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Background: Continuous-flow left ventricular assist devices (LVADs) produces supraphysiologic shear stress that causes von Willebrand factor (VWF) degradation and a bleeding diathesis. Reduction of revolutions per minute (RPM) with axial-flow LVADs does not decrease shear stress enough to reduce VWF degradation and bleeding. However, it is unknown if RPM reduction with centrifugal flow LVADs may minimize VWF degradation. We tested the hypothesis that RPM reduction preserves VWF multimers in the centrifugal-flow EVAHEART left ventricular assist system (LVAS), which is designed to minimize shear stress and blood trauma.Methods: Whole blood samples were collected from humans (n = 28). Blood was circulated in ex vivo mock circulatory loops for 6 hours with an EVAHEART LVAS at 2300 (n = 12), 2100 (n = 8), or 1800 RPM (n = 8). Immunoblotting was used to resolve and quantify VWF multimers and degradation fragments.Results: RPM reduction from 2300 to 2100 to 1800 RPM significantly decreased EVAHEART blood flow from 5.8 ± 0.4 to 4.3 ± 0.6 to 4.1 ± 0.5 L/min (analysis of variance [ANOVA], P = .03). RPM reduction protected VWF from pathologic degradation. At lower RPMs, significantly greater levels of VWF multimers were observed (ANOVA, P = .001). Similarly, at lower RPMs, significantly fewer VWF fragments, a product of VWF degradation, were observed (ANOVA, P = .007).Conclusions: RPM reduction significantly reduced VWF degradation with the centrifugal-flow EVAHEART LVAS, an LVAD specifically designed with low shear stress. Different LVADs have unique hematologic footprints and should be managed with device-specific protocols. Adjustment of RPM to minimize blood trauma while still maintaining physiologic hemodynamics has the potential to decrease complications related to LVAD-associated von Willebrand's disease, such as gastrointestinal bleeding and hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

A large tube may still behave, to a certain extent, as a capillary in a micro-gravity environment. This very basic concept is here applied to a two-phase passive heat transfer device to obtain a new family of hybrid wickless heat pipes. Indeed, a Loop Thermosyphon, which usually consists of a large tube, closed end to end in a loop, evacuated and partially filled with a working fluid and intrinsically gravity assisted, may become a capillary tube in space condition and turn its thermo-fluidic behavior into a Pulsating Heat Pipe. This work presents the results obtained on such a hybrid device heated at 200 W both on board a sounding rocket (ESA REXUS 22, microgravity period ~120 s), and on ground in vertical and anti-gravity orientation. Since no steady state occurred in microgravity conditions, the comparison between flight and ground data focuses on the startup phenomenon, whereas the thorough ground test campaign describes the limits and performances of the device working in thermosyphon mode. The expected thermal behavior in microgravity conditions is between that of a purely conductive tube in anti-gravity conditions on ground and that of a gravity assisted thermosyphon. Since a microgravity period of approximately 120 s is not enough to reach a pseudo steady state regime, further investigation on a longer-term weightless condition is mandatory. [ABSTRACT FROM AUTHOR]

This article describes the development of a high power density Direct Formate Fuel Cell (DFFC) fed with potassium formate (KCOOH). The membrane electrode assembly (MEA) contains no platinum metal. The cathode catalyst is FeCo/C combined with a commercial anion exchange membrane (AEM). To enhance the power output and energy efficiency we have employed a nanostructured Pd/C-CeO2 anode catalyst. The activity for the formate oxidation reaction (FOR) is enhanced when compared to a Pd/C catalyst with the same Pd loading. Fuel cell tests at 60 °C show a peak power density of almost 250 mW cm-2. The discharge energy (14 kJ), faradic efficiency (89%) and energy efficiency (46%) were determined for a single fuel charge (30 mL of 4 M KCOOH and 4 M KOH). Energy analysis demonstrates that removal of the expensive KOH electrolyte is essential for the future development of these devices. To compensate we apply for the first time a polymeric ionomer in the catalyst layer of the anode electrode. A homopolymer is synthesized by the radical polymerization of vinyl benzene chloride followed by amination with 1,4-diazabicyclo[2.2.2]octane (DABCO). The energy delivered, energy efficiency and fuel consumption efficiency of DFFCs fed with 4 M KCOOH are doubled with the use of the ionomer. [ABSTRACT FROM AUTHOR]

