Interaction of the Mechano-Electrical Feedback With Passive Mechanical Models on a 3D Rat Left Ventricle: A Computational Study

In this paper, we are investigating the interaction between different passive material models and the mechano-electrical feedback (MEF) in cardiac modeling. Various types of passive mechanical laws (nearly incompressible/compressible, polynomial/exponential-type, transversally isotropic/orthotropic material models) are integrated in a fully coupled electromechanical model in order to study their specific influence on the overall MEF behavior. Our computational model is based on a three-dimensional (3D) geometry of a healthy rat left ventricle reconstructed from magnetic resonance imaging (MRI). The electromechanically coupled problem is solved using a fully implicit finite element-based approach. The effects of different passive material models on the MEF are studied with the help of numerical examples. It turns out that there is a significant difference between the behavior of the MEF for compressible and incompressible material models. Numerical results for the incompressible models exhibit that a change in the electrophysiology can be observed such that the transmembrane potential (TP) is unable to reach the resting state in the repolarization phase, and this leads to non-zero relaxation deformations. The most significant and strongest effects of the MEF on the rat cardiac muscle response are observed for the exponential passive material law

Dexel-Based Simulation of Directed Energy Deposition Additive Manufacturing

Additive manufacturing is typically a flexible alternative to conventional manufacturing processes. However, manufacturing costs increase due to the effort required to experimentally determine optimum process parameters for customized products or small batches. Therefore, simulation models are needed in order to reduce the amount of effort necessary for experimental testing. For this purpose, a novel technological simulation method for directed energy deposition additive manufacturing is presented here. The Dexel-based simulation allows modeling of additive manufacturing of varying geometric shapes by considering multi-axis machine tool kinematics and local process conditions. The simulation approach can be combined with the simulation of subtractive processes, which enables integrated digital process chains

About the implantation process of mobile computing in AEC

The AEC industry is conscious of the potentials arising from the usage of mobile computer systems to increase productivity by streamlining their business processes. Discussions are no longer on whether or not to use a mobile computer solution, but rather, on how it should be used. However, the implantation process of this new technology in Architecture, Engineering and Construction (AEC) and Facility Management (FM) practise is very slow and should be improved. One way to encourage and ease the usage of mobile computer systems in AEC is a more process-oriented usability and context appropriateness of mobile computer solutions. Context-sensitivity is defined as a crucial feature to be taken into account for further research in the area of Mobile Computing. Context-sensitive, mobile IT-solutions depend on two features: (1) flexible definitions of (construction) processes describing the context and (2) tools for flexible, multi-dimensional information management representing the context. It is on this premise that the authors propose the n-dimensional data management approach for the implementation of mobile computing solutions. In this paper, we analyse working scenarios in the AEC and FM sector, defining context aspects which are transformed and formalized as dimension hierarchies of the envisaged context model

Cyanotic nephropathy and use of non-ionic contrast agents during cardiac catherization in patients with cyanotic congenital heart disease

Background: Chronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair. Methods: We investigated 23 cyanotic patients with an oxygen saturation of 82 (50–92)%, age 25 (5–63) years, and 13 control subjects with atrial septal defect, age 37 (20–66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluatated by selective analysis of urinary proteins and enzymes. Results: Before cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. Cardiac catherization was performed with 3.0 (1.2 – 6.8) mls/kg non ionic contrast medium. Only one of the 23 patients (4.3%) with normal urinary analysis before cardiac catheterization showed renal damage, which involved tubular and glomerular function. Elevated blood viscosity in cyanotic patients was slightly reduced by the contrast. None of the acyanotic controls had contrast-induced nephropathy. Conclusions: The use of non-ionic contrast medium does not worsen cyanotic glomerulopathy. This finding may be due to the reduction of blood viscosity by the application of the contrast medium. The finding of contrast-induced nephropathy in one patient underlines the importance of monitoring renal function after cardiac catheterization

