heffron model of a parallel high voltage alternative current/high voltage direct current (HVAC/HVDC) power system is presented to study power system stability. It is well known that appropriate coupling of inputs-outputs signals in the multivariable HVDC-HVAC system can improve the performance of designed supplemetary controller. In this work, different analysis techniques are used to measure controllability and observability of electromechanical oscillation mode. Also inputs–outputs interactions are considered and suggestions are drawn to select the best signal pair through the system inputs-outputs. In addition, a supplementary online adaptive controller for nonlinear HVDC to damp low frequency oscillations in a weakly connected system is proposed. The results obtained using MATLAB software show that the best output-input for damping controller design is rotor speed deviation as out put and phase angle of rectifier as in put. Also response of system equipped with adaptive damping controller based on HVDC system has appropriate performance when it is faced with faults and disturbance.

  1. A High-Gain Three-Port Power Converter with Fuel Cell, Battery Sources and Stacked Output for Hybrid Electric Vehicles and DC-Microgrids

    Directory of Open Access Journals (Sweden)

    Ching-Ming Lai

    2016-03-01

    Full Text Available This paper proposes a novel high-gain three-port power converter with fuel cell (FC, battery sources and stacked output for a hybrid electric vehicle (HEV connected to a dc-microgrid. In the proposed power converter, the load power can be flexibly distributed between the input sources. Moreover, the charging or discharging of the battery storage device can be controlled effectively using the FC source. The proposed converter has several outputs in series to achieve a high-voltage output, which makes it suitable for interfacing with the HEV and dc-microgrid. On the basis of the charging and discharging states of the battery storage device, two power operation modes are defined. The proposed power converter comprises only one boost inductor integrated with a flyback transformer; the boost and flyback circuit output terminals are stacked to increase the output voltage gain and reduce the voltage stress on the power devices. This paper presents the circuit configuration, operating principle, and steady-state analysis of the proposed converter, and experiments conducted on a laboratory prototype are presented to verify its effectiveness.

  2. Building block diode laser concept for high brightness laser output in the kW range and its applications

    Science.gov (United States)

    Ferrario, Fabio; Fritsche, Haro; Grohe, Andreas; Hagen, Thomas; Kern, Holger; Koch, Ralf; Kruschke, Bastian; Reich, Axel; Sanftleben, Dennis; Steger, Ronny; Wallendorf, Till; Gries, Wolfgang

    2016-03-01

    The modular concept of DirectPhotonics laser systems is a big advantage regarding its manufacturability, serviceability as well as reproducibility. By sticking to identical base components an economic production allows to serve as many applications as possible while keeping the product variations minimal. The modular laser design is based on single emitters and various combining technics. In a first step we accept a reduction of the very high brightness of the single emitters by vertical stacking several diodes in fast axis. This can be theoretically done until the combined fast axis beam quality is on a comparable level as the individual diodes slow axis beam quality without loosing overall beam performance after fiber coupling. Those stacked individual emitters can be wavelength stabilized by an external resonator, providing the very same feedback to each of those laser diodes which leads to an output power of about 100 W with BPP of stacking those building blocks using the very same dense spectral combing technique up to multi kW Systems without further reduction of the BPP. The 500 W building blocks are consequently designed in a way that they feature a high flexibility with regard to their emitting wavelength bandwidth. Therefore, new wavelengths can be implemented by only exchanging parts and without any additional change of the production process. This design principal theoretically offers the option to adapt the wavelength of those blocks to any applications, from UV, visible into the far IR as long as there are any diodes commercially available. This opens numerous additional applications like laser pumping, scientific applications, materials processing such as cutting and welding of copper aluminum or steel and also medical application. Typical operating at wavelengths in the 9XX nm range, these systems are designed for and mainly used in cutting and welding applications, but adapted wavelength ranges such as 793 nm and 1530 nm are also offered. Around 15

  3. [Anaphylactic shock during the use of high doses of aprotinin in cardiac surgery].

    Science.gov (United States)

    Cottineau, C; Moreau, X; Drouet, M; De Brux, J L; Brenet, O; Delhumeau, A

    1993-01-01

    A 77-year-old man was admitted for mitral valve replacement, 46 days after a failed conservative mitral surgery where he received high-dose aprotinin. Twenty minutes after induction of anaesthesia, 250 UPh E of aprotinin were infused intravenously; before the end of this infusion, bronchospasm, systemic hypotension and generalized rash were noted. Immediate treatment included intravenous adrenaline and methylprednisolone; cardiovascular stability was restored after 10 minutes. Immediate histamine liberation was confirmed by the analysis of the time course of the clinical events, a previous contact and positive skin tests. Aprotinin has the antigenic molecular structure of natural proteins. Since 1987, it is used in cardiac surgery to reduce postoperative blood loss: to prevent serious allergic reactions to aprotinin, it is necessary, in patients known to have had previous aprotinin therapy, to perform skin testing with diluted aprotinin before infusion.

  4. High Trypanosoma cruzi infection prevalence associated with minimal cardiac pathology among wild carnivores in central Texas

    Directory of Open Access Journals (Sweden)

    Rachel Curtis-Robles

    2016-08-01

    Full Text Available Infection with the zoonotic vector-borne protozoal parasite Trypanosoma cruzi causes Chagas disease in humans and dogs throughout the Americas. Despite the recognized importance of various wildlife species for perpetuating Trypanosoma cruzi in nature, relatively little is known about the development of cardiac disease in infected wildlife. Using a cross-sectional study design, we collected cardiac tissue and blood from hunter-donated wildlife carcasses- including raccoon (Procyon lotor, coyote (Canis latrans, gray fox (Urocyon cinereoargenteus, and bobcat (Lynx rufus – from central Texas, a region with established populations of infected triatomine vectors and increasing diagnoses of Chagas disease in domestic dogs. Based on PCR analysis, we found that 2 bobcats (14.3%, 12 coyotes (14.3%, 8 foxes (13.8%, and 49 raccoons (70.0% were positive for T. cruzi in at least one sample (right ventricle, apex, and/or blood clot. Although a histologic survey of right ventricles showed that 21.1% of 19 PCR-positive hearts were characterized by mild lymphoplasmocytic infiltration, no other lesions and no amastigotes were observed in any histologic section. DNA sequencing of the TcSC5D gene revealed that raccoons were infected with T. cruzi strain TcIV, and a single racoon harbored a TcI/TcIV mixed infection. Relative to other wildlife species tested here, our data suggest that raccoons may be important reservoirs of TcIV in Texas and a source of infection for indigenous triatomine bugs. The overall high level of infection in this wildlife community likely reflects high levels of vector contact, including ingestion of bugs. Although the relationship between the sylvatic cycle of T. cruzi transmission and human disease risk in the United States has yet to be defined, our data suggest that hunters and wildlife professionals should take precautions to avoid direct contact with potentially infected wildlife tissues.