Continuous-flow left ventricular assist devices (CF LVADs) are rotary blood pumps that improve mean blood flow, but with potential limitations of non-physiological ventricular volume unloading and diminished vascular pulsatility. In this study, we tested the hypothesis that left ventricular unloading with increasing CF LVAD flow increases myocardial flow normalized to left ventricular work. Healthy ( n = 8) and chronic ischemic heart failure (IHF, n = 7) calves were implanted with CF LVADs. Acute hemodynamics and regional myocardial blood flow were measured during baseline (LVAD off, clamped), partial (2-4 L/min) and full (>4 L/min) LVAD support. IHF calves demonstrated greater reduction of cardiac energy demand with increasing LVAD support compared to healthy calves, as calculated by rate-pressure product. Coronary artery flows ( p < 0.05) and myocardial blood flow (left ventricle (LV) epicardium and myocardium, p < 0.05) decreased with increasing LVAD support in normal calves. In the IHF model, blood flow to the septum, LV, LV epicardium, and LV myocardium increased significantly with increasing LVAD support when normalized to cardiac energy demand ( p < 0.05). In conclusion, myocardial blood flow relative to cardiac demand significantly increased in IHF calves, thereby demonstrating that CF LVAD unloading effectively improves cardiac supply and demand ratio in the setting of ischemic heart failure. [ABSTRACT FROM AUTHOR]

Evidence suggests a major role for von Willebrand factor (vWF) in left ventricular assist device (LVAD)-associated bleeding. However, the mechanisms of vWF degradation during LVAD support are not well understood. We developed: (i) a simple and inexpensive vortexer model; and (ii) a translational LVAD mock circulatory loop to perform preclinical investigations of LVAD-associated vWF degradation. Whole blood was obtained from LVAD patients (n = 8) and normal humans (n = 15). Experimental groups included: (i) blood from continuous-flow LVAD patients (baseline vs. post-LVAD, n = 8); (ii) blood from normal humans (baseline vs. 4 h in vitro laboratory vortexer, ∼ 2400 rpm, shear stress ∼175 dyne/cm2, n = 8); and (iii) blood from normal humans (baseline vs. 12 h HeartMate II mock circulatory loop, 10 000 rpm, n = 7). vWF multimers and degradation fragments were characterized with electrophoresis and immunoblotting. Blood from LVAD patients, blood exposed to in vitro supraphysiologic shear stress, and blood circulated through an LVAD mock circulatory loop demonstrated a similar profile of decreased large vWF multimers and increased vWF degradation fragments. A laboratory vortexer and an LVAD mock circulatory loop reproduced the pathologic degradation of vWF that occurs during LVAD support. Both models are appropriate for preclinical studies of LVAD-associated vWF degradation. [ABSTRACT FROM AUTHOR]

Background Left ventricular assist device (LVAD) thrombosis is a life-threatening complication that remains a major clinical problem. Consensus diagnostic criteria do not exist. We investigated whether hematologic, echocardiographic, or pump parameters reliably change during LVAD thrombosis. Methods A retrospective analysis of 20 consecutive cases of continuous-flow LVAD thrombosis (Thoratec HeartMate II n = 16, HeartWare HVAD n = 4) was performed. Hematologic markers (lactate dehydrogenase, plasma-free hemoglobin, hemoglobin, creatinine), echocardiographic parameters (left ventricular end-systolic and end-diastolic diameter, mitral regurgitation, aortic insufficiency, inflow-cannula velocity), and pump characteristics (speed, power, estimated flow, pulsatility index) were analyzed with one-way repeated measures ANOVA with Tukey post-test or paired Student t-tests. Results Lactate dehydrogenase and plasma-free hemoglobin were significantly (p < 0.05) elevated at admission for LVAD thrombosis. Hemoglobin and creatinine were not significantly different at admission but changed significantly after admission. Left ventricular end-systolic and end-diastolic diameter, mitral regurgitation, aortic insufficiency, inflow-cannula velocity, LVAD speed, power consumption, estimated flow, and pulsatility index were not significantly different at admission for LVAD thrombosis. Conclusion Hematological markers of hemolysis, but not echocardiographic or pump parameters, reliably changed during LVAD thrombosis. Markers of hemolysis are the best early predictors of LVAD thrombosis. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) thrombosis is a life-threatening complication. Multiple case reports describe successful nonsurgical management with thrombolytics, aggressive antiplatelet therapy, or percutaneous catheter-directed thrombectomy. However, consensus management of LVAD thrombosis has not been established and guidelines are urgently needed. In order to raise awareness of nonsurgical treatment options, we review the current strategies for the clinical diagnosis, management, and prevention of LVAD thrombosis. doi: 10.1111/jocs.12238 (J Card Surg 2014;29:83-94) [ABSTRACT FROM AUTHOR]

