1. Giriş İmplante kardiyoverter-defibrilatör (ICD) atlattı SCD sonra veya bozulmuş sol ventrikül fonksiyonu nedeniyle AKÖ riski olan hastalarda ani kardiyak ölüm (SCD) önlemek. Bununla birlikte, uygun olmayan tedavilerin bir tehlike, özellikle tek bölmeli cihazlarında, yüksek. Bu gereksiz elektrik deşarjı zararlı olabilir ve hastaların yaşam kalitesini bozabilir. Atriyal algılama cihazı performansını artırmak ve uygunsuz çarpması riskini azaltabilir. 1,2 Ancak atriyal algılama kendi içinde anlamlı bir ilişkili risk taşıyan bir atriyal elektrot gerektirir. 3 Bir üretici, BIOTRONIK, atriyal algılama yetenekleri ile ventriküler tek odasının elektrot geliştirdi. İlk elektrot mükemmel algılama yetenekleri açığa A +, Kainox oldu. 4. Ancak, yaygın (3.5 mm, 10.5 F) elektrot sertlik ve büyük çaplı nedeniyle kullanılmamıştır. Bu elektrot daha ileri gelişmelerdaha küçük çaplı (2.6 mm, 7.8 F) sahiptir ve mükemmel implantasyon özellikleri ve algılama yeteneklerini gösteriyor Linox akıllı S DX kurşun, yaratılması için e kurşun. 5 Bu kağıt verileri vurgulamak için, bu elektrot yerleştirme anlatıyor ana çalışma ve implantasyon kolaylığı ve bu elektrot mükemmel algılama yetenekleri hem de göstermek için. 2. Olgu Sunumu <ol><li> Hasta koroner arter hastalığı öyküsü (CAD), tekrarlayan anterior miyokard infarktüsü (AMI) durumu sonrası perkütan koroner girişim (PCI), bozulmuş sol ventrikül fonksiyonu (EF =% 25), hiperkolesterolemi ile 40 yaşındaki kadın içiyordu ve paroksismal atriyal fibrilasyon (PAF). </li><li> Dört ay önce, kalp yetmezliği için ilaç tedavisi başlandı. Onun rejimi beta-blokerler, ACE inhibitörleri ve diüretik, ancak sol ventrikül fonksiyonlarında düzelme olmadı. </li><li>Onu önemli ölçüde bozulmuş sol ventrikül fonksiyonu nedeniyle, hastanın ani kardiyak ölüm (SCD) ciddi risk altında idi. </li><li> Sunum, hastanın göğüs derivasyonlarda R dalgaları kaybı sinüs ritmi oldu. 24 saatlik holter monitör atriyal fibrilasyon 32 dakikalık bölüm saptandı. </li><li> Karar atriyal fibrilasyon atağı takip etmek ve bir başka çok aktif hastada gereksiz tedaviyi önlemek için atriyal algılama yeteneği ile bir tek odacıklı ICD implantasyonu yapıldı. </li></ol> 3. Tanı, Değerlendirme ve Planı <ol><li> Tedavi planı elektrofizyolojik laboratuar bölgesel anestezi altında BIOTRONIK Linox akıllı S DX kurşun ile Lumax VR-T DX defibrilatör implante oldu. </li><li> Bir transtorasik eko sol ventrikül ejeksiyon fraksiyonu yeniden değerlendirmek ve yasaklar olabilir bir ventrikül trombüsü, dışlamak için implantasyon öncesinde yapıldıimplantasyonu sırasında defibrillatör test. </li></ol> 4. İmplantasyon Prosedürü <ol><li> Peri-prosedürel hazırlık profilaktik antibiyotik ve subkutan heparin tek bir intravenöz doz içeriyordu. Bir koroner olay riskini işlem sırasında kanama riski ağır bastı, çünkü antitrombotik tedavi