  5. High-Order Current-Mode and Transimpedance-Mode Universal Filters with Multiple-Inputs and Two-Outputs Using MOCCIIs

    Directory of Open Access Journals (Sweden)

    J. Horng

    2009-12-01

    Full Text Available A high-order current-mode and transimpedance-mode universal filter with multiple-inputs and two-outputs based on multiple output second-generation current conveyors (MOCCIIs is introduced. By choosing the input current terminals appropriately, the current-mode and transimpedance-mode lowpass, bandpass, highpass, notch or allpass filters can be obtained without component matching conditions. The proposed nth order universal filter requires (n+1 MOCCIIs, (n+1 resistors and n grounded capacitors. As examples, the first-order, biquadratic and third-order universal filters are given and compared with previous published works.

  6. Resveratrol inhibits high glucose induced collagen upregulation in cardiac fibroblasts through regulating TGF-β1-Smad3 signaling pathway.

    Science.gov (United States)

    Liu, Junhui; Zhuo, Xiaozhen; Liu, Weimin; Wan, Zhaofei; Liang, Xiao; Gao, Shanshan; Yuan, Zuyi; Wu, Yue

    2015-02-05

    Cardiac fibrosis is a common pathological process presented in a variety of diseases, including hypertension and diabetes. Cardiac fibroblasts (CFs) have been identified as the most important participants in the development of cardiac fibrosis. Exposure of cultured CFs to high glucose (HG) or angiotensin II (Ang II) resulted in increased collagen synthesis. Resveratrol (Res) is a natural polyphenol exhibiting anti-fibrosis effects in a number of different organs fibrosis process, whether Res can prevent HG and Ang II induced fibrosis response in CFs remains unclear. The aim of this work was to evaluate the effects of Res in HG and Ang II induced fibrosis response in CFs. We cultured rat CFs in either normal glucose (5.6 mM) or HG (25 mM) media in the presence of Res or not and the changes in collagens synthesis and TGF-β1 production were assessed by Real-time PCR, Western blotting, and enzyme linked immunosorbent assay (ELISA). Furthermore, normal and diabetic mice (induced by single dose of streptozotocin (100 mg/kg) via tail vein) receiving Res (10 mg/kg) were used to explore the effects of Res on cardiac fibrosis in vivo. Masson staining and immunohistochemistry were performed to visualize cardiac collagen deposition. Results indicate that CFs exposed to HG condition shows enhanced proliferation rate. Furthermore, in the presence of HG or Ang II, CFs exhibited increased collagens synthesis and TGF-β1 production. And these effects were abolished by Res intervention. In vivo results show that diabetic mice exhibit increased collagen deposition in the cardiac compared with the normal mice. And this change was prevented by the treatment of Res. These results suggest that Res possesses a potential antifibrogenic effect in hypertension and diabetes-related cardiac fibrosis. Moreover, the action mechanism is probably associated with its ability to reduce TGF-β1 content in CFs.

  7. Medium performance effect on the high output energy from a xenon lamp-pumped pyrromethene-567 solid-state dye laser

    Institute of Scientific and Technical Information of China (English)

    Wang Lei; Chen De-Ying; Fan Rong-Wei; He Wei-Ming

    2012-01-01

    In order to obtain a high output energy from a xenon lamp-pumped solid-state dye laser,homogeneities of laser mediums and flatnesses of medium faces with different processing treatments are discussed in the paper.The mediums without aging treatment,which are prepared by using a prepolymer process and have diamond-machined end faces to produce the required optical finish,give a highest laser output of 281.9 mJ with 0.215% slope efficiency at 2.0×10-4 mol/L.The best medium lifetime is 21 shots to 50% of original output equating 74.6 kJ/liter.

  8. Study of a high output coupling ratio Q-switched erbium-doped fibre laser using MoS2 saturable absorber

    Science.gov (United States)

    Chong, W. Y.; Yap, Y. K.; Behameen, S.; Ahmad, H.

    2017-02-01

    In the work here, the performance of a Q-switched erbium-doped fibre laser using a MoS2 saturable absorber and operating with a high output coupling ratio has been studied. It is found that the pump conversion efficiency for the higher output coupling ratio is higher in the current setup. Q-switched laser oscillation is observed over the set wavelength range from 1525-1565 nm with a maximum pulse energy of ~0.50 µJ achieved at a pump power of ~83 mW, corresponding to a maximum peak power of ~186 mW. With lower intra-cavity laser intensity achieved using the higher output coupling ratio, the second order absorption of the MoS2 is mitigated. However, scaling of the peak power and pulse energy seems to be limited by the interplay between the pulse duration, pulse energy and repetition rate.

  9. Effects of low and high cadence interval training on power output in flat and uphill cycling time-trials.

    Science.gov (United States)

    Nimmerichter, Alfred; Eston, Roger; Bachl, Norbert; Williams, Craig

    2012-01-01

    This study tested the effects of low-cadence (60 rev min(-1)) uphill (Int(60)) or high-cadence (100 rev min(-1)) level-ground (Int(100)) interval training on power output (PO) during 20-min uphill (TT(up)) and flat (TT(flat)) time-trials. Eighteen male cyclists ([Formula: see text]: 58.6 ± 5.4 mL min(-1) kg(-1)) were randomly assigned to Int(60), Int(100) or a control group (Con). The interval training comprised two training sessions per week over 4 weeks, which consisted of six bouts of 5 min at the PO corresponding to the respiratory compensation point (RCP). For the control group, no interval training was conducted. A two-factor ANOVA revealed significant increases on performance measures obtained from a laboratory-graded exercise test (GXT) (P (max): 2.8 ± 3.0%; p < 0.01; PO and [Formula: see text] at RCP: 3.6 ± 6.3% and 4.7 ± 8.2%, respectively; p < 0.05; and [Formula: see text] at ventilatory threshold: 4.9 ± 5.6%; p < 0.01), with no significant group effects. Significant interactions between group and uphill and flat time-trial, pre- versus post-training on PO were observed (p < 0.05). Int(60) increased PO during both TT(up) (4.4 ± 5.3%) and TT(flat) (1.5 ± 4.5%). The changes were -1.3 ± 3.6, 2.6 ± 6.0% for Int(100) and 4.0 ± 4.6%, -3.5 ± 5.4% for Con during TT(up) and TT(flat), respectively. PO was significantly higher during TT(up) than TT(flat) (4.4 ± 6.0; 6.3 ± 5.6%; pre and post-training, respectively; p < 0.001). These findings suggest that higher forces during the low-cadence intervals are potentially beneficial to improve performance. In contrast to the GXT, the time-trials are ecologically valid to detect specific performance adaptations.