Ventricular assist devices ( VADs) have emerged as a successful treatment option for advanced heart failure. The objective of this study was to develop a clinically relevant model of chronic ischemic cardiomyopathy to investigate functional, histological, and molecular changes during mechanical circulatory support. In calves ( n = 17, 94 ± 7 kg), 90 μm microspheres were injected percutaneously into the left coronary artery. Serial echocardiography was performed weekly to evaluate cardiac function. Sixty days after coronary microembolization, a terminal study was performed via thoracotomy to measure hemodynamics. Regional myocardial and end-organ blood flows were quantified with 15-μm fluorescent-labeled microspheres. Myocardial fibrosis, myocyte size, and myocardial apoptosis were quantified with histological stains. Eleven animals survived coronary microembolization and exhibited clinical and statistically significant echocardiographic and hemodynamic signs of severe systolic dysfunction. Statistically significant decreases in regional myocardial blood flow and increases in myocardial fibrosis, myocyte size, total myocardial apoptosis, and cardiac myocyte-specific apoptosis were observed. End-organ hypoperfusion was observed. Coronary microembolization induced stable and reproducible chronic left ventricular failure in calves. The anatomical size and physiology of the bovine heart and thorax are appropriate to study novel interventions for the clinical management of heart failure. This model is an appropriate physiological substrate in which to test VAD and adjunctive biological therapies. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) pocket infection is a serious and potentially fatal complication. Not infrequently, the device erodes externally through the thoracoabdominal wall or internally into the peritoneum. In this article, we report two cases to illustrate the presentation and challenges associated with management of LVAD-pocket infection and wound necrosis. Afterward, we review the current therapeutic strategies for LVAD erosion. doi: 10.1111/jocs.12207 (J Card Surg 2013;28:776-782) [ABSTRACT FROM AUTHOR]

A counterpulsation device (Symphony) is being developed to provide long-term circulatory support for advanced heart failure (HF) patients. In acute animal experiments, flow waveform patterns in the aortic, carotid, and coronary arteries were compared during Symphony and intra-aortic balloon pump (IABP) support. Human data were examined for similarities. The 30-mL Symphony was compared to a 40-mL IABP in calves with cardiac dysfunction (80-100 kg, n = 8). Aortic pressures and aortic, carotid, and coronary artery flows were simultaneously recorded at baseline (devices off) and during 1:1 and 1:2 support. Forward, retrograde, and mean flows were calculated and compared for each test condition. Findings were also compared to aortic flow measurements recorded in HF patients ( n = 21) supported by 40-mL IABP. IABP caused significant retrograde flows in the aorta, coronary (IABP: −24 ± 8 mL/min, Symphony: −6 ± 2 mL/min, baseline: −2 ± 1 mL/min, P < 0.05), and carotid arteries (IABP: −30 ± 5 mL/min, Symphony: −0 ± 0 mL/min, baseline: −0 ± 0 L/min, P < 0.05) during ventricular systole compared to the Symphony. IABP support produced higher diastolic pressure and flow augmentation compared to Symphony. Due to retrograde flows during IABP support, Symphony provided higher overall coronary, carotid, and aortic flows. Similar reduction in total aortic flows due to retrograde flow was observed in HF patients during IABP support. Counterpulsation with an IABP via aortic volume displacement produces retrograde flows during rapid balloon deflation that reduces total flow. Counterpulsation with Symphony via volume removal eliminates retrograde flow and improves total flow more than that achieved with IABP. The Symphony may provide long-term hemodynamic benefits in HF patients. [ABSTRACT FROM AUTHOR]

