1. 소개 Implantable cardioverter - defibrillators (ICD) 살아 SCD 후 또는 장애인 왼쪽 심실 기능으로 인해 SCD 위험이있는 환자에서 갑작스런 심장 죽음 (SCD)를 방지. 그러나, 부적 절한 요법의 위험은 특히 단일 챔버 장치에 높습니다. 이러한 불필요한 전기 방전는 유해한이어야하며 삶의 환자 품질에 악영향을 줄 수 있습니다. 심방 감지 장치의 성능을 개선하고 부적 절한 충격의 위험을 줄일 수 있습니다. 1,2하지만 심방 검색이 자체가 상당한 연관된 위험을 지니고 심방 전극이 필요합니다. 3 한 제조 업체, BIOTRONIK은 심방 감지 기능과 함께 심실 단일 챔버 전극을 개발했다. 제 1 전극은 뛰어난 감지 능력을 보여주 + Kainox했습니다. 4 그러나 일반적으로 (3.5 mm, 10.5 F) 전극 강성 및 대형 지름으로 인해 사용되지 않았습니다. 이 electrod의 추가 개발작은 직경 (2.6 mm, 7.8 F)를 가지고 우수한 주입 기능과 감지 능력을 보여줍니다 Linox 스마트 S DX 리드의 생성에 대한 전자의 리드. 5 본 논문은 데이터를 강조하기 위하여,이 전극의 배치 모습 마스터 연구에서와 이식의 용이성이 전극의 탁월한 감지 능력을 모두 발휘하기. 2. 사례 발표 <ol><li> 환자는 관상 동맥 질환의 역사 (CAD), 재발성 앞쪽에 심근 경색 (AMI) 상태 - 포스트 percutaneous 관상 동맥 중재 (PCI), 장애인 왼쪽 심실 기능 (LVEF = 25 %), 고콜레스테롤혈증있는 40 세의 여성 흡연자였다 그리고 발작 심방 세동 (PAF). </li><li> 4 달 전 심장 마비에 대한 의학적 치료가 시작 됐습니다. 그녀의 섭생은 베타 차단제, ACE-저해제와 diuretics를 포함하지만, 왼쪽 심실 기능에 아무런 개선이 없었다. </li><li>그녀의 대폭 장애인 왼쪽 심실 기능으로 인해 환자가 갑작스런 심장 죽음 (SCD)의 상당한 위험했습니다. </li><li> 프레 젠 테이션에서, 환자는 흉부 리드에서 R-물결의 손실과 함께 부비동 리듬에 있었어요. 24 시간 홀터 모니터는 심방 세동의 32 분 에피소드를 공개했다. </li><li> 결정은 심방 세동의 추가 에피소드를 모니터하기와 달리 매우 활동적인 환자에서 부적 절한 치료를 방지하기 위해 심방 감지 기능이있는 단일 챔버 ICD를 이식하기 위해 만들어졌습니다. </li></ol> 3. 진단, 평가 및 계획 <ol><li> 치료 계획은 electrophysiological 실험실에서 지방 마취 하에서 BIOTRONIK Linox 스마트 S DX 리드와 Lumax VR-T DX 제세 동기를 이식하는 것이었다. </li><li> transthoracic 반향은 왼쪽 심실 방출 분율을 다시 평가하는과 금지할 수도 심실 혈전을 제외하기 위해 주입하기 전에 수행되었다주입 중에 제세 동기 테스트. </li></ol> 4. 임플랜테이션 절차 <ol><li> 사망 시에 절차적 준비 예방 항생제와 피하 헤파린의 단일 정맥 복용량을 포함시켰습니다. 관상 동맥 사건의 위험이 절차를 수행하는 동안 출혈의 위험보다 훨씬 더 무거운 때문에 Antithrombotic 치료는 유지되었다 </li><li> 환자는 적절하게 준비하고 살균 방식으로 draped되었다. </li><li> 환자는 지속적인 전기적 심장 모니터링, 지속적인 펄스 oximetry 및 비침습 혈압 모니터링을 포함한 적절한 감시와 함께 적당한 진정 작용하에 놓여되었습니다. </li><li> 진정 작용이 행정은 국소 마취의 사려 분별이있는 응용 프로그램과 함께 midazolam 펜타 닐과 propofol IV 구성되어. </li><li> 이식은 손상 피부와 하부 대정 맥 (IVC)에서 전선의 배치를 통해 좌측 쇄골하 정맥의 주사와 함께 시작되었다. 위치는 X가 확인되었다선. 대부분의 interventional electrophysiologists 오히려 주머니에서 정맥 펑쳐링의 많은 측면적인 접근보다 transcutaneous 접근, 더 경험이 있기 때문에 이것은 비정상적인 접근 방법이 사용되었다. </li><li> 피부 쇄골에 대한 아래와 평행 2cm에 대해 메스로 절단되었다. 장치의 포켓이 왼쪽 쇄골 아래 준비가 된 후에, 정맥의 와이어는 포켓과 Seldinger 기술 도입 8 프랑스어 칼집에 그려진되었다. </li><li> 전극 그런 다음 오른쪽 심방에 칼집을 통해 SVC에 소개되었습니다. 곡선 탐침 (S 65-K, Biotronik)가 전극에 소개되었습니다 후, 전극은 오른쪽 심실 유출의 넓이에 tricuspid 밸브 불구 밀었습니다. </li><li> 스트레이트 탐침 (S 65 C, Biotronik)은 다음 전극에 소개되었습니다. 전극은 열등 우심실로 떨어져 오른쪽 심실 꼭대기에 기회 였는데되었다. 전극 팁의 위치뿐만 아니라 세대아트리움의 두 전극 eral 위치는 X-레이에 의​​해 감시되었다. 두 심방 고리 전극은 SVC 및 오른쪽 심방의 교차점에 놓여 있었다. </li><li> 전극이 적절하게 배치되었다 후, 심방과 심실 신호의 측정이 수행되었다. </li><li> 심실 전극에 대한 서성 임계값은 (비디오 = &quot;7시 27분&quot;시간) 측정되었다. 심방 신호는 6.5와 8mv (비디오 = &quot;7시 56분&quot;시간) 사이에 측정되었다. 심방 신호 장치 필터 설정으로 세 번 개선되었다. 심실 신호는 8.4 9.5 MV 사이에 측정되었다. 이러한 감지 및 임계값을 서성로 전극은 쇄골 하 정맥의 입구에 해결되었습니다. </li><li> 전극은 다음 제세 동기에 연결되었다. </li><li> 모든 조치는 다시 확인해 있었고, 심실 세동은 제세 동기를 통해 T-웨이브 충격에 의해 유도된하고 자동 장치에 의해 종료되었습니다. (비디오 = &quot;11시 1분&quot;시간) </li><li> 팻ient는 구의로 보내진 뒤 다음 날 때까지 병원에 남아되었다. 수술 1 일에서 X-레이 리드의 위치를​​ 확인하고 pneumothorax를 제외하도록 찍은. 감지와 서성 임계값은 다시 확인해 있었고, intraoperative 측정과 유사했다. 환자는 회복에 약 4 시간 동안 관찰되었다 또한 주입 후 감시되었다. 전체적으로 이식이 성공적이었고, 환자는 다음날 퇴원하게되었다. 후속의 처음 세 달 동안 사건없는 있었고, 감지 신호는이 기간 동안 안정적으로 남아 있었다. </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>

