Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting

OBJECTIVES: Reoperative coronary artery bypass grafting presents unique challenges for myocardial preservation. The purpose of this study was to compare oxygenated blood cardioplegia with oxygenated crystalloid cardioplegia during reoperative coronary artery bypass grafting using transesophageal echocardiography to assess regional wall motion of the left ventricle before and after cardiopulmonary bypass. METHODS: Sixty-one patients undergoing reoperative coronary artery bypass grafting were prospectively randomized to receive oxygenated blood cardioplegia or oxygenated crystalloid cardioplegia delivered with a combined antegrade-retrograde technique. Transgastric short axis views of the left ventricle were made with transesophageal echocardiography during the operation before cardiopulmonary bypass and immediately after cardiopulmonary bypass. Regional wall motion was graded by a blinded observer, and before cardiopulmonary bypass scores were compared with after cardiopulmonary bypass scores. RESULTS: No significant differences were found in the change in regional wall motion score from before cardiopulmonary bypass to after cardiopulmonary bypass between the blood and crystalloid cardioplegia groups. CONCLUSIONS: This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting.     

An observation on quartz resonator aging

Aging and acceleration sensitivity of certain fabrication lots of quartz resonators show a trend that may arise from a common predominating mechanism, such as stresses arising from the mounting structure. The presence or absence of such a trend is discussed. As part of the work on bulk-acoustic-wave (BAW) resonators, a database of all known parameters of the resonators in question was assembled. Resonator processing and electrical parameters were examined for correlations with the acceleration sensitivity. A similar effort was being undertaken in regard to resonator aging, and possible correlations between the aging and acceleration sensitivities of the various resonators were examined. The results for two such fabrication lots are shown. The magnitude of the observed aging was typically in the 10(-10) per day range. The identity of the common contributor is unknown at the present time. It is likely that mounting related stresses are the common contributor.     

Thermoelastic coefficients of alpha quartz

Experimental measurements of alpha quartz thermal expansion as reported in the literature have been critically analyzed. A recommended set of best measured values over the temperature range -50 degrees C to +150 degrees C have been determined, as have values for the coefficient of thermal linear expansion (CTE) and the thermoelastic coefficients. The impact of using the coefficients on determinations of quartz material temperature coefficients and on the calculation of temperature coefficients of frequency for the case of the AT-cut is discussed.     

Designing for low acceleration sensitivity

Recent advances in acceleration sensitivity measurement and modeling are discussed, with an emphasis on what these advances indicate in terms of designing for low acceleration sensitivity. The design suggestions are separated into two parts, namely, those that use the crystal resonator as a mechanical vibrator and those that use the crystal oscillator as an electronic circuit. Such topics as symmetry considerations, metallization, mounting etc., in both bulk acoustic wave (BAW) and surface acoustic wave (SAW) devices are discussed for the former, while for the latter the equivalent circuit modeling of crystal resonators and other loop components is addressed.     

Science and technology in the region: The output of regional science and technology, its strengths and its leading institutions

Summary We operationalize scientific output in a region by means of the number of articles (as in the SciSearch database) per year and technology output by means of the number of patent applications (as in the database of the European Patent Office) per priority year. All informetric analyses were done using the DIALOG online-system. The main research questions are the following: Which scientific and technological fields or topics are most influent within a region and which institutions or companies are mainly publishing articles or holding patents? Do the distributions of regional science and technology fields and of publishing institutions follow the well-known informetric function? Are there - as it is expected - only few fields and few institutions which dominate the region? Is there a connection between the economic power of a region and the regional publication and patent output? Examples studied in detail are seven German regions: Aachen, Düsseldorf, Hamburg, Köln (Cologne), Leipzig - Halle - Dessau, München (Munich), and Stuttgart. Three different indicators were used, science and technology attraction of a region (number of scientific articles and patents), science and technology intensity (articles and patents per 1,000 inhabitants), and science and technology density (articles and patents per 1 billion EURO gross value added). Top region concerning both attraction and intensity is Munich, concerning density it is Aachen.     

Transport, chemical and electrochemical processes in a planar solid oxide fuel cell: Detailed three-dimensional modeling

A detailed numerical three-dimensional (3D) model for a planar solid oxide fuel cell (SOFC) is developed in this paper. The 3D model takes into account detailed processes including transport, chemical and electrochemical processes taking place in the cell. Moreover, effects of the composite electrodes are taken into account by considering an electrochemically active layer of finite thickness in each of the electrodes. The developed model is applied to a repeating unit of an anode-supported SOFC working under direct internal reforming conditions. Detailed results for chemical species, temperature, current density and electric potential distribution are presented and discussed. It was found that the temperature distribution across the cell is more uniform in the interconnects than in the inner part of the cell. However, only small differences in the electric potential between the electrode and the corresponding interconnect are found. The current density in the electrodes is found to be high near the electrolyte and low deep into the electrochemically active layer. The current density is also low under the ribs of the interconnects.     

Improved clinical effectiveness with a collagen vascular hemostasis device for shortened immobilization time following diagnostic angiography and percutaneous transluminal coronary angioplasty

This study prospectively compared immobilization time followed by use of a vascular hemostasis device (VasoSeal) versus manual compression to achieve hemostasis at the arterial puncture after angiography and percutaneous transluminal coronary angioplasty (PTCA). The trial shows that use of a vascular hemostasis device results in earlier mobilization, even in highly anticoagulated PTCA patients compared with manual compression, with no statistically significant complications.     

Update on implantable cardioverter-defibrillators. New, safer devices have led to changes in indications

The safety and efficacy of ICDs have improved significantly in the past few years. Recent evidence supports the value of these devices not only for secondary prevention of sudden cardiac death, but also for primary prevention in post-myocardial infarction patients with poor left ventricular function, unsustained ventricular tachycardia, and inducible ventricular tachycardia on electrophysiologic study. Transvenous defibrillation using the defibrillator case as the high-voltage electrode and a biphasic shock is currently the procedure of choice. Implantation is simple, and the defibrillation thresholds are acceptably low. However, the possibility of interactions must be considered in patients with cardiac pacemakers.     

Recurrent unexplained syncope: the role of head-upright tilt table testing

Recurrent episodes of sudden unexplained syncope are a common complaint of patients referred to health care professionals for evaluation. Traditional evaluations are both time consuming and expensive and leave many patients without a diagnosis. Although vasovagally mediated episodes of hypotension and bradycardia have been thought to be a common cause of unexplained syncope, this was traditionally a diagnosis of exclusion. Head-upright tilt table testing has recently emerged as a valuable method for confirming the diagnosis of vasovagal syncope and has allowed a better understanding of this phenomena. This article reviews the pathophysiology of vasovagal syncope, the use of head-upright tilt table testing in its diagnosis, and potential therapies used to prevent recurrences.