Hemodynamic response to in situ latissimus dorsi muscle stimulation: implications in dynamic cardiomyoplasty

Dynamic cardiomyoplasty (DCM) involves the electrical stimulation of a pedicled latissimus dorsi muscle flap wrapped around the falling ventricle as a means of cardiac assist. To further elucidate a potential neurohumoral mechanism for improvement of cardiac output after myoplasty, we evaluated the hemodynamic effects of in situ stimulation of the latissimus dorsi muscle (in the absence of cardiomyoplasty). In seven mongrel dogs, a nerve cuff electrode (Medtronic 6901) was placed around the left thoracodorsal nerve (TDN). This was attached to a pulse generator (Medtronic, Itrel 7420), delivering a 4.0 volt, 0.19 second on, 0.81 second off, 33 Hz, 210 microsecond pulse width, cyclic bursts similar to that used in DCM. Stroke volume index (SVI) and other hemodynamic parameters as well as plasma norepinephrine (NE) levels were measured at five stages: baseline, stimulator on at 0, 2, and 5 minutes, and stimulator off at 30 minutes after. The animals were then subjected to 4 weeks of rapid pacing at 240 beats/min (Medtronic 8329) to induce heart failure, and as the rapid pacing was discontinued, measurements were repeated as above. After rapid pacing, cardiac function was significantly depressed, and NE was elevated (133 +/- 69 versus 500 +/- 353 pg/mL, p < 0.05). In the normal hearts, TDN stimulation increased SVI, heart rate, systemic pressure, and NE levels. In heart failure, however, no significant changes in cardiac function and NE levels were noted. In conclusion, our data indicate that in the normal hearts, afferent impulses from TDN stimulation alone may augment cardiac function by means of a neurohumoral effect that is not seen in severe heart failure. The implications of these findings in DCM are discussed.     

Coronary bypass in vascular patients: a relatively high-risk procedure

A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.     

Adaptive wavelet packet based image coding with optimalentropy-constrained lattice vector quantizer (ECLVQ)

In this work, wavelet basis and source coding are jointly optimized, while specifying the source coding strategy as entropy-constrained lattice vector quantizer (ECLVQ). The presented approach differs from previous works in which the choice of wavelet basis is quasioptimal, but the quantizer set is optimally chosen     

Unexplained physical symptoms: outcome, utilization of medical care and associated factors

BACKGROUND: Measurement of intracardiac hemodynamic parameters has been limited to brief periods in the acute care setting. We developed and evaluated an implantable hemodynamic monitor that is capable of measuring chronic right ventricular oxygen saturation and pulmonary artery pressure. METHODS AND RESULTS: The device consists of an electronic controller placed subcutaneously and two transvenous leads placed in the right ventricle (reflectance oximeter) and pulmonary artery (variable capacitance pressure sensor). Implantation was performed in 10 patients with severe left ventricular dysfunction. Average implant pulmonary artery pressures were systolic, 52 +/- 16 mm Hg; diastolic, 29 +/- 11 mm Hg; and mean, 40 +/- 12 mm Hg. The mean right ventricular oxygen saturation at implant was 51%. Provocative maneuvers, including postural changes, sublingual nitroglycerin, and bicycle exercise, demonstrated expected changes in measured oxygen saturation and pulmonary artery pressures over time. At follow-up of 0.5 to 15.5 months, there were no significant differences between pulmonary artery pressures or oxygen saturation values transmitted from the device and simultaneous measurement with balloon flotation catheters. Four of the pulmonary artery leads dislodged and three demonstrated sensor drift, whereas two of the oxygen saturation sensors failed. Four patients died and four received transplants. Pathological study did not demonstrate injury to the right ventricular outflow tract or pulmonic valve. CONCLUSIONS: Chronic measurement of hemodynamic parameters in the outpatient setting with implantable sensor technology appears to be feasible. The devices are well tolerated without significant untoward effects, and the sensors generally function well over time, providing reliable information. Clinical usefulness remains to be established.     

Measurements and correlation of effect of cosolvents on the solubilities of complex molecules in supercritical carbon dioxide

A new transparent microscale circulation-type high pressure equilibrium cell with on-line sampling was devised. With this apparatus, experimental solubility of molecularly complex species such as steroids (cholesterol, stigmasterol and ergosterol) and fatty acids (palmitic acid and stearic acid) in supercritical carbon dioxide(sc-C0₂) were measured. Also, to find an appropriate substance for enhancing both the polarity and the solubility power of the SC-CO₂ solvent, we arbitrarily selected three polar substances such as acetone, methanol and water and the effect of these cosolvents on the solubility of solutes in SC-CO₂ are examined. The supercritical phase equilibrium data of solute-cosolvent-sc-CO₂ systems were quantitatively correlated using a new equation of state based on the lattice fluid theory incorporated with the concept of multibody interaction. We found that the addition of tracer amount of acetone or methanol to SC-CO₂ enhances the solubility of all solutes about thirty to sixty times when compared with the case of pure sc-CO₂ However, for the case of cosolvent water, no further enhancement of the solubility of solutes was realized. Also, the versatile fittability of the equation of state proposed in this work was demonstrated with the newly measured ternary supercritical equilibrium data.     