  10. Study of High Sensitive-CRP and Cardiac Marker Enzymes in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Srikrishna R,

    2015-04-01

    Full Text Available Background: Inflammation has been proposed as a contributor to different stages in the pathogenesis of Coronary Heart Disease (CHD. High sensitive C-Reactive Protein (hs-CRP, an acute-phase plasma protein synthesized by the liver, is the most extensively studied systemic marker of inflammation. Elevated hsCRP concentrations early in Acute Coronary Syndrome (ACS, prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. The cardiac marker enzymes Creatine Kinase myocardial bound (CK-MB, Aspartate Aminotransferase (AST and lactate dehydrogenase (LDH have been known to be increased in coronary artery diseases. Objective: The aim of the study was to measure hs-CRP levels and other cardiac marker enzymes in ACS patients and to compare the levels of hs-CRP with other cardiac marker enzymes between ST Elevation Myocardial Infarction (STEMI and Non-ST Elevation Myocardial Infarction (NSTEMI patients. Material and Methods: The study group consisted of 207 consecutive patients admitted to Sri Siddhartha Medical College Hospital within the first 6 hours from the onset of chest pain. Patients were diagnosed as Unstable Angina (UA, (n=84; STEMI (n=63 and NSTEMI (n=60. ACS patients were compared with 211 healthy age and sex matched controls. Hs-CRP, CK-MB, AST and LDH levels were measured by standard methods in both groups at baseline and forcases at 36-48 hours i.e. Peak levels. Results: ACS patients had significantly (p<0.05 higher levels of hs-CRP, CKMB, AST and LDH in comparison to controls at baseline. Hs-CRP, CK-MB, AST and LDH levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05 at baseline. There was a significant difference regarding peak hs-CRP levels between the two groups, as STEMI patients had significantly higher peak hs-CRP levels compared to NSTEMI patients (p<0.05. Conclusion: STEMI patients have significantly higher peak hsCRP levels compared to NSTEMI patients. These data

  11. Utility of high-sensitivity cardiac troponin T in patients receiving anthracycline chemotherapy

    Directory of Open Access Journals (Sweden)

    Blaes AH

    2015-11-01

    Full Text Available Anne H Blaes,1 Aamer Rehman,2 David M Vock,3,4 Xianghua Luo,3,4 Mark Menge,5 Douglas Yee,3 Emil Missov,6 Daniel Duprez6 1Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, 2Division of Cardiology, University of Louisville, Louisville, KY, 3Masonic Cancer Center, 4Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, 5Park Nicollet Frauenshuh Cancer Center, St Louis Park, 6Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA Background: Anthracycline chemotherapy remains an integral part of the care for curative intent chemotherapy in breast cancer and non-Hodgkin lymphoma patients. Better tools need to be identified to predict cardiac complications of anthracycline chemotherapy. Materials and methods: We investigated the utility of high-sensitivity cardiac troponin T (hscTnT, N-terminal pro-B-type natriuretic peptide, cardiac troponin T and I, and creatine kinase (CK-MB in cancer patients receiving anthracycline-based chemotherapy, in order to determine whether baseline levels or changes in these biomarkers may help predict the onset of congestive heart failure. Results: Eighteen consecutive patients with a pathologic diagnosis of breast cancer or non-Hodgkin lymphoma were enrolled. The median dose of doxorubicin exposure was 240 mg/m2 (range 240–400 mg/m2. After treatment with doxorubicin, the hscTnT increased to 19.1 pg/mL (P<0.001. CKMB and N-terminal pro-B-type natriuretic peptide levels increased to 1.1 ng/mL and 88.3 pg/mL, respectively (P=0.02. When subjects who had a decline in left ventricular ejection fraction (LVEF by equilibrium radionuclide ventriculography were compared to those who did not have a change in LVEF, there was a suggestion that those subjects with an elevated baseline hscTnT were more likely to have a decline in LVEF (2.7 pg/mL and 0.1 pg/mL, respectively; P=0.07. Spearman

  12. Characterization of Cardiac-Resident Progenitor Cells Expressing High Aldehyde Dehydrogenase Activity

    Directory of Open Access Journals (Sweden)

    Marc-Estienne Roehrich

    2013-01-01

    Full Text Available High aldehyde dehydrogenase (ALDH activity has been associated with stem and progenitor cells in various tissues. Human cord blood and bone marrow ALDH-bright (ALDHbr cells have displayed angiogenic activity in preclinical studies and have been shown to be safe in clinical trials in patients with ischemic cardiovascular disease. The presence of ALDHbr cells in the heart has not been evaluated so far. We have characterized ALDHbr cells isolated from mouse hearts. One percent of nonmyocytic cells from neonatal and adult hearts were ALDHbr. ALDHvery-br cells were more frequent in neonatal hearts than adult. ALDHbr cells were more frequent in atria than ventricles. Expression of ALDH1A1 isozyme transcripts was highest in ALDHvery-br cells, intermediate in ALDHbr cells, and lowest in ALDHdim cells. ALDH1A2 expression was highest in ALDHvery-br cells, intermediate in ALDHdim cells, and lowest in ALDHbr cells. ALDH1A3 and ALDH2 expression was detectable in ALDHvery-br and ALDHbr cells, unlike ALDHdim cells, albeit at lower levels compared with ALDH1A1 and ALDH1A2. Freshly isolated ALDHbr cells were enriched for cells expressing stem cell antigen-1, CD34, CD90, CD44, and CD106. ALDHbr cells, unlike ALDHdim cells, could be grown in culture for more than 40 passages. They expressed sarcomeric α-actinin and could be differentiated along multiple mesenchymal lineages. However, the proportion of ALDHbr cells declined with cell passage. In conclusion, the cardiac-derived ALDHbr population is enriched for progenitor cells that exhibit mesenchymal progenitor-like characteristics and can be expanded in culture. The regenerative potential of cardiac-derived ALDHbr cells remains to be evaluated.

  13. Cardiac sodium channelopathies

    NARCIS (Netherlands)

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

    2010-01-01

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

  14. Cardiac sodium channelopathies

    NARCIS (Netherlands)

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

    2010-01-01

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

  15. Cardiac thrombus developing after an accidental high-voltage electric shock in a child.

    Science.gov (United States)

    Akın, Alper; Bilici, Meki; Demir, Fikri; Gözü Pirinççioğlu, Ayfer; Yavuz, Celal

    2015-01-01

    Electric shock is a condition that may affect various organ systems and potentially cause death. Cardiac findings vary from asymptomatic mild injury to fatal myocardial involvement. Herein we present a five-year-old boy with a cardiac thrombus developing after an accidental electrical shock. Cardiac arrhythmias and evidence of ischemia have been reported after electric shock; we were, however, unable to identify an earlier case report of intracardiac thrombosis related to electric shock. Findings such as elevated cardiac enzymes and systolic dysfunction, which indicate myocardial damage following electric shock, were present in our patient. We think that the cardiac thrombus might have resulted from the myocardial damage and the slowed intracardiac blood flow related to systolic dysfunction. As the thrombus was thought to have been formed through known mechanisms, it was treated traditionally. However, further data regarding the etiology and management of such thrombi is needed.

  16. Output Model of Steel Plant

    Institute of Scientific and Technical Information of China (English)

    ZHANG Long-qiang; TIAN Nai-yuan; ZHANG Jin; XU An-jun

    2008-01-01

    Based on the requirement of compactivity, continuity, and high efficiency, and taking full advantage of cushion capability of flexible parts such as external refining in new generation steel plant, an output model of steel plant was established in terms of matching between BOF and caster. Using this model, the BOF nominal capacity is selected, the caster output and equipment amount are computed, and then the steel plant output is computed.

  17. Gender-dependent effects of high-fat lard diet on cardiac function in C57Bl/6J mice.

    NARCIS (Netherlands)

    Louwe, M.C.; Hoorn, J.W. van der; Berg, S.A. van den; Jukema, J.W.; Romijn, J.A.; Willems van Dijk, K.; Rensen, P.C.; Smit, J.W.A.; Steendijk, P.