devam edildi </li><li> Hastaya uygun şekilde hazırlanan ve steril bir şekilde örtülmüş edildi. </li><li> Hasta sürekli elektrik kardiyak izleme, sürekli pulse oksimetre ve non-invazif kan basıncı kontrolünü de içeren uygun bir izleme ile Bilinçli sedasyon altında yerleştirildi. </li><li> Sedasyon uygulanan topikal anestezi akılcı uygulama ile birlikte midazolam, fentanil ve propofol IV oluşuyordu. </li><li> Implantasyon sağlam deri ve inferior vena kava (IVC) bir tel yerleştirme ile sol subklavian ven ponksiyonu ile başladı. X pozisyonu ile teyit edilmiştir-Ray. En girişimsel electrophysiologists yerine cebinden ven delinmesiyle en fazla lateral yaklaşım daha bu transkutanöz yaklaşım, daha deneyimli olduğu için bu alışılmadık bir yaklaşım olarak kullanıldı. </li><li> Cilt clavicles için aşağıdaki ve paralel 2cm ilgili bir neşter ile kesildi. Cihaz için cep sol klavikula altında hazırlanmıştır sonra ven tel cep ve Seldinger tekniği ile getirilen 8 Fransız kılıf çizilmiş oldu. </li><li> Elektrot sonra sağ atriuma kılıf üzerinden SVC girmiştir. Bir kavisli stile (S 65-K, BIOTRONIK) elektrot sokuldu sonra, elektrot sağ ventrikül çıkış yolu ile triküspid olsa itildi. </li><li> Bir düz stile (S 65-C, BIOTRONIK) sonra elektrot girmiştir. Elektrot inferior sağ ventrikül düştü ve sağ ventrikül için bir manevra yapıldı. Elektrot ucu pozisyonu gibi genatrium içinde iki elektrot eral konumu X-ray tarafından takip edildi. İki atriyal halka elektrot SVC ve sağ atrium kavşağında yerleştirilmiştir. </li><li> Elektrot uygun bir konumda sonra, atriyal ve ventriküler sinyallerin ölçümler yapıldı. </li><li> Ventriküler elektrot için pacing eşiği (Video = &quot;07:27&quot; Zaman) ölçüldü. Atriyal sinyali 6.5 ve 8mv (Video = &quot;07:56&quot; Zaman) arasında ölçüldü. Atriyal sinyali aygıt içinde filtre ayarına ile üç kez geliştirilmiştir. Ventriküler sinyali 8,4 ve 9,5 mV ile ölçülmüştür. Bu algılama ve-eşikleri pacing ile elektrot subklavian ven girişinde tespit edildi. </li><li> Elektrot sonra defibrilatör bağlanmıştır. </li><li> Tüm tedbirler tekrar kontrol edildi ve ventriküler fibrilasyon defibrilatör ile T dalga şoku ile tetiklenen ve otomatik cihaz tarafından sona erdirildi. (Video = &quot;11:01&quot; Zaman) </li><li> Patient koğuşa getirilen ve şu güne kadar hastanede kaldı. Post-operatif 1. günde, bir X-ışını kurşun konumu onaylamak ve bir pnömotoraks dışlamak götürüldü. Algılama ve pacing eşik tekrar kontrol edildi ve intraoperatif ölçümler ile benzer bulunmuştur. Hasta geri kazanım yaklaşık 4 saat süreyle gözlenmiştir ve ayrıca implantasyondan sonra takip edilmiştir. Genel olarak, implantasyon başarılı oldu ve hasta ertesi gün taburcu edildi. Izlem ilk üç aylık olaysız vardı ve algılama sinyalleri bu süre boyunca sabit kalmıştır. </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>