Femoral Arterial Thrombosis After Cardiac Catheterization In Infancy: Impact of Doppler Ultrasound for Diagnosis

Femoral arterial thrombosis (FAT) is a nonnegligible complication after cardiac catheterization (CC) in infancy. The aim of this study was to evaluate the impact of Doppler ultrasound (US) for diagnostic work-up after catheterization. We compared standard follow-up (FU) without Doppler US by relying on clinical signs of FAT with advanced FU using Doppler US of the femoral vessels. Between January and December 2009, we evaluated the rate of FAT in infants <12months of age using a multicenter, prospective observational survey. We analysed 171 patients [mean age 4.1±3.3 (SD) months; mean body weight 5.3±1.8kg] from 6 participating centres. The mean duration of catheter studies was 57.7±38.0min. The overall rate of FAT based on clinical diagnosis was 4.7% and was comparable in both groups [3.4% undergoing standard FU vs. 7.4% undergoing advanced FU (p=0.15)]. However, the overall rate of thrombosis as screened by Doppler US was greater at 7.1%, especially in patients after advanced FU [18.5% advanced vs. standard FU 1.7% (p<0.01)]. In conclusion, FAT remains a relevant and underestimated complication after catheterization in young infants when relying only on clinical signs of FAT. Therefore, to start effective treatment as soon as possible, we recommend Doppler US to be performed the day after C

Association of Lymphatic Abnormalities with Early Complications after Fontan Operation.

BACKGROUND  Increased central venous pressure is inherent in Fontan circulation but not strongly related to Fontan complication. Abnormalities of the lymphatic circulation may play a crucial role in early Fontan complications. METHODS  This was a retrospective, single-center study of patients undergoing Fontan operation from 2008 to 2015. The primary outcome was significant early Fontan complication defined as secondary in-hospital treatment due to peripheral edema, ascites, pleural effusions, protein-losing enteropathy, or plastic bronchitis. All patients received T2-weighted magnetic resonance images to assess abdominal and thoracic lymphatic perfusion pattern 6 months after Fontan completion with respect to localization, distribution, and extension of lymphatic perfusion pattern (type 1-4) and with application of an area score (0-12 points). RESULTS  Nine out of 42 patients developed early Fontan complication. Patients with complication had longer chest tube drainage (mean 28 [interquartile range [IQR]: 13-60] vs. 13 [IQR: 2-22] days, p = 0.01) and more often obstructions in the Fontan circuit 6 months after surgery (56 vs. 15%, p = 0.02). Twelve patients showed little or no abnormalities of lymphatic perfusion (lymphatic perfusion pattern type 1). Most frequently magnetic resonance imaging showed lymphatic congestion in the supraclavicular region (24/42 patients). Paramesenteric lymphatic congestion was observed in eight patients. Patients with early Fontan complications presented with higher lymphatic area score (6 [min-max: 2-10] vs. 2 [min-max: 0-8]), p = 0.001) and greater distribution and extension of thoracic lymphatic congestion (type 3-4: n = 5/9 vs. n = 1/33, p = 0.001). CONCLUSION  Early Fontan complication is related to hemodynamic factors such as circuit obstruction and to the occurrence and extent of lymphatic congestion

Dynamics of quantum dissipation systems interacting with Fermion and Boson grand canonical bath ensembles: Hierarchical equations of motion approach

A hierarchical equations of motion formalism for a quantum dissipation system in a grand canonical bath ensemble surrounding is constructed, on the basis of the calculus-on-path-integral algorithm, together with the parametrization of arbitrary non-Markovin bath that satisfies fluctuation-dissipation theorem. The influence functionals for both the Fermion or Boson bath interaction are found to be of the same path-integral expression as the canonical bath, assuming they all satisfy the Gaussian statistics. However, the equation of motion formalism are different, due to the fluctuation-dissipation theories that are distinct and used explicitly. The implications of the present work to quantum transport through molecular wires and electron transfer in complex molecular systems are discussed.Comment: 12page