Epidemiologic studies indicate an association between airborne particulate matter and cardiovascular morbidity and mortality. However, the underlying pathophysiologic mechanisms require further investigation. This review examines insights derived from large animal inhalation studies on systemic and coronary hemodynamic function and susceptibility to cardiac arrhythmias. We present evidence of acute cardiovascular alterations in chronically instrumented or anesthetized large animals exposed to concentrated ambient particles. Significant changes were observed in a number of clinically relevant variables. These included elevations in arterial blood pressure and reductions in myocardial perfusion during coronary occlusion that resulted in the exacerbation of ischemic parameters, such as ST-segment elevation and vasoconstriction. The involvement of sympathetic nerve activity was implicated by the fact that alpha-adrenergic blockade with prazosin significantly blunted the vasoconstrictor effects. Alterations in baroreceptor function during air particulate exposure were also substantial. Enhanced susceptibility to both atrial and ventricular arrhythmias was demonstrated. These studies with clinically relevant large animal models underscore the importance of the role of air particulate pollution in inducing adverse effects on cardiovascular function and warrant further exploration of specific components of air pollution as well as the physiologic triggers that lead to cardiovascular events. New clinically applicable research tools have evolved, particularly heart rate turbulence, a noninvasive measure of baroreceptor function, and T-wave alternans, an index of susceptibility to life-threatening arrhythmias, which can be employed clinically to evaluate the impact of air pollution on cardiovascular risk. [ABSTRACT FROM AUTHOR]

Left ventricular assist devices (LVADs) constitute a recent advance in heart failure (HF) therapeutics. As the rigorous experimental assessment of LVADs in HF requires large animal models, our objective was to develop a bovine model of cardiomyopathy. Male calves (n = 8) were used. Four animals received 1.2 mg/kg intravenous doxorubicin weekly for seven weeks and four separate animals were studied as controls. Doxorubicin-treated animals were followed with weekly echocardiography. Target LV dysfunction was defined as an ejection fraction ≤35%. Sixty days after initiating doxorubicin, a terminal study was performed to determine hemodynamic, histological, biochemical, and molecular parameters. All four doxorubicin-treated animals exhibited significant (P < 0.05) contractile dysfunction, with target LV dysfunction achieved in three animals. Doxorubicin-treated hearts exhibited significantly reduced coronary blood flow and interstitial fibrosis and significantly increased apoptosis and myocyte size. Gene expression of atrial natriuretic factor increased more than 3-fold. Plasma norepinephrine and epinephrine levels were significantly increased early and late during the development of cardiomyopathy, respectively. We conclude that sequential administration of intravenous doxorubicin in calves induces a cardiomyopathy with many phenotypic hallmarks of the failing human heart. This clinically-relevant model may be useful for testing pathophysiologic responses to LVADs in the context of HF. [ABSTRACT FROM AUTHOR]

Medical devices implanted in subcutaneous tissue elicit wound-healing events that encapsulate the device. To investigate the foreign-body response to devices of clinically relevant size, we studied the relationship between capsule thickness, vascular density, and blood flow within the capsule. In nine canines, we implanted 40 subcutaneous devices (polysulfone n = 14, titanium n = 17, silicone-coated n = 9). Devices and surrounding tissue structures were harvested at 208 ± 142 (mean ± standard deviation) days after implantation. Tissues were processed for histological analysis with light microscopy. Foreign-body capsule (FBC) thickness and vascular density were determined. A subset of five animals was instrumented via thoracotomy for microsphere injections and reference blood sampling. In these animals, regional blood flow was determined in mL/min/g of tissue in the FBC to examine the relationship between capsule thickness and blood flow. One-way analysis of variance and linear regression analyses were performed. The FBC thickness was 0.92 ± 0.67 mm for all devices studied and was not influenced by device material. Capsule thickness correlated with vascular density for all devices ( R = 0.85, P < 0.0001) and for each device material (polysulfone R = 0.85, P < 0.0001; silicone R = 0.95, P < 0.0001; titanium R = 0.87, P < 0.0001). Capsule thickness correlated modestly with blood flow for all devices studied ( R = 0.59, P < 0.0001) and for each device material (polysulfone R = 0.77, P < 0.001; silicone R = 0.65, P = 0.10; titanium R = 0.52, P = 0.03). Capsule thickness, vascular density, and blood flow were similar within individual animals but variable across animals. Material type did not influence the thickness of FBCs surrounding devices of clinically relevant size. Capsule thickness correlated strongly with vascular density and modestly with blood flow within the capsule. Individual animals exhibited variable foreign-body responses. [ABSTRACT FROM AUTHOR]