    2012-01-01

    Increased availability of fatty acids released from insulin-resistant adipose tissue may lead to excess fatty acid uptake in nonadipose organs, including the heart. Accumulation of toxic fatty acid intermediates may affect cardiac function. Our aim was to identify to which extent high-fat diet feedi

  18. Gender-dependent effects of high-fat lard diet on cardiac function in C57Bl/6J mice

    NARCIS (Netherlands)

    Louwe, M.C.; Hoorn, J.W.A. van der; Berg, S.A.A. van den; Wouter Jukema, J.; Romijn, J.A.; Dijk, K.W. van; Rensen, P.C.N.; Smit, J.W.A.; Steendijk, P.

    2012-01-01

    Increased availability of fatty acids released from insulin-resistant adipose tissue may lead to excess fatty acid uptake in nonadipose organs, including the heart. Accumulation of toxic fatty acid intermediates may affect cardiac function. Our aim was to identify to which extent high-fat diet feedi

  19. Serial high sensitivity cardiac troponin T measurement in acute heart failure : insights from the RELAX-AHF study

    NARCIS (Netherlands)

    Felker, G. Michael; Mentz, Robert J.; Teerlink, John R.; Voors, Adriaan A.; Pang, Peter S.; Ponikowski, Piotr; Greenberg, Barry H.; Filippatos, Gerasimos; Davison, Beth A.; Cotter, Gad; Prescott, Margaret F.; Hua, Tsushung A.; Lopez-Pintado, Sara; Severin, Thomas; Metra, Marco

    2015-01-01

    AimsTroponin elevation is common in acute heart failure (AHF) and may be useful for prognostication; however, available data are mixed and many previous studies used older, less sensitive assays. We examined the association between serial measurements of high-sensitivity cardiac troponin T (hs-cTnT)

  20. High-sensitivity cardiac troponin T is associated with cognitive decline in older adults at high cardiovascular risk

    DEFF Research Database (Denmark)

    Wijsman, Liselotte W; de Craen, Anton JM; Trompet, Stella

    2016-01-01

    AIMS: Cardiac troponin T (cTnT), measured with a high-sensitivity (hs) assay, is associated with cognitive decline, but the underlying mechanism is unknown. We investigated the association of hs-cTnT with cognitive function and decline, and studied whether this association was independent....... Participants with pre-existent advanced clinical heart failure were excluded. Hs-cTnT and NT-proBNP obtained after 6 months of follow-up were related with cognitive function, tested repeatedly during a mean follow-up of 3.2 years. Participants with higher hs-cTnT performed worse at baseline on Stroop test...... diseases risk factors or Apolipoprotein E genotype. Further adjusting for NT-proBNP levels revealed the same results. CONCLUSIONS: Higher levels of hs-cTnT associate with worse cognitive function and steeper cognitive decline in older adults independent of cardiovascular diseases, risk factors and NT-proBNP....

  1. Bipartite output consensus in networked multi-agent systems of high-order power integrators with signed digraph and input noises

    Science.gov (United States)

    Ma, Hongwen; Liu, Derong; Wang, Ding; Luo, Biao

    2016-10-01

    In this paper, we concentrate on investigating bipartite output consensus in networked multi-agent systems of high-order power integrators. Systems with power integrator are ubiquitous among weakly coupled, unstable and underactuated mechanical systems. In the presence of input noises, an adaptive disturbance compensator and a technique of adding power integrator are introduced to the complex nonlinear multi-agent systems to reduce the deterioration of system performance. Additionally, due to the existence of negative communication weights among agents, whether bipartite output consensus of high-order power integrators can be achieved remains unknown. Therefore, it is of great importance to study this issue. The underlying idea of designing the distributed controller is to combine the output information of each agent itself and its neighbours, the state feedback within its internal system and input adaptive noise compensator all together. When the signed digraph is structurally balanced, bipartite output consensus can be reached. Finally, numerical simulations are provided to verify the validity of the developed criteria.

  2. Effect of increases in cardiac contractility on cerebral blood flow in humans.

    Science.gov (United States)

    Ogoh, Shigehiko; Moralez, Gilbert; Washio, Takuro; Sarma, Satyam; Hieda, Michinari; Romero, Steven A; Cramer, Matthew N; Shibasaki, Manabu; Crandall, Craig G

    2017-09-15

    The effect of acute increases in cardiac contractility on cerebral blood flow (CBF) remains unknown. We hypothesized that the external carotid artery (ECA) downstream vasculature modifies the direct influence of acute increases in heart rate and cardiac function on CBF regulation. Twelve healthy subjects received two infusions of dobutamine (first a low dose; 5 μg/kg/min and then a high dose; 15 μg/kg/min) for 12 min each. Cardiac output, blood flow through the internal carotid artery (ICA) and ECA and echocardiographic measurements were performed during dobutamine infusions. Despite increases in cardiac contractility, cardiac output and arterial pressure with dobutamine, ICA blood flow and conductance slightly decreased from resting baseline during both low and high dose infusions. In contrast, ECA blood flow and conductance increased appreciably during both low and high dose infusions. Greater ECA vascular conductance and corresponding increases in blood flow may protect over-perfusion of intracranial cerebral arteries during enhanced cardiac contractility and associated increases in cardiac output and perfusion pressure. Importantly, these findings suggest that the acute increase of blood perfusion due to dobutamine administration does not cause cerebral over-perfusion or an associated risk of cerebral vascular damage. Copyright © 2017, American Journal of Physiology-Heart and Circulatory Physiology.

  3. Serum high-sensitivity C-reaction protein and heart fatty acid binding protein level and cardiac accidents in patients with unstable angina pectoris

    Institute of Scientific and Technical Information of China (English)

    朱红秋

    2006-01-01

    Objective To investigate the relationship between serum high-sensitivity C-reaction protein (hs-CRP) and heart fatty acid binding protein (h-FABP) on cardiac accidents in patients with unstable angina pectoris (UAP). Methods Serum levels of hs-CRP, h-FABP, cardiac troponin-Ⅰ(cTn-Ⅰ) and creatine kinase MB isoenzyme (CK-MB) were measured and cardiac accidents within 2 weeks after the test were observed in 74 patients (male

  4. Application of pulse index continuous cardiac output monitoring to improve efficiency of acute heart failure care%应用脉搏指数连续心输出量监测提升急性心力衰竭护理效果

    Institute of Scientific and Technical Information of China (English)

