1. Introdução Cardioversores-desfibriladores implantáveis ​​(CDI) para prevenir a morte súbita cardíaca (MSC) em pacientes após SCD sobreviveu ou em risco de anemia falciforme, devido à disfunção ventricular esquerda. No entanto, o perigo de terapias inapropriadas é elevado, particularmente em dispositivos de câmara única. Essas descargas elétricas supérfluos pode ser prejudicial e comprometer a qualidade de vida do paciente. Detecção atrial pode melhorar o desempenho do dispositivo e reduzir o risco de choque inadequado. 1,2 detecção No entanto atrial requer um eléctrodo atrial que em si acarreta um risco significativo associado. 3 fabricante One, Biotronik, desenvolveu um eléctrodo de câmara única ventricular com atriais capacidades de detecção. O primeiro eléctrodo era o Kainox A +, que revelou excelentes capacidades de detecção. 4 No entanto, não foi usado geralmente devido à rigidez eléctrodo e de grande diâmetro (3,5 mm, 10,5 F). Outros desenvolvimentos deste electrodchumbo e para a criação de chumbo a inteligente Linox S DX, que tem um diâmetro menor (2,6 mm, 7,8 F) e demonstra características excelentes de implantação e capacidades de detecção. 5 Este documento descreve a colocação deste eléctrodo, a fim de realçar os dados a partir do estudo mestre e para demonstrar a facilidade de implantação e as capacidades de detecção excelentes deste eléctrodo. 2. Apresentação de Caso <ol><li> O paciente era um tabagista de 40 anos de idade, com história de doença arterial coronariana (DAC), infarto anterior recidivante do miocárdio (IAM) estado pós-intervenção coronária percutânea (PCI), disfunção ventricular esquerda (FEVE = 25%), hipercolesterolemia e fibrilação atrial paroxística (FAP). </li><li> Quatro meses atrás, o tratamento médico para a insuficiência cardíaca foi iniciado. Seu regime incluído beta-bloqueadores, inibidores da ECA e diuréticos; no entanto, não houve melhora da função ventricular esquerda. </li><li>Devido à sua função ventricular esquerda significativamente prejudicada, o paciente estava em risco considerável de morte súbita cardíaca (MSC). </li><li> Na apresentação, o paciente estava em ritmo sinusal, com perda de ondas R nas derivações torácicas. A 24 horas Holter revelou um episódio de 32 minutos de fibrilação atrial. </li><li> A decisão foi tomada para implantar um CDI de câmara única com capacidade de detecção atrial, a fim de monitorar novos episódios de fibrilação atrial e evitar tratamento inadequado em um paciente de outra maneira muito ativa. </li></ol> 3. Diagnóstico, Avaliação, Plano e <ol><li> O plano de tratamento foi a implantação de um Lumax VR-T DX com um desfibrilador inteligente Linox BIOTRONIK S DX chumbo sob anestesia regional em laboratório eletrofisiológico. </li><li> Um eco transtorácico foi realizado antes da implantação, a fim de reavaliar a fração de ejeção do ventrículo esquerdo e para excluir trombo ventricular, que pode proibirtestes durante o implante de desfibrilador. </li></ol> 4. Procedimento de implante <ol><li> Peri-processual preparação incluída uma dose intravenosa única de antibiótico profilático e heparina por via subcutânea. Terapia anti-trombótica foi mantida porque o risco de um evento coronário compensado o risco de hemorragia durante o procedimento </li><li> O paciente foi preparado de forma adequada e envolto em uma forma estéril. </li><li> O paciente foi colocado sob sedação moderada, com acompanhamento adequado, incluindo a monitorização elétrica contínua cardíaca, oximetria de pulso contínuo, e não invasivo de monitorização da pressão arterial. </li><li> A sedação administrada consistiu de midazolam IV, fentanil e propofol junto com a aplicação criteriosa de anestesia tópica. </li><li> A implantação começou com punção da veia subclávia esquerda através da pele intacta e colocação de um fio na veia cava inferior (IVC). A posição foi confirmada por X-Ray. Esta abordagem usual foi utilizado uma vez que a maioria dos eletrofisiologistas intervencionais são mais experientes nesta abordagem transcutânea, em vez da abordagem mais lateral de punção da veia do bolso. </li><li> A pele foi cortada com um bisturi cerca de 2 cm abaixo e paralela às clavículas. Após o bolso para o dispositivo foi preparado abaixo da clavícula esquerda, o arame na veia foi desenhada para o bolso e uma bainha 8 francês introduzido com a técnica de Seldinger. </li><li> O eléctrodo foi então introduzida no SVC através da bainha para o átrio direito. Depois de um estilete curvo (S 65-K, Biotronik) foi introduzido no eléctrodo, o eléctrodo foi empurrado embora a válvula tricúspide para o ventrículo direito. </li><li> Um estilete hetero (S 65-C, Biotronik) foi então introduzida no eléctrodo. O eletrodo caiu para o ventrículo inferior direito e foi manobrado para o ápice ventricular direita. A posição da ponta do eléctrodo, bem como genposição ral dos dois eletrodos no átrio foi monitorada por raio-X. Os dois eléctrodos de anel atriais foram colocados na junção do átrio VCS e direita. </li><li> Depois de o eléctrodo foi devidamente posicionado, as medições dos sinais atriais e ventriculares foram realizadas. </li><li> O limiar de estimulação para o eletrodo ventricular foi medida (Tempo em vídeo = &quot;7:27&quot;). O sinal atrial foi medida entre 6,5 e 8mV (Tempo em vídeo = &quot;7:56&quot;). O sinal atrial foi aumentada três vezes com a configuração de filtro no dispositivo. O sinal de ventricular foi medida entre 8,4 e 9,5 mV. Com estes sensores e andando de limiares, o eletrodo foi fixado na entrada da veia subclávia. </li><li> O eléctrodo foi então ligado ao desfibrilhador. </li><li> Todas as medidas foram reverificados e fibrilação ventricular foi induzida por T-onda de choque através do desfibrilhador e automaticamente terminado pelo dispositivo. (Tempo em vídeo = &quot;11:01&quot;) </li><li> O patient foi levado para a enfermaria e permaneceu no hospital até o dia seguinte. Em pós-operatória dia 1, um de raios-X foi levado para confirmar a posição do chumbo e para excluir um pneumotórax. Limiares de detecção e estimulação eram checados e foram semelhantes às medições intra-operatórias. O paciente foi observado durante aproximadamente 4 horas em recuperação e foi também monitorizada após o implante. No geral, a implantação foi bem sucedida eo paciente teve alta do hospital no dia seguinte. Os primeiros três meses de seguimento foram eventless e os sinais de detecção manteve-se estável ao longo deste período. </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>