생산 및 동영상 - 기사의 무료 액세스가 BIOTRONIK의 후원됩니다.

Lumax DX ICD, Biotronik와 함께 새로운 Linox 스마트 S DX 전극의 주입은 어떤 단일 챔버 ICD의 위치만큼 쉬웠다. 이 경험은 Linox 스마트 S DX 전극은 심방 리드의 단점없이 심방 감지의 장점을 제공 DX - 시험 5.되지 않은 마스터의 데이터에 의해 지원됩니다. 심방 신호는 DX-재판에서 입증되었습니다대로 우리의 환자에서 시간이지나면서 안정 5. 듀얼 챔버 장치가 하나의 미래의 무작위 시험에서 단일 챔버 감지 우월을 증명 한것, 1 +1 재판했다. 1이 재판에서, 느린 VT 환자는 중으로 듀얼 프로그래밍 걸로 듀얼 챔버 ICD와 함께 심어되었습니다 또는 단일 챔버 감지. 통합 종점은 검출 률 아래 SVTs 및 VTs에 대응 부적 절한 요법의 숫자였다. 이 끝점은 ​​1 +1- 재판을 시연듀얼 챔버 (DCH) 통상 프로그램된 단일 챔버 (SCH) 감지에 비해 긴 이라는데요 감지 간격 (TDI)와 감지의 ignificant의 우수성. 이 연구 결과는 Deisenhofer 외 의해 revisited되었습니다., 임의로 DCH 또는 SCH ICD 주입으로 환자를 할당 사람. 그러나, 그들의 재판은 특히 평균 이라는데요 검출 간격은 368 MS 그대로 느린 VTs 환자를 해결하고, 단일 및 듀얼 챔버 장치가 생명을 위협하는 심실 tachyarrhythmias의 치료에 동일하게 효과적이라는 결론을하지 않았다. DCH 장치 SVTs 동안 부적 절한 요법을 최소화의 관점에서 SCH 장치 다르지을 탁월한 리듬 분류가 표시되지 않습니다었지만되었다. 6 tachycardias가 단지를 위해 그것을 이온 주입의 개념의 진단 및 차별 화를위한 듀얼 챔버 ICD의 장점에도 불구하고 향상된 검색이 리드 complic의 위험이 증가하여 카운터 균형이기 때문에 검출은 일반적으로 허용되지 않습니다ations뿐만 아니라 증가 사망률과 병적 상태. 따라서 2,7,8는 듀얼 챔버 검출을위한 주입법 또는 VDD 시스템의 개선이 필요합니다. 9,10. Lumax DX ICD와 결합 Linox 스마트 S DX 전극이 장점을 제공합니다. 감지 시설은 듀얼 챔버 장치와 합병증 률은 기존의 단일 챔버 ICDs만큼 낮은 비슷 5. 결론 Lumax VR-T DX 안정 심방 신호를 감지하고 심방 arrhythmias의 조기 발견을 위해 수 있도록 유용한 정보를 수집하는 증명되었습니다. 또한 장치가 안전 충격 감소를위한 스마트로 유명 차별을 제공합니다. 가능한 심방 IEGM 채널 진단 ICD 감지 및 치료의 적합성은이를 부적 절한 충격을 줄이고 장치 프로그래밍을 최적화하기 위해 정보를 얻고.

