1。介绍植入式心脏除颤器（ICD）的防止术后存活猝死或心脏性猝死（SCD），SCD的风险，由于左心室功能受损。然而，不适当的治疗方法的危险是很高，特别是在单室设备。这些多余的放电可能是有害的，损害患者的生活质量。心房检测可提高设备的性能和减少不适当休克的风险。1,2然而心房的检测需要一个心房电极，这本身就带有明显的相关风险。3一个制造商，百多力，开发感应功能心房心室单腔电极。第一电极Kainox，通过A +，这显示了良好的感知能力。4然而，它不常用由于电极刚度和大直径（3.5毫米，10.5 F）。这种电极的进一步发展é率先创造对Linox 智能 S DX铅，其中有一个较小的直径（2.6毫米，7.8 F），并表现出优异的植入功能和感应功能。本文描述了该电极的位置，以突出的数据从主研究，并表现出既便于植入和传感技术，该电极的优秀能力。 2。病例报告<ol><li>病人是一个40岁的女性吸烟者的冠状动脉疾病（CAD）的历史，经常性前壁心肌梗死（AMI）状态后经皮冠状动脉介入治疗（PCI），左心室功能受损（LVEF≥25％），高胆固醇血症阵发性心房颤动（PAF）的。 </li><li>四个月前，开始心脏衰竭的药物治疗。她的方案，包括β-受体阻滞剂，ACE抑制剂和利尿剂;然而，有没有改善左心室功能。 </li><li>由于她的显著左心室功能受损，病人心源性猝死（SCD），是在相当大的风险。 </li><li>通过演示，病人在窦性心律与在胸导联R波损失。 24小时动态心电图监测发现房颤的一个32分钟的情节。 </li><li>在作出决定植入单腔ICD的心房检测能力，以监测进一步发作房颤，以避免不适当的治疗中一个非常活跃的病人。 </li></ol> 3。诊断，评估和计划<ol><li>治疗计划是1向应VR-T的DX转复除颤器植入智能 1百多力Linox S DX尼克尔率先在电生理实验室的局部麻醉下。 </li><li>一个胸回声植入前进行，以便重新评估左心室射血分数和排除心室血栓，这可能禁止在植入去纤颤器测试。 </li></ol> 4。植入手术<ol><li>围术期的准备工作，包括预防性抗生素和皮下肝素单一静脉注射剂量。抗血栓治疗维持，因为冠脉事件的风险超过在手术过程中出血的危险</li><li>病人适当的准备和披在无菌的方式。 </li><li>病人被置于适度镇静，用适当的监测，包括连续心电监测，连续脉搏血氧饱和度，和非侵入性血压监测。 </li><li>四咪唑安定，芬太尼和异丙酚镇静下辖包括明智应用局部麻醉。 </li><li>通过完整的皮肤和安置下腔静脉（IVC）线在左锁骨下静脉穿刺植入开始。经X位置射线。这个不寻常的做法，因为大多数的介入electrophysiologists这个皮的方法，而不是更外侧的口袋静脉穿刺的方法，更有经验。 </li><li> 1约2cm以下手术刀和平行的锁骨，皮肤被切断。设备的口袋，左锁骨下准备后，在静脉线绘制的口袋里，Seldinger技术引入法国8鞘。 </li><li>然后引入SVC的鞘通过右心房电极。弯曲的管芯（65 - K，BIOTRONIK）被介绍到电极后，电极推虽然三尖瓣到右心室流出道。 </li><li>一个直管芯（65-C的BIOTRONIK），然后被引入电极。电极下降到劣的右心室和被操纵的右心室心尖部。电极的位置，以及根通过X射线监测ERAL位置的两个电极中庭。两个心房环电极被放置在SVC与右心房交界处。 </li><li>电极的适当位置后，心房和心室的信号的测量进行。 </li><li>心室电极起搏阈值测定（=“7:27”影片中的时间）。心房信号测量6.5和8mV的（=“7:56”影片中的时间）之间。心房信号增强设备中的过滤器设置的3倍。心室之间的8.4和9.5毫伏信号测量。有了这些感知和起搏阈值，电极被固定在锁骨下静脉的入口。 </li><li>然后将电极连接到除颤器。 </li><li>一切措施，复查和心室颤动诱导T波冲击，通过转复除颤器和设备由自动终止。 （视频=“00”时） </li><li>八ient被带到病房，并留在医院，直到第二天。在手术后第1天，X射线被确认领先地位，并排除气胸。感知和起搏阈值复查，术中测量是相似的。观察病人的恢复时间约4小时，也被植入后的监测。总体而言，植入成功，病人从医院出院的第二天。首三个月的后续eventless和传感信号超过此期限内保持稳定。 </li></ol>