The miniaturization of mechanical assist devices and less invasive implantation techniques may lead to earlier intervention in patients with heart failure. As such, we evaluated the effectiveness of a novel, minimally invasive, implantable counterpulsation device (CPD) in augmenting cardiac function during impaired hemodynamics. We compared the efficacy of a 32-mL stroke volume CPD with a standard 40-mL intra-aortic balloon pump (IABP) over a range of clinically relevant pathophysiological conditions. Male calves were instrumented via thoracotomy, the CPD was anastomosed to the left carotid artery, and the IABP was positioned in the descending aorta. Hemodynamic conditions of hypertension, hypotension, and heart failure were pharmacologically simulated and data were recorded during CPD and IABP support (off, 1:2, 1:1 modes) for each condition. In all three pathophysiological conditions, the CPD and IABP produced similar and statistically significant ( P < 0.05) increases in coronary artery blood flow normalized to the left ventricular (LV) workload. During hypotension and heart failure conditions, however, the CPD produced significantly greater reductions in LV workload and myocardial oxygen consumption as compared with the IABP. A novel 32-mL CPD connected to a peripheral artery produced equivalent or greater hemodynamic benefits than a standard 40-mL IABP during pharmacologically induced hypertension, hypotension, and heart failure conditions. [ABSTRACT FROM AUTHOR]

Objective: In this article, the presentation, pathophysiology, diagnosis, treatment, and complications of lipomas of the hand are reviewed and evaluated. Methods: A thorough review of the literature is completed, and a series of 13 patients are summarized and briefly examined. Results: Lipomas may present as asymptomatic tumors or produce concerning signs and symptoms such as muscular atrophy and paralysis. Some lipomas may be identified by physical examination alone. However, magnetic resonance imaging best facilitates definitive diagnosis. Conclusions: In the absence of mechanical impairment or cosmetic concern, observation remains the clinical standard of care. When pain, compression neuropathy, disfigurement, or decreased function affect the patient, surgical resection is typically curative. Malignant transformation rarely occurs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epidemiologic studies suggest a positive association between fine particulate matter and arterial blood pressure, but the results have been inconsistent. OBJECTIVES: We investigated the effect of ambient particles on systemic hemodynamics during a 5-hr exposure to concentrated ambient air particles (CAPs) or filtered air (FA) in conscious canines. METHODS: Thirteen dogs were repeatedly exposed via permanent tracheostomy to CAPs (358.1 ± 306.7 µg/m3, mean ± SD) or FA in a crossover protocol (55 CAPs days, 63 FA days). Femoral artery blood pressure was monitored continuously via implanted telemetry devices. We measured baroreceptor reflex sensitivity before and after exposure in a subset of these experiments (n = 10 dogs, 19 CAPs days, 20 FA days). In additional experiments, we administered α-adrenergic blockade before exposure (n = 8 dogs, 16 CAPs days, 15 FA days). Blood pressure, heart rate, rate--pressure product, and baroreceptor reflex sensitivity responses were compared using linear mixed-effects models. RESULTS: CAPs exposure increased systolic blood pressure (2.7 ± 1.0 mmHg, p = 0.006), diastolic blood pressure (4.1 ± 0.8 mmHg; p < 0.001), mean arterial pressure (3.7 ± 0.8 mmHg; p < 0.001) heart rate (1.6 ± 0.5 bpm; p < 0.001) and rate--pressure product (539 ± 110 bpm × mmHg; p < 0.001) and decreased pulse pressure (--1.7 ± 0.7 mmHg, p = 0.02). These changes were accompanied by a 20 ± 6 msec/mmHg (p = 0.005) increase in baroreceptor reflex sensitivity after CAPs versus FA. After α-adrenergic blockade, responses to CAPs and FA no longer differed significantly. CONCLUSIONS: Controlled exposure to ambient particles elevates arterial blood pressure. Increased peripheral vascular resistance may mediate these changes, whereas increased baroreceptor reflex sensitivity may compensate for particle-induced alterations in blood pressure. [ABSTRACT FROM AUTHOR]