High colloid oncotic pressure priming of cardiopulmonary bypass in neonates and infants: implications on haemofiltration, weight gain and renal function

Abstract Objective: To evaluate the influence of high colloid oncotic pressure (COP) priming of cardiopulmonary bypass (CPB) on fluid balances, haemofiltration, capillary leakage and renal function in neonates and infants. Methods: Twenty neonates or infants underwent heart surgery using CPB and were randomised in two groups. For group 1 (FFP-group) a blood priming with fresh frozen plasma (FFP, low oncotic pressure) was chosen, for group 2 (HA-group) a blood priming containing FFP and human albumin 20% (HA) to realise higher oncotic pressures was substituted. All patients were monitored before, during and 6 h after CPB. We measured weights, fluid balances, transfusion volumes, colloid oncotic pressures, inflammatory parameters (c-reactive protein, interleukin-6, interleukin-8, thrombocytes, leucocytes) and renal function (creatinine clearances, renal protein losses). Results: Patient&apos;s demographics and operational procedures were comparable in both groups with no further differences in operation procedures regarding palliation or correction. Colloid oncotic pressures of the priming solutions were higher in the HA-group (28 mmHg AE 4.9) than in the FFP-group (6 mmHg AE 1.3, p &lt; 0.001). Relative weight gain as a marker of capillary leakage in the HA-group (2% AE 4.5) was significantly lower 6 h post CPB than in the FFP-group (8% AE 8.0, p = 0.015). Haemofiltration rates were higher in the HA-group (569 ml AE 197 vs 282 ml AE 157, p = 0.002) on CPB. There were no differences of creatinine clearances 6 h after the end of CPB. Renal protein losses were elevated in both groups without any inter-group differences during and 6 h after CPB. Conclusion: Addition of concentrated human albumin to priming fluids in paediatric cardiac surgery leads to less weight gain even after CPB. Supplementing paediatric patients undergoing cardiac surgery with concentrated human albumin does not affect renal function more severely than in paediatric patients undergoing cardiac surgery on CPB with blood priming.

Penetration of left and right atrial wall and aortic root by an Amplatzer atrial septal occluder in a nine year old boy with Marfan syndrome: Case report

<p>Abstract</p> <p>Background</p> <p>To describe complications associated with Amplatzer septal occluders in a patient with Marfan syndrome</p> <p>Case presentation</p> <p>A nine-year-old boy with Marfan syndrome and a 22 mm atrial septal defect (ASD) was treated successfully by interventional closure of his ASD by placing a 24 mm Amplatzer septal occluder. Follow up examinations showed a good result but an increasing enlargement of aortic root, so the patient was scheduled for operation. Intraoperative findings showed a perforation of the left atrial roof and the non-coronary sinus by penetration of the occluder device as well as penetration into the right atrial wall. The occluder was resected, the ASD was closed and the aortic sinus was reconstructed using a Dacron patch.</p> <p>Conclusion</p> <p>We describe the first case of a patient with Marfan syndrome and an interventional closure of an ASD. Due to alterations of the connective tissue, as it is typical for patients with Marfan syndrome, the Amplatzer occluder probably perforated adjacent structures more easily as in non-affected individuals. Amplatzer occluders should be used with caution and follow up examinations should be performed in short intervals.</p

First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery

Background: Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality. Methods: Tolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response. Results: Multivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p &lt; 0.0001), earlier weaning from ventilator during TLV (p = 0.0421) and shorter time in the ICU after TLV treatment (p = 0.0155). Serum sodium and serum osmolality increased significantly over time in all patients treated with TLV. Conclusion: In neonates and infants with diuretic-refractory CLS after cardiac surgery, additional aquaretic therapy with TLV showed an increase in urinary output and reduction in bodyweight in patients classified as TLV responder. Increase in urinary output and mean BP on day 2 of treatment were strong predictors for TLV response