<ol>
	<li>B&#228;nsch, D., Steffgen, F., Gronefeld, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+1+1+trial+-+A+prospective+trial+of+a+dual-+versus+a+single-chamber+implantable+defibrillator+in+patients+with+slow+ventricular+tachycardias.">The 1+1 trial - A prospective trial of a dual- versus a single-chamber implantable defibrillator in patients with slow ventricular tachycardias.</a> Circulation. 110, 1022-1029 (2004).</li><li>Gilliam, F. R., Hayes, D. L., Boehmer, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real+World+Evaluation+of+Dual-Zone+ICD+and+CRT-D+Programming+Compared+to+Single-Zone+Programming.">Real World Evaluation of Dual-Zone ICD and CRT-D Programming Compared to Single-Zone Programming.</a> The ALTITUDE REDUCES Study. Journal of Cardiovascular Electrophysiology. 22, 1023-1029 (2011).</li><li>Dewland, T. A., Pellegrini, C. N., Wang, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dual-Chamber+Implantable+Cardioverter-Defibrillator+Selection+Is+Associated+With+Increased+Complication+Rates+and+Mortality+Among+Patients+Enrolled+in+the+NCDR+Implantable+Cardioverter-Defibrillator+Registry.">Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR Implantable Cardioverter-Defibrillator Registry.</a> Journal of the American College of Cardiology. 58, 1007-1013 (2011).</li><li>Sticherling, C., Zabel, M., Spencker, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+Novel,+Single-Lead+Atrial+Sensing+System+With+a+Dual-Chamber+Implantable+Cardioverter-Defibrillator+System+in+Patients+Without+Antibradycardia+Pacing+Indications+Results+of+a+Randomized+Study.">Comparison of a Novel, Single-Lead Atrial Sensing System With a Dual-Chamber Implantable Cardioverter-Defibrillator System in Patients Without Antibradycardia Pacing Indications Results of a Randomized Study.</a> Circulation-Arrhythmia and Electrophysiology. 4, 56-63 (2011).</li><li>Safak, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+atrial+sensing+quality+in+ICD+patients+with+a+floating+atrial+dipole+ICD+lead+(interim+results).">Assessment of atrial sensing quality in ICD patients with a floating atrial dipole ICD lead (interim results).</a> Europace. , 1027-1027 (2011).</li><li>Deisenhofer, I., Kolb, C., Ndrepepa, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Do+current+dual+chamber+cardioverter+defibrillators+have+advantages+over+conventional+single+chamber+cardioverter+defibrillators+in+reducing+inappropriate+therapies?+A+randomized,+prospective+study.">Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defibrillators in reducing inappropriate therapies? A randomized, prospective study.</a> J. Cardiovasc. Electrophysiol. 12, 134-142 (2001).</li><li>Dewland, T. A., Pellegrini, C. N., Wang, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dual-Chamber+Implantable+Cardioverter-Defibrillator+Selection+Is+Associated+With+Increased+Complication+Rates+and+Mortality+Among+Patients+Enrolled+in+the+NCDR+Implantable+Cardioverter-Defibrillator+Registry.">Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR Implantable Cardioverter-Defibrillator Registry.</a> Journal of the American College of Cardiology. 58, 1007-1013 (2011).</li><li>Poole, J. E., Gleva, M. J., Mela, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complication+Rates+Associated+With+Pacemaker+or+Implantable+Cardioverter-Defibrillator+Generator+Replacements+and+Upgrade+Procedures+Results+From+the+REPLACE+Registry.">Complication Rates Associated With Pacemaker or Implantable Cardioverter-Defibrillator Generator Replacements and Upgrade Procedures Results From the REPLACE Registry.</a> Circulation. 122, 1553-1U43 (2010).</li><li>Niehaus, M., Schuchert, A., Thamasett, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multicenter+experiences+with+a+single+lead+electrode+for+dual+chamber+ICD+systems.">Multicenter experiences with a single lead electrode for dual chamber ICD systems.</a> Pacing Clin. Electrophysiol. 24, 1489-1493 (2001).</li><li>Gradaus, R., Block, M., Dorszewski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implantation+of+a+dual+chamber+pacing+and+sensing+single+pass+defibrillation+lead.">Implantation of a dual chamber pacing and sensing single pass defibrillation lead.</a> Pacing Clin. Electrophysiol. 24, 416-423 (2001).</li></ol>