    孙秀月; 张领; 赵书琴

    2015-01-01

    Objective To ihvestigate the effect of pulse index continuous cardiac output (PiCCO) monitoring to nursing care of acute heart failure care.Methods The clinical data of 43 acute heart failure patients were retrospectively analyzed,patients were given pulse index continuous cardiac output monitoring and care,the patient' s nursing outcomes were observed,and the intrathoracic blood volume,cardiac output and oxygen consumption before and after the intervention were compared.Results After the implementation of PiCCO and nursing intervention,43 patients had no serious complications,improved 42 cases discharged,the other 1 patient in critical condition due to old age and heart function improvement sustained no automatic discharge.Oxygen consumption,cardiac output and intrathoracic blood volume were improved after the intervention,there was a significant difference (P < 0.05) compared to the previous indicators and intervention after intervention.Conclusions Application of pulse index continuous cardiac output can effectively improve patient's clinical parameters such as cardiac output,through the implementation of appropriate care can improve symptoms and reduce complications.%目的 探讨急性心力衰竭患者护理中应用脉搏指数连续心输出量监测(PiCCO)的效果.方法 选取平顶山市第二人民医院收治的43例急性心力衰竭患者作为研究对象,收集患者的临床资料并对其做回顾性分析,对患者实施脉搏指数连续心输出量监测和护理,对患者的护理效果进行观察,并对其干预前后的胸腔内血容量、心排血量与氧耗量进行对比观察.结果 实施PiCCO和护理干预,本研究43例患者均无严重并发症产生,42例好转出院,1例由于病情危重、高龄及心功能持续无改善自动出院.患者干预后的氧耗量、心排血量与胸腔内血容量均有所改善,干预后各项指标与干预前比较差异有统计学意义(P<0.05).结论 应用脉搏指数连续心

  5. Indirect calorimetry can be used to measure cardiac output in septic patients? A calorimetria indireta pode ser utilizada para medir o débito cardíaco em pacientes sépticos?

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Martins

    2008-01-01

    Full Text Available PURPOSE: The aim of this study was to compare two different cardiac output (CO monitoring systems based on the thermodilution principle (Thermo-CO and indirect calorimetry (Fick mixed-CO in septic patients. METHODS: Prospective study in septic patients admitted in an intensive care unit of a university hospital. Nineteen patients aged on average 45.4 ± 21.5 years were enrolled in the study. Four series of hourly measurements by the two techniques were carried out simultaneously. RESULTS: No significant differences were observed between Thermo-CO and Fick mixed-CO (7.0 ± 1.8 L.min-1 and 6.4 ± 1.7 L.min-1.. Parallel analysis of Fick mixed-CO and Fick atrial-CO was performed introducing a correction factor for the eight atrial samples in order to adjust the values of oxygen saturation obtained from atrial blood (Fick corrected atrial-CO to those obtained from mixed venous blood. No significant differences could be detected between Fick mixed-CO and Fick corrected atrial-CO. The correlation coefficients of Thermo CO/Fick mixed-CO and Fick mixed-CO/Fick corrected atrial-CO were 0.84 and 0.94, respectively. CONCLUSION: We observed that the agreement between the two methods was satisfactory on the basis of the decisions made for treatment. Indirect calorimetry is useful to measure CO in patients with septic shock.OBJETIVO: O objetivo deste estudo foi comparar as medidas do débito cardíaco (DC obtidas pela termodiluição (DC-termo e pela calorimetria indireta (DC-Fick misto em pacientes com choque séptico. MÉTODOS: Estudo prospectivo em pacientes sépticos internados em unidade de terapia intensiva de um hospital universitário. Foram estudados 19 pacientes (45,4 ± 21,5 anos. Foram realizadas quatro séries de medidas do DC pelos dois métodos, simultaneamente. RESULTADOS: Não houve diferenças significativas entre os valores do DC-termo e DC-Fick misto (7,0 ± 1,8 L.min-1 e 6,4 ± 1,7 L.min-1, respectivamente. Na avaliação dos oito casos

  6. Sodium Butyrate Protects Against High Fat Diet-induced Cardiac Dysfunction and Metabolic Disorders in Type II Diabetic Mice.

    Science.gov (United States)

    Zhang, Ling; Du, Jianfeng; Yano, Naohiro; Wang, Hao; Zhao, Yu Tina; Patricia, Dubielecka-Szczerba; Zhuang, Shougang; Chin, Eugene Y; Qin, Gangjian; Zhao, Ting C

    2017-01-21

    Histone deacetylases are recently identified to act as key regulators for cardiac pathophysiology and metabolic disorders. However, the function of histone deacetylase (HDAC) in controlling cardiac performance in type II diabetes and obesity remains unknown. Here we determine whether HDAC inhibition attenuates high fat diet (HFD)-induced cardiac dysfunction and improves metabolic features. Adult mice were fed with either HFD or standard chow food for 24 weeks. Starting at 12 weeks, mice were divided into four groups randomly, in which sodium butyrate (1%), a potent HDAC inhibitor, was provided to chow and HFD-fed mice in drinking water, respectively. Glucose intolerance, metabolic parameters, cardiac function, and remodeling were assessed. Histological analysis and cellular signaling were examined at 24 weeks following euthanization of mice. HFD-fed mice demonstrated myocardial dysfunction and profound interstitial fibrosis, which were attenuated by HDAC inhibition. HFD-induced metabolic syndrome features insulin resistance, obesity, hyperinsulinemia, hyperglycemia, lipid accumulations, and cardiac hypertrophy, these effects were prevented by HDAC inhibition. Furthermore, HDAC inhibition attenuated myocyte apoptosis, reduced production of reactive oxygen species, and increased angiogenesis in the HFD-fed myocardium. Notably, HFD induced decreases in MKK3, p38, p38 regulated/activated protein kinase (PRAK) and Akt-1, but not p44/42 phosphorylation, which were prevented by HDAC inhibition. These results suggest that HDAC inhibition plays a critical role to preserve cardiac performance and mitigate metabolic disorders in obesity and diabetes, which is associated with MKK3/p38/PRAK pathway. The study holds promise in developing a new therapeutic strategy in the treatment of type II diabetic-induced heart failure and metabolic disorders. This article is protected by copyright. All rights reserved.

  7. Highly-Accelerated Real-Time Cardiac Cine MRI Using k-t SPARSE-SENSE

    Science.gov (United States)

    Feng, Li; Srichai, Monvadi B.; Lim, Ruth P.; Harrison, Alexis; King, Wilson; Adluru, Ganesh; Dibella, Edward VR.; Sodickson, Daniel K.; Otazo, Ricardo; Kim, Daniel

    2012-01-01

    For patients with impaired breath-hold capacity and/or arrhythmias, real-time cine MRI may be more clinically useful than breath-hold cine MRI. However, commercially available real-time cine MRI methods using parallel imaging typically yield relatively poor spatio-temporal resolution due to their low image acquisition speed. We sought to achieve relatively high spatial resolution (~2.5mm × 2.5mm) and temporal resolution (~40ms), to produce high-quality real-time cine MR images that could be applied clinically for wall motion assessment and measurement of left ventricular (LV) function. In this work, we present an 8-fold accelerated real-time cardiac cine MRI pulse sequence using a combination of compressed sensing and parallel imaging (k-t SPARSE-SENSE). Compared with reference, breath-hold cine MRI, our 8-fold accelerated real-time cine MRI produced significantly worse qualitative grades (1–5 scale), but its image quality and temporal fidelity scores were above 3.0 (adequate) and artifacts and noise scores were below 3.0 (moderate), suggesting that acceptable diagnostic image quality can be achieved. Additionally, both 8-fold accelerated real-time cine and breath-hold cine MRI yielded comparable LV function measurements, with coefficient of variation cine MRI with k-t SPARSE-SENSE is a promising modality for rapid imaging of myocardial function. PMID:22887290