Oxidative regeneration of sulfided sorbent by H2S without emission of SO2

Much SO₂, another perilous air pollutant, was emitted during the oxidative regeneration of sulfided sorbent by H₂S. In order to prevent emission of SO₂, we carried out oxidative regeneration with the physical mixture of CaO and sulfided sorbent and investigated the effect of regeneration temperature and oxygen concentration on the reactivity of CaO with S0₂. The effluent gases were analyzed by G.C. and the properties of sorbent were characterized by XRD. SEM, TG/DTA and EPMA. Deterioration of reactivity of CaO with S0₂ resulted in increment of emission of SO₁₂ due to the structural changes of CaO above 750°C and that at 850°C was more severe. Furthermore EPMA and XRD analysis revealed that product layer diffusion through the solid product, CaSO₄, was the rate limiting step for CaO sulfidation. The reaction of CaO w:.th SO₂ was first order approximately and that was accelerated by high O₂ concentration.     

Selection of network and learning parameters for an adaptive neural robotic control scheme

This paper presents the results of a study in the design of a neural network based adaptive robotic control scheme. The neural network used here is a two hidden layer feedforward network and the learning scheme is the well-known backpropagation algorithm. The neural network essentially provides the inverse of the plant and acts in conjunction with a standard PD controller in the feedback loop. The objective of the controller is to accurately control the end position of a single link manipulator in the presence of large payload variations, variations in the link length and also variations in the damping constant. Based on results of this study, guidelines are presented in selecting the number of neurons in the hidden layers and also the parameters for the learning scheme used for training the network. Results also indicate that increasing the number of neurons in the hidden layer will improve the convergence speed of learning scheme up to a certain limit beyond which the addition of neurons will cause oscillations and instability. Guidelines for selecting the proper learning rate, momentum and fast backpropagation constant that ensure stability and convergence are presented. Also, a relationship between the r.m.s. error and the number of iterations used in training the neural network is established.     

Biochemical identification of transmembrane segments of the Ca(2+)-ATPase of sarcoplasmic reticulum

The transmembrane segments of sarcoplasmic reticulum Ca(2+)-ATPase were determined by trypsinization of cytoplasmic side-out intact sarcoplasmic reticulum vesicles. The membrane portion of tryptic digest comprising the transmembrane fragments, joined by the intravesicular segments, was separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis after labeling with fluorescein 5-maleimide in the presence of sodium dodecyl sulfate. In this way, seven fluorescent bands of tryptic fragments below 11 kDa were observed which were derived from 4 pairs of membrane spanning segments and one hydrophobic sequence at the C-terminal end. Two peptides of 10.8 and 10.6 kDa had the identical N-terminal sequence beginning at Glu826, representing the transmembrane segments M7 and M8 and their connecting loop. A band at 8.1 kDa contained one peptide beginning at Tyr36 (M1/loop/M2). A 7.7-kDa peptide starting at Leu253 (M3/loop/M4) and a 7.3-kDa peptide beginning at Ala752 (M5/loop/M6) were also observed. A band at 6.7 kDa contained two peptides, one beginning at Ser48 (M1/loop/M2) and another beginning at Tyr763 (M5/loop/M6). In addition, a 4-kDa peptide beginning at Met925 was observed. The size of this peptide did not allow for a complete pair of transmembrane segments, but this peptide could have been derived from trypsinolysis between the last pair of membrane spanning segments. These data therefore provide biochemical evidence for at least 8 transmembrane segments and perhaps two more at the C-terminal end of the enzyme.     

MULTI-PROJECT SCHEDULING WITH EXPLICIT LATENESS COSTS

We propose a heuristic procedure for planning and scheduling multiple projects subject to limited resource availabilities. We depart from previous research in that explicit lateness costs for each project are considered. Our procedure involves aggregate analysis using linear programming to determine target resource loading profiles for each project that optimize trade-offs of lateness costs among projects, followed by detailed multi-project scheduling consistent with the target profiles. Target profiles and detailed schedules are iteratively modified through N iterations, where N is the number of projects. The procedure can be used to jointly schedule previously committed and newly proposed projects, as well as to assign due dates to proposed projects. We compare the performance of our procedure to that of the traditional minimum slack heuristic, as well to a simple extension of the minimum slack rule that accounts for lateness costs. On a set of 60 multi-project test problems adapted from the Patterson set of single-project problems, results are very favorable for our proposed algorithm.