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新Linox SMART S DX尼克尔电极植入一起向应的DX ICD，BIOTRONIK，如容易放置任何单腔ICD。这方面的经验是由DX审判。5 Linox SMART S DX尼克尔电极提供无房遥感的优势的心房领先的缺点，未发表的主数据支持。心房信号稳定时间在我们的病人已经在DX-试验证明。 双室设备只有一个前瞻性随机试验已经证明，在单室的检测优势，被称为1 +1审判。在这项试验中，缓慢的VT患者植入了双腔ICD，编程双或单室检测。联合终点是不适当的治疗方法的检出率低于SVTs和VT的回应。对于这个端点，1 +1的试验证明了S双室（DCH）的长期性心动过速检测间隔（TDI）与传统编程的单腔（SCH）的检测，检测ignificant优势。这一发现被重新由Deisenhofer等。，大昌行，或中学ICD植入患者随机分配的。然而，没有对他们的审判，特别是解决与缓慢的心室心动过速患者平均心动过速检测时间间隔为368毫秒，并得出结论，单，双室设备是危及生命的室性心律失常的治疗同样有效。大昌行设备显示有优越的节奏分类，但不超过中学设备减少在SVTs不适当的治疗方面的不同。尽管一个双腔ICD的优势，只是为了植入的概念心动过速的诊断和分化检测一般是不会被接受，因为完善的检测计数器由增加铅complic的风险平衡ations，以及增加发病率和死亡率。2,7,8因此，植入双室检测技术或一个VDD系统的改进是必要的。9,10。结合向应的DX ICD的Linox SMART S DX尼克尔电极提供了这种优势。传感设施是双室设备及并发症的发生率是低，在传统的单腔心脏除颤器类似。 结论向应VR-T的DX已经被证明可靠地感知心房信号和收集有价值的信息，以便为房性心律失常的早期检测。此外，该设备提供安全的冲击减少SMART AV歧视。可用心房IEGM通道诊断适当ICD的检测和治疗，从而减少不适当的冲击和获取信息，以优化器件编程。

a new single chamber implantable defibrillator with atrial sensing: a practical demonstration of sensing and  ease of implantation

植入式心脏除颤器（ICD）终止室性心动过速（VT）和心室颤动（VF），疗效高，可以保护心脏猝死（SCD）的患者。但是，不适当的冲击可能会发生心动过速，如果是误诊。不适当的冲击是有害的，损害患者的生活质量。在ICD的编程与低检测率不恰当的治疗的风险增加。与双室设备，有额外的心房信息的利益相比，单室检测误诊带来更大的风险。然而，仅仅为了检测使用双室设备，一般不接受，因为与第二电极相关的风险可能超过检测的好处。因此，百多力开发的名为SMART S DX尼克尔Linox心室铅，允许从两个电极在定位日心房部分心房信号检测é心室电极。该器件包含两个环形电极，一接触上腔静脉（SVC）和自由浮动部分心房电极定位的交界处的心房壁。优异的信号质量只能达到一个特殊的过滤器设置在ICD（向应540和740 VR-T的DX，百多力）。这里将证明，植入系统的易用性。

Watch this Scientific Journal Video about A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation at JoVE.com

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation

双腔植入式心脏除颤器（ICD）可提高检测房颤以及心动过速分化的。然而，这种优势被削弱第二电极，这是在传统的双室设备需要与相关的并发症。因此，百多力已开发出一种新的电极称为“Linox<sup&gt;智能</sup&gt; S DX尼克尔，向应的DX ICD一起使用时，提供双室检测，没有相关的风险与第二电极。