  8. Highly accelerated real-time cardiac cine MRI using k-t SPARSE-SENSE.

    Science.gov (United States)

    Feng, Li; Srichai, Monvadi B; Lim, Ruth P; Harrison, Alexis; King, Wilson; Adluru, Ganesh; Dibella, Edward V R; Sodickson, Daniel K; Otazo, Ricardo; Kim, Daniel

    2013-07-01

    For patients with impaired breath-hold capacity and/or arrhythmias, real-time cine MRI may be more clinically useful than breath-hold cine MRI. However, commercially available real-time cine MRI methods using parallel imaging typically yield relatively poor spatio-temporal resolution due to their low image acquisition speed. We sought to achieve relatively high spatial resolution (∼2.5 × 2.5 mm(2)) and temporal resolution (∼40 ms), to produce high-quality real-time cine MR images that could be applied clinically for wall motion assessment and measurement of left ventricular function. In this work, we present an eightfold accelerated real-time cardiac cine MRI pulse sequence using a combination of compressed sensing and parallel imaging (k-t SPARSE-SENSE). Compared with reference, breath-hold cine MRI, our eightfold accelerated real-time cine MRI produced significantly worse qualitative grades (1-5 scale), but its image quality and temporal fidelity scores were above 3.0 (adequate) and artifacts and noise scores were below 3.0 (moderate), suggesting that acceptable diagnostic image quality can be achieved. Additionally, both eightfold accelerated real-time cine and breath-hold cine MRI yielded comparable left ventricular function measurements, with coefficient of variation cine MRI with k-t SPARSE-SENSE is a promising modality for rapid imaging of myocardial function. Copyright © 2012 Wiley Periodicals, Inc.

  9. Automated high-throughput measurement of body movements and cardiac activity of Xenopus tropicalis tadpoles

    Directory of Open Access Journals (Sweden)

    Kay Eckelt

    2014-07-01

    Full Text Available Xenopus tadpoles are an emerging model for developmental, genetic and behavioral studies. A small size, optical accessibility of most of their organs, together with a close genetic and structural relationship to humans make them a convenient experimental model. However, there is only a limited toolset available to measure behavior and organ function of these animals at medium or high-throughput. Herein, we describe an imaging-based platform to quantify body and autonomic movements of Xenopus tropicalis tadpoles of advanced developmental stages. Animals alternate periods of quiescence and locomotor movements and display buccal pumping for oxygen uptake from water and rhythmic cardiac movements. We imaged up to 24 animals in parallel and automatically tracked and quantified their movements by using image analysis software. Animal trajectories, moved distances, activity time, buccal pumping rates and heart beat rates were calculated and used to characterize the effects of test compounds. We evaluated the effects of propranolol and atropine, observing a dose-dependent bradycardia and tachycardia, respectively. This imaging and analysis platform is a simple, cost-effective high-throughput in vivo assay system for genetic, toxicological or pharmacological characterizations.

  10. Design and rationale of the high-sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial.

    Science.gov (United States)

    Hunter, Benton R; Collins, Sean P; Fermann, Gregory J; Levy, Phillip D; Shen, Changyu; Ayaz, Syed Imran; Cole, Mette L; Miller, Karen F; Soliman, Adam A; Pang, Peter S

    2017-01-01

    Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful. The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment. High-sensitivity troponin T (hsTnT) will be drawn at the time of enrollment and 3 hours after the initial draw. The initial hsTnT draw will be no more than 3 hours after initiation of therapy for AHF (vasodilator, loop diuretic, noninvasive ventilation). Treating clinicians will be blinded to hsTnT results. We will assess whether hsTnT, as a single measurement or in series, can accurately predict patients at low risk of short-term adverse events. TACIT will explore the value of hsTnT measurements in isolation, or in combination with other markers of disease severity, for the identification of ED patients with AHF who are at low risk of short-term adverse events.

  11. Effects of adiponectin on oxidative stress and apoptosis in human cardiac myocytes cultured with high glucose

    Institute of Scientific and Technical Information of China (English)

    LI Xing; LI Mei-rong; GUO Zhi-xin

    2012-01-01

    Background Diabetic cardiomyopathy is the major cause of morbidity and mortality in diabetic patients.Oxidative stress plays an important role in diabetic cardiomyopathy.This study aimed to investigate the effects of adiponectin on oxidative stress and apoptosis in human cardiac myocytes (HCM) cultured with high glucose.Methods The cells were assigned to three group: control group,high glucose group and high glucose plus adiponectin group.After culture for 24,48,72 hours,oxidative stress was evaluated by detecting levels of malondialdehyde (MDA)and superoxide dismutase (SOD) in the supernatant of culture media.The expression of p66Shc and Heme oxygenase-1 (HO-1) was detected by real-time polymerase chain reaction (PCR).Flow cytometry was designed to observe and detect cellular apoptosis.Results Our findings showed significant increase in MDA levels and decrease in SOD activity in the high glucose group compared with the control group (P <0.05).However,MDA levels were significantly decreased and SOD activity was significantly increased in the adiponectin group compared with those in the high-glucose group (P <0.05).The mRNA expression of HO-1 in the high glucose group was significantly increased in a time-dependent manner compared with that in the control group (P <0.05).Adiponectin further increased the mRNA expression of HO-1 induced by high glucose in a time-dependent manner (P <0.05).The expression of p66Shc was significantly increased in high glucose group compared with that in the control group (P <0.05).Adiponectin significantly suppressed the upregulation of p66Shc induced by high glucose (P <0.05).The apoptotic rate of cardiomyocytes was significantly increased in the high glucose group compared with that in the control group while the apoptotic rate in the adiponectin group was remarkably declined in comparison with that in the high glucose group.Conclusion Adiponectin reduces high glucose-induced oxidative stress and apoptosis and plays a

  12. LCLS X-Ray FEL Output Performance in the Presence of Highly Time-Dependent Undulator Wakefields

    CERN Document Server

    Fawley, W M; Emma, P; Huang, Z; Nuhn, H D; Reiche, S; Stupakov, G

    2005-01-01

    Energy loss due to wakefields within a long undulator, if not compensated by an appropriate tapering of the magnetic field strength, can degrade the FEL process by detuning the resonant FEL frequency. The wakefields arise from the vacuum chamber wall resistivity, its surface roughness, and abrupt changes in its aperture. For LCLS parameters, the resistive component is the most critical and depends upon the chamber wall material (e.g. Cu) and its radius. Of recent interest [1] is the so-called "AC" component of the resistive wake which can lead to strong variations on very short timescales (e.g. ~20 fs). To study the expected performance of the LCLS in the presence of these wakefields, we have made an extensive series of start-to-end SASE simulations with tracking codes PARMELA and ELEGANT, and time-dependent FEL simulation codes GENESIS1.3 and GINGER. We discuss the impact of the wakefield losses upon output energy, spectral bandwidth, and temporal envelope of the output FEL pulse, as well a...