Üretim ve bu video-makale Ücretsiz Erişim BIOTRONIK tarafından desteklenmektedir.

Lumax DX ICD, BIOTRONIK, ile birlikte yeni Linox SMART S DX elektrod implantasyonu tek bir odacık ICD yerleştirilmesi kadar kolay oldu. Bu deneyim Linox SMART S DX elektrot bir atriyal kurşun dezavantajı olmadan atriyal algılama avantaj sunuyor DX-deneme. 5 yayınlanmamış ana verileri tarafından desteklenmektedir. Atriyal sinyal DX-deneme kanıtlanmıştır olarak hastada zamanla stabil oldu. 5 Çift bölmeli aygıtlar tek prospektif randomize tek odacıklı algılama üstünlük göstermiştir, 1 +1 deneme denir. 1. Bu çalışmada, yavaş VT olan hastalarda ya dual-programlanmış olduğunu bir çift odacıklı ICD implante edildi veya tek odacıklı algılama. Kombine nokta algılama oranının altında SVT&#39;ler ve VT&#39;ler yanıt olarak uygunsuz tedavilerin sayısı oldu. Bu nokta için, 1 +1- deneme s gösterdiçift ​​odacıklı (DCH) geleneksel programlanmış tek odacıklı (SCH) algılama ile karşılaştırıldığında uzun bir taşikardi algılama aralığı (TDI) ile algılama ignificant üstünlüğü. Bu bulgu Deisenhofer ark dönülmüş oldu., Rastgele DCH-ya SCH ICD takılması için hasta atanan kim. Ancak, deneme, özellikle ortalama taşikardi algılama aralığı 368 ms olduğu gibi yavaş VT&#39;ler olan hastalarda ele ve tek ve çift odacıklı cihazlar yaşamı tehdit eden ventriküler aritmi yılında tedavi için eşit derecede etkili olduğu sonucuna vermedi. DCH cihazlar SVT&#39;ler sırasında uygunsuz tedavilerin en aza indirmek açısından SCH cihazları daha farklı, üstün ritm sınıflandırması gösterilen ancak idi. 6 taşikardi, sadece uğruna bunu implante kavramının tanı ve farklılaşması için bir çift odacıklı ICD avantajlarına rağmen gelişmiş algılama kurşun istenme riskinin artışı ile karşı dengeli çünkü algılama genellikle kabul edilmemektedirations yanı sıra artmış mortalite ve morbidite. Bu nedenle 2,7,8, çift kamara tespiti için implantasyon tekniği veya VDD-sisteminin iyileştirilmesi gerekmektedir. 9,10. Lumax DX ICD ile kombine Linox SMART S DX elektrot bu avantajı sunuyor. Algılama tesisleri iki odacıklı cihazlar ve komplikasyon oranı, klasik tek odacık ICD&#39;ler kadar düşük olduğu benzer. 5 Sonuç Lumax VR-T DX güvenilir atriyal sinyallerini algılayan ve atriyal aritmilerin erken tespiti için izin vermek için değerli bilgiler toplamak için kanıtlanmıştır. Ayrıca, cihazın güvenli bir şok azaltılması için SMART AV ayrımcılık sunuyor. Kullanılabilir atriyal IEGM kanal tanılar ICD tespit ve tedavinin uygunluğunu, böylece uygunsuz şoklar azaltılması ve cihaz programlama optimize etmek için bilgi kazanıyor.