心房遥感新的单一商会植入去纤颤器：一个实用的遥感示范和易于植入

Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect ...

a-new-single-chamber-implantable-defibrillator-with-atrial-sensing

Research

JoVE Journal

Medicine

25.9K 次观看.  University Hospital of Rostock, Germany. 双腔植入式心脏除颤器（ICD）可提高检测房颤以及心动过速分化的。然而，这种优势被削弱第二电极，这是在传统的双室设备需要与相关的并发症。因此，百多力已开发出一种新的电极称为“Linox智能 S DX尼克尔，向应的DX ICD一起使用时，提供双室检测，没有相关的风险与第二电极。

视频: A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

结合消融房颤左心耳封堵

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

科研

医学

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the low-molecular-weight-heparin (LMWH), enoxaparin. There are also urgent clinical situations where it would be important if this could be determined rapidly. The present assay is designed to accomplish this. We only assayed human blood samples that were spiked with known concentrations of enoxaparin. The essential feature of the present assay is the quantification of the efficacy of enoxaparin in a patient's blood sample by degrading it to complete inactivity with heparinase. Two blood samples were drawn into Vacutainer tubes (Becton-Dickenson; Franklin Lakes, NJ) that were spiked with enoxaparin; one sample was digested with heparinase for 5 min at 37 &deg;C, the other sample represented the patient's baseline anticoagulated status. The percent shortening of clotting time in the heparinase-treated sample, as compared to the baseline state, yielded the anticoagulant contribution of enoxaparin. We used the portable, battery operated Hemochron 801 apparatus for measurements of clotting times (International Technidyne Corp., Edison, NJ). The apparatus has 2 thermostatically controlled (37 &deg;C) assay tube wells. We conducted the assays in two types of assay cartridges that are available from the manufacturer of the instrument. One cartridge was modified to increase its sensitivity. We removed the kaolin from the FTK-ACT cartridge by extensive rinsing with distilled water, leaving only the glass surface of the tube, and perhaps the detection magnet, as activators. We called this our minimally activated assay (MAA). The use of a minimally activated assay has been studied by us and others. 2-4 The second cartridge that was studied was an activated partial thromboplastin time (aPTT) assay (A104). This was used as supplied from the manufacturer. The thermostated wells of the instrument were used for both the heparinase digestion and coagulation assays. The assay can be completed within 10 min. The MAA assay showed robust changes in clotting time after heparinase digestion of enoxaparin over a typical clinical concentration range. At 0.2 anti-Xa I.U. of enoxaparin per ml of blood sample, heparinase digestion caused an average decrease of 9.8% (20.4 sec) in clotting time; at 1.0 I.U. per ml of enoxaparin there was a 41.4% decrease (148.8 sec). This report only presents the experimental application of the assay; its value in a clinical setting must still be established.

Demonstration of a rapid quantitative assay of the inhibition of blood coagulation by the low-molecular-weight-heparin, enoxaparin. The contribution of enoxaparin is assessed by removing its influence through digestion with heparinase. A fuller description of the assay is detailed in our published paper.1 The assay still requires clinical confirmation.

快速点护理依诺肝素的抗凝血剂功效的测定全血中

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the ...

Surgical Technique for Spinal Cord Delivery of Therapies: Demonstration of Procedure in Gottingen Minipigs

This is a compact visual description of a combination of surgical technique and device for the delivery of (gene and cell) therapies into the spinal cord. While the technique is demonstrated in the animal, the procedure is FDA-approved and currently being used for stem cell transplantation into the spinal cords of patients with ALS. While the FDA has recognized proof-of-principle data on therapeutic efficacy in highly characterized rodent models, the use of large animals is considered critical for validating the combination of a surgical procedure, a device, and the safety of a final therapy for human use. The size, anatomy, and general vulnerability of the spine and spinal cord of the swine are recognized to better model the human. Moreover, the surgical process of exposing and manipulating the spinal cord as well as closing the wound in the pig is virtually indistinguishable from the human. We believe that the healthy pig model represents a critical first step in the study of procedural safety.