  13. Bioimpedância transtorácica comparada à ressonância magnética na avaliação do débito cardíaco Transthoracic impedance compared to magnetic resonance imaging in the assessment of cardiac output

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta Junior

    2012-12-01

    Full Text Available FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58% do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001, índice cardíaco (r = 0,74; p = 0,0001 e volume sistólico (r = 0,88; p = 0,0001. A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained

  14. Bioimpedância transtorácica comparada à ressonância magnética na avaliação do débito cardíaco Transthoracic impedance compared to magnetic resonance imaging in the assessment of cardiac output

    Directory of Open Access Journals (Sweden)

    Humberto Villacorta Junior

    2012-01-01

    Full Text Available FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58% do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001, índice cardíaco (r = 0,74; p = 0,0001 e volume sistólico (r = 0,88; p = 0,0001. A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained

  15. Application of pulse contour cardiac output monitoring technique in hemodynamic monitoring in critical patients%脉搏轮廓心排血量监测技术在危重病患者血流动力学监测中的应用

    Institute of Scientific and Technical Information of China (English)

    房贺; 郑兴锋; 夏照帆

    2014-01-01

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

  16. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)

    2011-01-01

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

  17. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)

    2011-01-01

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

  18. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)

    2011-01-01

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

  19. Adaptive Output Tracking of Driven Oscillators

    Directory of Open Access Journals (Sweden)

    Lili Diao

    2008-01-01

    of the output tracking error to an adjustable neighborhood of the origin. In addition, good approximation of the unknown nonlinearities is also achieved by incorporating a persistent exciting signal in the parameter update law. The effectiveness of the proposed method is demonstrated by an application to a cardiac conduction system modelled by two coupled driven oscillators.

  20. Fast implementation for compressive recovery of highly accelerated cardiac cine MRI using the balanced sparse model.

    Science.gov (United States)

    Ting, Samuel T; Ahmad, Rizwan; Jin, Ning; Craft, Jason; Serafim da Silveira, Juliana; Xue, Hui; Simonetti, Orlando P

    2017-04-01

    Sparsity-promoting regularizers can enable stable recovery of highly undersampled magnetic resonance imaging (MRI), promising to improve the clinical utility of challenging applications. However, lengthy computation time limits the clinical use of these methods, especially for dynamic MRI with its large corpus of spatiotemporal data. Here, we present a holistic framework that utilizes the balanced sparse model for compressive sensing and parallel computing to reduce the computation time of cardiac MRI recovery methods. We propose a fast, iterative soft-thresholding method to solve the resulting ℓ1-regularized least squares problem. In addition, our approach utilizes a parallel computing environment that is fully integrated with the MRI acquisition software. The methodology is applied to two formulations of the multichannel MRI problem: image-based recovery and k-space-based recovery. Using measured MRI data, we show that, for a 224 × 144 image series with 48 frames, the proposed k-space-based approach achieves a mean reconstruction time of 2.35 min, a 24-fold improvement compared a reconstruction time of 55.5 min for the nonlinear conjugate gradient method, and the proposed image-based approach achieves a mean reconstruction time of 13.8 s. Our approach can be utilized to achieve fast reconstruction of large MRI datasets, thereby increasing the clinical utility of reconstruction techniques based on compressed sensing. Magn Reson Med 77:1505-1515, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  1. Aliskiren improves blood pressure control and prevents cardiac damage in high-risk hypertensive subjects.

    Science.gov (United States)

    Mazza, A; Montemurro, D; Zuin, M; Schiavon, L; Zorzan, S; Chondrogiannis, S; Ferretti, A; Ramazzina, E; Rubello, D

    2013-08-01

    Longitudinal study aimed to evaluate the antihypertensive efficacy, safety and the effect on cardiac damage of Aliskiren, administered to a group of high-risk hypertensive patients with mild impairment of renal function and uncontrolled blood pressure (BP) despite a two-drug antihypertensive treatment. One hundred and six patients (56 men and 50 females) aged 61.9±12.7 years, were assigned to receive Aliskiren 150-300 mg once-daily for 12 months. Clinic BP measurements were taken at every follow-up visit (1st, 6th and 12th month), while biochemical tests, estimated glomerular filtration rate (eGFR), 24-hours ambulatory BP measurements (ABMP) and echocardiography were evaluated at baseline and at the end of follow-up. Analysis of variance for repeated measures compared BP, left ventricular mass index (LVMI) and eGFR values changes. A significant reduction (all P0.05). Putative adverse events caused withdrawal of 7 subjects (6 for gastrointestinal disturbances, 1 for alopecia). Aliskiren was effective in decreasing both clinical and ABPM values and in reducing LVMI in both genders without any influence on eGFR. The treatment resulted safe, even in combination with ACE-inhibitors and angiotensin II receptor blockers. A significant reduction in the use of concomitant antihypertensive drugs was observed.

  2. From urban to national heat island: The effect of anthropogenic heat output on climate change in high population industrial countries

    Science.gov (United States)

    Murray, John; Heggie, Douglas

    2016-06-01

    The project presented here sought to determine whether changes in anthropogenic thermal emission can have a measurable effect on temperature at the national level, taking Japan and Great Britain as type examples. Using energy consumption as a proxy for thermal emission, strong correlations (mean r2 = 0.90 and 0.89, respectively) are found between national equivalent heat output (HO) and temperature above background levels Δt averaged over 5- to 8-yr periods between 1965 and 2013, as opposed to weaker correlations for CMIP5 model temperatures above background levels Δmt (mean r2 = 0.52 and 0.10). It is clear that the fluctuations in Δt are better explained by energy consumption than by present climate models, and that energy consumption can contribute to climate change at the national level on these timescales.

  3. Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit?

    Science.gov (United States)

    Gayda, Mathieu; Ribeiro, Paula A B; Juneau, Martin; Nigam, Anil

    2016-04-01

    In this review, we discuss the most recent forms of exercise training available to patients with cardiac disease and their comparison or their combination (or both) during short- and long-term (phase II and III) cardiac rehabilitation programs. Exercise training modalities to be discussed include inspiratory muscle training (IMT), resistance training (RT), continuous aerobic exercise training (CAET), and high-intensity interval training (HIIT). Particular emphasis is placed on HIIT compared or combined (or both) with other forms such as CAET or RT. For example, IMT combined with CAET was shown to be superior to CAET alone for improving functional capacity, ventilatory function, and quality of life in patients with chronic heart failure. Similarly, RT combined with CAET was shown to optimize benefits with respect to functional capacity, muscle function, and quality of life. Furthermore, in recent years, HIIT has emerged as an alternative or complementary (or both) exercise modality to CAET, providing equivalent if not superior benefits to conventional continuous aerobic training with respect to aerobic fitness, cardiovascular function, quality of life, efficiency, safety, tolerance, and exercise adherence in both short- and long-term training studies. Finally, short-interval HIIT was shown to be useful in the initiation and improvement phases of cardiac rehabilitation, whereas moderate- or longer-interval (or both) HIIT protocols appear to be more appropriate for the improvement and maintenance phases because of their high physiological stimulus. We now propose progressive models of exercise training (phases II-III) for patients with cardiac disease, including a more appropriate application of HIIT based on the scientific literature in the context of a multimodal cardiac rehabilitation program.