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

Implantable cardioverter - defibrillators (ICDs)는 높은 효능과 심실빈맥 이라는데요 (VT)과 심실세동 (VF)을 종료하고 갑자기 심장 죽음 (SCD)에서 환자를 보호할 수 있습니다. tachycardias가 misdiagnosed 경우 단, 부적 절한 쇼크가 발생할 수 있습니다. 부적 절한 충격은 유해하며 삶의 질을 손상 환자. 부적 절한 치료의 위험 ICD에 프로그램된 낮은 검출 속도로 증가합니다. 추가 심방 정보의 혜택을 이중 챔버 장치와 비교해 볼 때 단일 챔버 감지 misdiagnosis에 대한 더 큰 위험 포즈. 두 번째 전극과 관련된 위험이 감지의 혜택을보다 중요한 수 있으므로 그러나, 단지 탐지를 위해 듀얼 챔버 장치를 사용은 일반적으로 허용되지 않습니다. 따라서 BIOTRONIK은 일의 심방 부분에 위치하고 두 전극에서 심방 신호의 검출을 허용 Linox 스마트 S DX라는 심실 리드 개발전자 심실 전극. 이 장치는 두 개의 링 전극을 포함하고, 하나를 그 우수한 대정 맥 (SVC) 및 중앙홀에서 전극의 자유로운 부동 부분에 위치 하나의 교차점에서 연락처 심방 벽. 우수한 신호 품질은 ICD의 특수 필터 설정 (Lumax 540 740 VR-T DX, BIOTRONIK)에 의해 형성될 수 있습니다. 여기서 시스템의 이식의 용이성이 입증됩니다.

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

듀얼 챔버 implantable cardioverter - defibrillators (ICDs)은 심방 세동의 검출뿐만 아니라 tachycardias의 차별을 향상시킬 수 있습니다. 그러나이 장점은 기존의 듀얼 챔버 장치가 필요합니다 두 번째 전극과 관련된 합병증에 의해 손상된다. 따라서 BIOTRONIK는 Linox라는 새로운 전극을 개발했다<sup&gt; 스마트</sup&gt; S DX 즉, Lumax DX ICD와 함께 사용할 때, 두 번째 전극과 관련된 위험없이 듀얼 챔버 감지 기능을 제공합니다.

새로운 싱글 회의소 Implantable 심방세동 감지와 심장 박동기 : 감지의 실용 데모와 주입의 용이성

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 조회수.  University Hospital of Rostock, Germany. 듀얼 챔버 implantable cardioverter - defibrillators (ICDs)은 심방 세동의 검출뿐만 아니라 tachycardias의 차별을 향상시킬 수 있습니다. 그러나이 장점은 기존의 듀얼 챔버 장치가 필요합니다 두 번째 전극과 관련된 합병증에 의해 손상된다. 따라서 BIOTRONIK는 Linox라는 새로운 전극을 개발했다 스마트 S DX 즉, Lumax DX ICD와 함께 사용할 때, 두 번째 전극과 관련된 ?...

비디오: 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.

심방 세동에 대한 왼쪽 심방 부위 요 폐쇄와 함께 카테 테르 박리

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

연구

의학

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.

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.

치료의 척추 배달을위한 수술 기법 : 괴팅겐 Minipigs의 절차의 데모

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.

혈관 동맥류 수리의 새로운 쥐과 모델

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.

인간 발달의 세 삼 분기의 상당 기간 동안 알코올에 쥐를 노출하는 데 사용 증기 챔버의 건설

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.

혈관 주위 약물 전달 패치의 주입과 대퇴 동맥 와이어 부상의 쥐 모델

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.

쥐 허혈성 피부 상처 모델의 데모

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.

급성 폐 손상의 열기 기관 절개 위산 흡인 쥐 모델은 최대한 급성 치명적 폐 손상의 결과

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.

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.

심 방 Cardiomyocytes 보존된 방출 분수와 함께 대사 증후군 관련 심장 마비의 쥐 모델에서의 격리

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