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

İmplante kardiyoverter-defibrilatör (ICD) yüksek etkinlik ile ventriküler taşikardi (VT) ve ventriküler fibrilasyon (VF) feshedebilir ve ani kardiyak ölüm (SCD) gelen hastalara koruyabilirsiniz. Taşikardi karıştırılabiliyor Bununla birlikte, uygun olmayan şoklar ortaya çıkabilir. Sakıncalı şoklar zararlı ve hastaların yaşam kalitesini bozabilir. Uygunsuz tedavi riski ICD programlanan düşük saptama oranları artar. Ek atriyal bilgilerin faydası çift odacıklı cihazlar ile karşılaştırıldığında tek odacıklı algılama yanlış tanı için daha büyük risk taşımaktadır. Ikinci elektrot ile ilgili riskleri tespit faydalarını geçebilir beri Ancak, sadece algılama uğruna bir çift odacıklı cihazı kullanarak, genellikle kabul edilmemektedir. Bu nedenle, BIOTRONIK th atriyal kısmına yerleştirilmiş iki elektrot ile atriyal sinyallerin bulgulanması için olanak Linox SMART S DX adı verilen bir ventriküler kurşun, geliştirilmişe ventriküler elektrot. Bu cihaz iki halka elektrot içerir; biri olduğu superior vena kava (SVK) ve atriyumda elektrodun serbest dalgalanan kısmında konumlandırılmış bir kavşakta temas atriyal duvar. Mükemmel kalitede tek sinyali ICD özel bir filtre ayarına (Lumax 540 ve 740 VR-T DX, BIOTRONIK) ile elde edilebilir. Burada, sistemin implantasyon kolaylığı gösterilecektir.

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

Çift kamara implante edilebilir kardiyoverter-defibrilatör (ICD) atriyal fibrilasyon algılama gibi taşikardi farklılaşma artırabilir. Bununla birlikte, bu avantajı, geleneksel çift odacık cihazlar gerekli olan ikinci elektrot, ile ilgili komplikasyonlar ile zayıflar. Bu nedenle, BIOTRONIK Linox adında yeni bir elektrot geliştirdi<sup&gt; SMART</sup&gt; S DX olduğu, Lumax DX ICD ile birlikte kullanıldığı zaman, ikinci elektrot ile ilişkili riskleri olmadan iki bölmeli algılama sunmaktadır.

Yeni Bir Tek Odası İmplante Atriyal Algılama ile Defibrilatör: Algılama Pratik Bir Gösteri ve İmplantasyon kolaylığı

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 Görüntüleme.  University Hospital of Rostock, Germany. Çift kamara implante edilebilir kardiyoverter-defibrilatör (ICD) atriyal fibrilasyon algılama gibi taşikardi farklılaşma artırabilir. Bununla birlikte, bu avantajı, geleneksel çift odacık cihazlar gerekli olan ikinci elektrot, ile ilgili komplikasyonlar ile zayıflar. Bu nedenle, BIOTRONIK Linox adında yeni bir elektrot geliştirdi SMART S DX olduğu, Lumax DX ICD ile birlikte kullanıldığı zaman, ikinci elektrot ile ilişkili riskleri olmad...

Video: 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.

Atriyal fibrilasyon için Apendikse Kapatma ile kombinasyonu Kateter Ablasyon

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

Tıp

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.

Tüm Kan enoksaparin Antikoagülan Etkinliğinin Rapid Point-of-Care Assay

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.

Terapiler Omurilik Teslimat için Cerrahi Tekniği: Göttingen Minipigs Prosedürü gösterilmesi

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.

Endovasküler Aort Anevrizma Onarımı Yeni Bir murin Modeli

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.

İnsani Gelişim her üç trimesterde Eşdeğeri sırasında Alkol Fare Expose Kullanılan Buhar Odaları İnşaatı

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.

Bir Perivasküler Drug Delivery Patch İmplantasyonunda ile Femoral Arter Tel Yaralanma sıçan Modeli

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.

Sıçan İskemik Cilt Yara Modeli Gösteri

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.

Akut Akciğer Hasarı Açık Trakeostomi Gastrik Asit Aspirasyon Fare Modeli Maksimal Akut Ölümcül olmayan Akciğer Hasarı Sonuçlar

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.

Bir Stroke Takım Algoritma Kurma ve acil serviste Simülasyon tabanlı Eğitim yürütmek - Pratik Bir Rehber

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.

Bir fare modeli Metabolik sendromu ile ilgili kalp yetmezliği ile korunmuş ejeksiyon fraksiyonu atriyal Cardiomyocytes izolasyonu

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