Short visual description of the surgical technique and device used for the delivery of (gene and cell) therapies into the spinal cord. The technique is demonstrated in the animal but is entirely translatable and currently being used for human application.

外科技术治疗脊髓交付：在哥廷根小型猪演示程序

This is a  compact visual description of a combination of surgical technique and device  for the  delivery of (gene and cell) therapies into the spinal ...

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

一种新的小鼠模型主动脉瘤腔内修复

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

蒸汽腔体建设用于公开小鼠酒精在所有三个学期人类发展的等效

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Murine Model of Femoral Artery Wire Injury with Implantation of a Perivascular Drug Delivery Patch

Percutaneous interventions including balloon angioplasty and stenting have been used to restore blood flow in vessels with occlusive vascular disease. While these therapies lead to the rapid restoration of blood flow, these technologies remain limited by restenosis in the case of bare metal stents and angioplasty, or reduced healing and possibly enhanced risk of thrombosis in the case of drug eluting stents. A key pathophysiological mechanism in the formation of restenosis is intimal hyperplasia caused by the activation of vascular smooth muscle cells and inflammation due to arterial stretch and injury. Surgeries that induce arterial injury in genetically modified mice are useful for the mechanistic study of the vascular response to injury but are often technically challenging to perform in mouse models due to the their small size and lack of appropriate sized devices. We describe two approaches for a surgical technique that induces endothelial denudation and arterial stretch in the femoral artery of mice to produce robust neointimal hyperplasia. The first approach creates an arteriotomy in the muscular branch of the femoral artery to obtain vascular access. Following wire injury this arterial branch is ligated to close the arteriotomy. A second approach creates an arteriotomy in the main femoral artery that is later closed through localized cautery. This method allows for vascular access through a larger vessel and, consequently, provides a less technically demanding procedure that can be used in smaller mice. Following either method of arterial injury, a degradable drug delivery patch can be placed over or around the injured artery to deliver therapeutic agents.

We describe a surgical technique that produces wire injury in the femoral artery of mice to induce neointimal hyperplasia to serve as a model testing system for the perivascular delivery of therapeutic compounds for the inhibition of restenosis.

股动脉线损伤的小鼠模型的血管周围给药补丁植入

Percutaneous interventions including balloon angioplasty and stenting have been used to restore blood flow in vessels with occlusive vascular disease. ...

Demonstration of the Rat Ischemic Skin Wound Model

The propensity for chronic wounds in humans increases with ageing, disease conditions such as diabetes and impaired cardiovascular function, and unrelieved pressure due to immobility. Animal models have been developed that attempt to mimic these conditions for the purpose of furthering our understanding of the complexity of chronic wounds. The model described herein is a rat ischemic skin flap model that permits a prolonged reduction of blood flow resulting in wounds that become ischemic and resemble a chronic wound phenotype (reduced vascularization, increased inflammation and delayed wound closure). It consists of a bipedicled dorsal flap with 2 ischemic wounds placed centrally and 2 non-ischemic wounds lateral to the flap as controls. A novel addition to this ischemic skin flap model is the placement of a silicone sheet beneath the flap that functions as a barrier and a splint to prevent revascularization and reduce contraction as the wounds heal. Despite the debate of using rats for wound healing studies due to their quite distinct anatomic and physiologic differences compared to humans (i.e., the presence of a panniculus carnosus muscle, short life-span, increased number of hair follicles, and their ability to heal infected wounds) the modifications employed in this model make it a valuable alternative to previously developed ischemic skin flap models.

The rat, due to its size, availability, and rather docile behavior, has been utilized as a research model for many years. The goal of this protocol is to utilize the rat as an ischemic skin wound healing model to provide valuable insight into the pathophysiology of chronic wounds.

在大鼠缺血性皮肤创伤模型的演示

The propensity for chronic wounds in humans increases with ageing, disease conditions such as diabetes and impaired cardiovascular function, and ...