  4. High fat diet enhances cardiac abnormalities in SHR rats: Protective role of heme oxygenase-adiponectin axis

    Directory of Open Access Journals (Sweden)

    Cao Jian

    2011-12-01

    Full Text Available Abstract Background High dietary fat intake is a major risk factor for development of cardiovascular and metabolic dysfunction including obesity, cardiomyopathy and hypertension. Methods The present study was designed to examine effect of high fat (HF diet on cardio-vascular structure and function in spontaneously hypertensive rats (SHR, fed HF diet for 15 weeks, a phenotype designed to mimic metabolic syndrome. Results Development of metabolic syndrome like phenotype was confirmed using parameters, including body weight, total cholesterol and blood pressure levels. High fat diet impaired vascular relaxation by acetylcholine and exacerbated cardiac dysfunction in SHRs as evidenced by lower left ventricular function, and higher coronary resistance (CR as compared to controls (p 2- levels in SHR fed a HF diet (p Conclusion In conclusion, this novel study demonstrates that up-regulation of HO-1 improves cardiac and vascular dysfunction by blunting oxidative stress, COX-2 levels and increasing adiponectin levels in hypertensive rats on HF diet.

  5. Precise reconstruction of fast moving cardiac valve in high frame rate synthetic transmit aperture ultrasound imaging

    Science.gov (United States)

    Suzuki, Mayumi; Ikeda, Teiichiro; Ishihara, Chizue; Takano, Shinta; Masuzawa, Hiroshi

    2016-04-01

    To diagnose heart valve incompetence, i.e., one of the most serious cardiac dysfunctions, it is essential to obtain images of fast-moving valves at high spatial and temporal resolution. Ultrasound synthetic transmit aperture (STA) imaging has the potential to achieve high spatial resolution by synthesizing multiple pre-beamformed images obtained with corresponding multiple transmissions. However, applying STA to fast-moving targets is difficult due to serious target deformation. We propose a high-frame-rate STA (fast STA) imaging method that uses a reduced number of transmission events needed for each image. Fast STA is expected to suppress deformation of moving targets; however, it may result in deteriorated spatial resolution. In this study, we conducted a simulation study to evaluate fast STA. We quantitatively evaluated the reduction in deformation and deterioration of spatial resolution with a model involving a radially moving valve at the maximum speed of 0.5 m/s. The simulated raw channel data of the valve phantom was processed with offline beamforming programs. We compared B-mode images obtained through single received-line in a transmission (SRT) method, STA, and fast STA. The results show that fast STA with four-times-reduced events is superior in reconstructing the original shape of the moving valve to other methods. The accuracy of valve location is 97 and 100% better than those with SRT and STA, respectively. The resolution deterioration was found to be below the annoyance threshold considering the improved performance of the shape reconstruction. The obtained results are promising for providing more precise diagnostic information on cardiovascular diseases.

  6. Functional Assessment of Cardiac Responses of Adult Zebrafish (Danio rerio to Acute and Chronic Temperature Change Using High-Resolution Echocardiography.

    Directory of Open Access Journals (Sweden)

    Ling Lee

    Full Text Available The zebrafish (Danio rerio is an important organism as a model for understanding vertebrate cardiovascular development. However, little is known about adult ZF cardiac function and how contractile function changes to cope with fluctuations in ambient temperature. The goals of this study were to: 1 determine if high resolution echocardiography (HRE in the presence of reduced cardiodepressant anesthetics could be used to accurately investigate the structural and functional properties of the ZF heart and 2 if the effect of ambient temperature changes both acutely and chronically could be determined non-invasively using HRE in vivo. Heart rate (HR appears to be the critical factor in modifying cardiac output (CO with ambient temperature fluctuation as it increases from 78 ± 5.9 bpm at 18°C to 162 ± 9.7 bpm at 28°C regardless of acclimation state (cold acclimated CA- 18°C; warm acclimated WA- 28°C. Stroke volume (SV is highest when the ambient temperature matches the acclimation temperature, though this difference did not constitute a significant effect (CA 1.17 ± 0.15 μL at 18°C vs 1.06 ± 0.14 μl at 28°C; WA 1.10 ± 0.13 μL at 18°C vs 1.12 ± 0.12 μl at 28°C. The isovolumetric contraction time (IVCT was significantly shorter in CA fish at 18°C. The CA group showed improved systolic function at 18°C in comparison to the WA group with significant increases in both ejection fraction and fractional shortening and decreases in IVCT. The decreased early peak (E velocity and early peak velocity / atrial peak velocity (E/A ratio in the CA group are likely associated with increased reliance on atrial contraction for ventricular filling.

  7. Antioxidant catalase rescues against high fat diet-induced cardiac dysfunction via an IKKβ-AMPK-dependent regulation of autophagy.

    Science.gov (United States)

    Liang, Lei; Shou, Xi-Ling; Zhao, Hai-Kang; Ren, Gu-Qun; Wang, Jian-Bang; Wang, Xi-Hui; Ai, Wen-Ting; Maris, Jackie R; Hueckstaedt, Lindsay K; Ma, Ai-Qun; Zhang, Yingmei

    2015-02-01

    Autophagy, a conservative degradation process for long-lived and damaged proteins, participates in a variety of biological processes including obesity. However, the precise mechanism of action behind obesity-induced changes in autophagy still remains elusive. This study was designed to examine the role of the antioxidant catalase in high fat diet-induced changes in cardiac geometry and function as well as the underlying mechanism of action involved with a focus on autophagy. Wild-type (WT) and transgenic mice with cardiac overexpression of catalase were fed low or high fat diet for 20 weeks prior to assessment of myocardial geometry and function. High fat diet intake triggered obesity, hyperinsulinemia, and hypertriglyceridemia, the effects of which were unaffected by catalase transgene. Myocardial geometry and function were compromised with fat diet intake as manifested by cardiac hypertrophy, enlarged left ventricular end systolic and diastolic diameters, fractional shortening, cardiomyocyte contractile capacity and intracellular Ca²⁺ mishandling, the effects of which were ameliorated by catalase. High fat diet intake promoted reactive oxygen species production and suppressed autophagy in the heart, the effects of which were attenuated by catalase. High fat diet intake dampened phosphorylation of inhibitor kappa B kinase β(IKKβ), AMP-activated protein kinase (AMPK) and tuberous sclerosis 2 (TSC2) while promoting phosphorylation of mTOR, the effects of which were ablated by catalase. In vitro study revealed that palmitic acid compromised cardiomyocyte autophagy and contractile function in a manner reminiscent of fat diet intake, the effect of which was significantly alleviated by inhibition of IKKβ, activation of AMPK and induction of autophagy. Taken together, our data revealed that the antioxidant catalase counteracts against high fat diet-induced cardiac geometric and functional anomalies possibly via an IKKβ-AMPK-dependent restoration of myocardial

  8. Using high-resolution displays for high-resolution cardiac data.

    Science.gov (United States)

    Goodyer, Christopher; Hodrien, John; Wood, Jason; Kohl, Peter; Brodlie, Ken

    2009-07-13

    The ability to perform fa