Produção e acesso gratuito deste vídeo-artigo é patrocinado pela BIOTRONIK.

O implante do eletrodo do novo Linox INTELIGENTE S DX juntamente com o Lumax DX ICD, Biotronik, foi tão fácil como a colocação de qualquer câmara única CID. Esta experiência é suportada por dados do mestre inédito DX julgamento. 5 O Linox INTELIGENTE S eletrodo DX oferece a vantagem de detecção auricular, sem a desvantagem de um eletrodo atrial. O sinal atrial foi estável ao longo do tempo no nosso paciente como foi demonstrado no ensaio de DX. 5 Dupla câmara de dispositivos demonstraram superioridade sobre câmara única de detecção em apenas um estudo prospectivo e randomizado, chamado de 1 +1 julgamento. 1 Neste estudo, os pacientes com VT lenta foram implantadas com um CDI de câmara dupla, que tinha sido programado para dual- ou câmara única detecção. O ponto de extremidade combinada foi o número de terapias inapropriadas em resposta a SVTs e VTS abaixo da taxa de detecção. Para este desfecho, o 1 +1- julgamento demonstrou a ssuperioridade ignificant de câmara dupla (DCH) detecção com um longo intervalo de detecção de taquicardia (TDI), em comparação com o convencional programada uma única câmara (SCH) de detecção. Este achado foi revisitado por Deisenhofer et al., Que aleatoriamente pacientes para DCH-SCH ou implante de CDI. No entanto, o seu julgamento particularmente não abordar pacientes com VTs lentos como o intervalo de detecção de taquicardia média foi de 368 ms, e concluiu que a única e dupla-câmara dispositivos são igualmente eficazes para o tratamento de taquiarritmias ventriculares ameaçadoras à vida. Dispositivos DCH foram mostrados têm classificação ritmo superior, mas não eram diferentes dos que os dispositivos SCH, em termos de minimização terapias inapropriadas durante SVTs. 6 Apesar das vantagens de uma câmara dupla ICD para o diagnóstico e diferenciação de taquicardias, o conceito de implantação que apenas por uma questão de detecção não é geralmente aceite, porque a detecção melhorada é contrabalançada pelo aumento do risco de complic chumboções, bem como aumento da mortalidade e morbidez. 2,7,8 Portanto, a melhoria da técnica de implante ou uma VDD sistema para detecção de dupla câmara é necessário. 9,10. Eletrodo A SMART Linox S DX combinado com o DX Lumax ICD oferece essa vantagem. As instalações de detecção são similares a um dispositivo de dupla câmara e da taxa de complicação é tão baixa quanto no convencional CDI de câmara única. 5 Conclusão A Lumax VR DX-T tem sido comprovada de forma confiável sentir sinais atriais e coletar informações valiosas para permitir a detecção precoce de arritmias atriais. Além disso, o dispositivo oferece discriminação AV com SMART para a redução de choque segura. Os diagnósticos disponíveis EGMI atriais canal a adequação da CID detecção e tratamento, reduzindo assim choques inapropriados e obtenção de informações para otimizar a programação do dispositivo.