BACKGROUND: Experimental and observational studies have demonstrated that short-term exposure to ambient particulate matter (PM) exacerbates myocardial ischemia. OBJECTIVES: We conducted this study to investigate the effects of concentrated ambient particles (CAPs) on myocardial blood flow during myocardial ischemia in chronically instrumented conscious canines. METHODS: Eleven canines were instrumented with a balloon occluder around the left anterior descending coronary artery and catheters for determination of myocardial blood flow using fluorescent microspheres. Telemetric electrocardiographic and blood pressure monitoring was available for four of these animals. After recovery, we exposed animals by inhalation to 5 hr of either filtered air or CAPs (mean concentration ± SD, 349.0 ± 282.6 µg/m3) in a crossover protocol. We determined myocardial blood flow during a 5-min coronary artery occlusion immediately after each exposure. Data were analyzed using mixed models for repeated measures. The primary analysis was based on four canines that completed the protocol. RESULTS: CAPs exposure decreased total myocardial blood flow during coronary artery occlusion by 0.12 mL/min/g (p < 0.001) and was accompanied by a 13% (p < 0.001) increase in coronary vascular resistance. Rate--pressure product, an index of myocardial oxygen demand, did not differ by exposure (p = 0.90). CAPs effects on myocardial blood flow were significantly more pronounced in myocardium within or near the ischemic zone versus more remote myocardium (p interaction < 0.001). CONCLUSIONS: These results suggest that PM exacerbates myocardial ischemia by increased coronary vascular resistance and decreased myocardial perfusion. Further studies are needed to elucidate the mechanism of these effects. [ABSTRACT FROM AUTHOR]

Introduction: Extensive in vitro studies and clinical evidence (MERLIN trial) indicate an antiarrhythmic potential of ranolazine, a novel antianginal agent. Programmed electrophysiologic testing was performed to quantify ranolazine's effects on ventricular vulnerability and defibrillation thresholds and to gain insights into mechanisms. Methods and Results: Effects of ranolazine (9.2 ± 2.1 μM, plasma level) on surface ECG, right ventricular effective refractory period (ERP), and repetitive extrasystole (RE), ventricular fibrillation (VF), and defibrillation (DFT) thresholds were determined in 29 normal closed-chest anesthetized pigs. The single extrastimulus method was employed for ERP and for RE and VF thresholds. DFT50 was determined using an up-down testing protocol with an implantable cardioverter-defibrillator. Ranolazine increased rate-corrected QT interval from 490 ± 30 to 527 ± 24 ms (P < 0.05) but did not alter Tpeak-Tend interval (59 ± 8 to 62 ± 11, P = 0.65). ERP increased by 40 ± 6 ms (P < 0.001). Compared with baseline, ranolazine raised RE threshold from 20 ± 6 to 34 ± 9 mA (P < 0.001) and VF threshold from 38 ± 4 to 48 ± 10 mA (P < 0.05). DFT50 was unchanged (baseline: 14 ± 2 J; ranolazine: 14 ± 2 J; P = 0.6), whereas diastolic pacing threshold increased from baseline pulse width of 0.07 ± 0.03 to 0.17 ± 0.07 ms (P < 0.01) with 1V pulse amplitude. Conclusions: Ranolazine, at therapeutic concentrations, produces a mild increase in QT interval and a marked increase in both RE and VF thresholds. Thus, ranolazine does not augment and may improve dispersion of ventricular repolarization, suggesting a potential antiarrhythmic action. Ranolazine is unlikely to affect the margin of safety of defibrillation, given no significant effect on DFT, but could result in a mild increase in pacing threshold. [ABSTRACT FROM AUTHOR]