Open Tracheostomy Gastric Acid Aspiration Murine Model of Acute Lung Injury Results in Maximal Acute Nonlethal Lung Injury

Acid pneumonitis is a major cause of sterile acute lung injury (ALI) in humans. Acid pneumonitis spans the clinical spectrum from asymptomatic to acute respiratory distress syndrome (ARDS), characterized by neutrophilic alveolitis, and injury to both alveolar epithelium and vascular endothelium. Clinically, ARDS is defined by acute onset of hypoxemia, bilateral patchy pulmonary infiltrates and non-cardiogenic pulmonary edema. Human studies have provided us with valuable information about the physiological and inflammatory changes in the lung caused by ARDS, which has led to various hypotheses about the underling mechanisms. Unfortunately, difficulties determining the etiology of ARDS, as well as a wide range of pathophysiology have resulted in a lack of critical information that could be useful in developing therapeutic strategies.
Translational animal models are valuable when their pathogenesis and pathophysiology accurately reproduce a concept proven in both in vitro and clinical settings. Although large animal models (e.g., sheep) share characteristics of the anatomy of human trachea-bronchial tree, murine models provide a host of other advantages including: low cost; short reproductive cycle lending itself to greater data acquisition; a well understood immunologic system; and a well characterized genome leading to the availability of a variety of gene deletion and transgenic strains. A robust model of low pH induced ARDS requires a murine ALI that targets mainly the alveolar epithelium, secondarily the vascular endothelium, as well as the small airways leading to the alveoli. Furthermore, a reproducible injury with wide differences between different injurious and non-injurious insults is important.
The murine gastric acid aspiration model presented here using hydrochloric acid employs an open tracheostomy and recreates a pathogenic scenario that reproduces the low pH pneumonitis injury in humans. Additionally, this model can be used to examine interaction of a low pH insult with other pulmonary injurious entities (e.g., food particles, pathogenic bacteria).

This protocol induces acute lung injury in a mouse that has close fidelity to the pathogenesis of acid pneumonitis observed in humans. We generate a maximal acute nonlethal low pH lung injury and account for differences in rodent-human anatomic respiratory structure using an open tracheostomy coupled with circumferential pressure release.

急性肺损伤开放气管切开胃酸吸入小鼠模型结果在急性最大非致命性肺损伤

Acid pneumonitis is a major cause of sterile acute lung injury (ALI) in humans. Acid pneumonitis spans the clinical spectrum from asymptomatic to acute ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Isolation of Atrial Cardiomyocytes from a Rat Model of Metabolic Syndrome-related Heart Failure with Preserved Ejection Fraction

In this article, we describe an optimized, Langendorff-based procedure for the isolation of single-cell atrial cardiomyocytes (ACMs) from a rat model of metabolic syndrome (MetS)-related heart failure with preserved ejection fraction (HFpEF). The prevalence of MetS-related HFpEF is rising, and atrial cardiomyopathies associated with atrial remodeling and atrial fibrillation are clinically highly relevant as atrial remodeling is an independent predictor of mortality. Studies with isolated single-cell cardiomyocytes are frequently used to corroborate and complement in vivo findings. Circulatory vessel rarefication and interstitial tissue fibrosis pose a potentially limiting factor for the successful single-cell isolation of ACMs from animal models of this disease.
We have addressed this issue by employing a device capable of manually regulating the intraluminal pressure of cardiac cavities during the isolation procedure, substantially increasing the yield of morphologically and functionally intact ACMs. The acquired cells can be used in a variety of different experiments, such as cell culture and functional Calcium imaging (i.e., excitation-contraction-coupling).
We provide the researcher with a step-by-step protocol, a list of optimized solutions, thorough instructions to prepare the necessary equipment, and a comprehensive troubleshooting guide. While the initial implementation of the procedure might be rather difficult, a successful adaptation will allow the reader to perform state-of-the-art ACM isolations in a rat model of MetS-related HFpEF for a broad spectrum of experiments.

Here, we describe an optimized, Langendorff-based procedure for the isolation of single-cell atrial cardiomyocytes from a rat model of metabolic syndrome-related heart failure with preserved ejection fraction. A manual regulation of intraluminal pressure of cardiac cavities is implemented to yield functionally intact myocytes suitable for excitation-contraction-coupling studies.

代谢综合征心力衰竭模型大鼠心房心肌细胞的分离与保留射血分数的关系

In this article, we describe an optimized, Langendorff-based procedure for the isolation of single-cell atrial cardiomyocytes (ACMs) from a rat model of ...