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

Cardioversores-desfibriladores implantáveis ​​(ICDs) terminar taquicardia ventricular (VT) e fibrilação ventricular (FV) com alta eficácia e pode proteger os pacientes de morte súbita cardíaca (MSC). No entanto, choques inapropriados pode ocorrer se taquicardias são diagnosticadas. Choques inapropriados são prejudiciais e prejudicar a qualidade de vida do paciente. O risco de tratamento inadequado aumenta com menores taxas de detecção programados no CDI. Uma câmara de detecção representa riscos maiores para o diagnóstico errado quando comparado com câmara dupla dispositivos que têm o benefício da informação atrial adicional. No entanto, usando um dispositivo de câmara dupla-meramente para fins de detecção não é geralmente aceite, uma vez que os riscos associados com o segundo eléctrodo podem compensar os benefícios de detecção. Portanto, BIOTRONIK desenvolvido um chumbo ventricular chamado o Linox a SMART S DX, que permite a detecção de sinais de atriais a partir de dois eléctrodos posicionados na parte atrial de theletrodo ventricular e. Este dispositivo contém dois eléctrodos de anel, um que os contactos parede do atrial na junção da veia cava superior (VPC) e uma posicionada na parte livre flutuação do eléctrodo no átrio. A excelente qualidade de sinal só pode ser alcançado por uma definição de filtro especial na CID (Lumax 540 e 740-T VR DX, BIOTRONIK). Aqui, a facilidade de implantação do sistema será demonstrado.

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

Câmara dupla cardioversores-desfibriladores implantáveis ​​(ICDs) pode melhorar a detecção de fibrilação atrial, bem como a diferenciação das taquicardias. No entanto, esta vantagem é prejudicada por complicações associadas com o segundo eléctrodo, o qual é requerido em dispositivos convencionais de dupla câmara. Portanto, BIOTRONIK desenvolveu um eléctrodo novo chamado o Linox<sup&gt; SMART</sup&gt; S DX que, quando usado em conjunto com o DX Lumax CID, oferece câmara dupla detecção sem os riscos associados com o segundo eléctrodo.

A Desfibrilador Implantável Câmara novo single com sensibilidade atrial: uma demonstração prática de Sensoriamento e facilidade de implantação

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 visualizações.  University Hospital of Rostock, Germany. Câmara dupla cardioversores-desfibriladores implantáveis ​​(ICDs) pode melhorar a detecção de fibrilação atrial, bem como a diferenciação das taquicardias. No entanto, esta vantagem é prejudicada por complicações associadas com o segundo eléctrodo, o qual é requerido em dispositivos convencionais de dupla câmara. Portanto, BIOTRONIK desenvolveu um eléctrodo novo chamado o Linox SMART S DX que, quando usado em conjunto com o DX Lumax CID...

Vídeo: 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.

Ablação por cateter em combinação com o fechamento do apêndice atrial esquerdo para Fibrilação Atrial

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

Medicina

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.

Ensaio de Point-of-Care rápida de eficácia anticoagulante enoxaparina em sangue total

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.

Técnica cirúrgica para entrega da Medula Espinhal de Terapias: Demonstração de Processo em Göttingen porquinhos

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.

Um novo modelo murino de reparação endovascular de aneurisma da aorta

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.

Construção de vapor Chambers usada para expor Ratos ao álcool durante o equivalente a todos os três trimestres de Desenvolvimento Humano

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.

Modelo murino de artéria femoral Injury fio com a implantação de uma droga patch Entrega perivascular

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.

Demonstração da Wound modelo de pele de rato Isquêmico

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.

Abrir traqueostomia ácido gástrico aspiração Modelo murino de lesão pulmonar aguda Resultados em Maximal aguda não-letal 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 ...

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.

Configurando um curso equipe Algoritmo e conduzir treinamento baseado em simulação no Departamento de Emergência - Um Guia Prático

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.

Isolamento dos Cardiomyocytes Atrial de um modelo do rato de metabólicas relacionadas com síndrome de insuficiência cardíaca com fração de ejeção preservada

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