Introduction For chronic, repeated cardiovascular studies in trained, conscious dogs, we describe a technique for implantation of an arterial vascular access catheter in the aorta. In comparison to previous techniques, our technique enables arterial catheter implantation without interrupting the systemic circulation or compromising peripheral arterial flow, requires only a single penetration of the aortic wall, and results in a catheter facing downstream in the aorta. The catheter is usable for both arterial blood sampling and intra-arterial injection of pharmacologic agents.Methods After thoracotomy, two purse-string sutures were set in the aortic wall at the catheter entry-site. A Debakey–Satinsky vena cava clamp was used to partially clamp and isolate a 3-cm portion of aorta surrounding the pursestring sutures. The catheter was prepared by inserting a 0.35 mm guide wire, curve tip end first, into a 7 French silicone Access Technologies catheter. This caused a slight bend at the tip of the catheter, which later facilitated entry into the aorta and prevented damage to the intima of the aortic wall. Catheters were tunneled from the thorax to the nape of the neck, attached to a subcutaneous vascular access port (VAP), and buried in the fascia. Catheters were locked with 2 mL heparinized saline (20 IU/mL). With this technique, we implanted 16 aortic vascular access catheters in 16 dogs.Results Of the 16 animals, 8 are being maintained for long-term study, 7 were sacrificed for histopathological examination, and 1 died due to improper catheter implantation without the aid of the curved-tip guide-wire technique. VAPs have remained bidirectionally patent in all long-term animals (n = 8) ongoing for 7.5 ± 1.4 months (mean ± SEM), with an ongoing maximum of 14 months. In these long-term animals, VAPs were used 5.88 ± 1.34 times. Postmortem examinations were performed on short-term animals (n = 8) sacrificed at 2.85 ± 1.29 months. The catheters have remained bidirectionally patent in all but the one animal that died. In the short-term animals, the 7 patent VAPs were used 12.71 ± 1.64 times. Histopathological examination of hematoxylin and eosin (H&E) slides from the catheter entry site revealed only minimal chronic inflammation. No evidence of tissue overgrowth around any of the intravascular segments of these silicone catheters was noted in any animal.Conclusions Thus, this dependable subcutaneous arterial access system provides a means for examining acute and long-term effects of environmental and pathophysiological influences in conscious dogs. These catheters have remained bidirectionally patent ongoing for more than 1 year and allowed infusion of agents and withdrawal of central arterial blood samples. [ABSTRACT FROM AUTHOR]

The paper provides results from a hardware-in-the-loop experimental campaign on the operation of an air-source heat pump (HP) for heating a reference dwelling in Pisa, Italy. The system performances suffer from typical oversizing of heat emission devices and high water-supply temperature, resulting in HP inefficiencies, frequent on-off cycles, and relevant thermal losses on the hydronic loop. An experimentally validated HP model under different supply temperatures and part-load conditions is used to simulate the installation of a thermal storage between heat generator and emitters, in both series and parallel arrangements. Results relative to a typical residential apartment show that the presence of the thermal storage in series configuration ensures smoother heat pump operation and energy performance improvement. The number of daily on-off cycles can be reduced from 40 to 10, also saving one-third of electric energy with the same building loads. Preliminary guidelines are proposed for correctly sizing the tank in relation to the HP capacity and the average daily heating load of the building. A storage volume of about 70 L for each kilowatt of nominal heating capacity is suggested. [ABSTRACT FROM AUTHOR]

The paper provides a methodology for the optimal control of heating, ventilation, and air conditioning (HVAC) systems used in public buildings, with the purpose of obtaining high comfort and safety standards along with energy efficiency. The combination of the two concurrent objectives of minimizing energy use and guaranteeing high standards of occupant comfort is obtained by means of multi-objective optimization, in which a comfort model is combined along with a dynamic energy model of the building. The use of dynamic setpoints for the HVAC and the inclusion of comfort indicators represent a step forward, compared to the current design and operation procedures suggested by technical standards. The utilization of the proposed methodology is tested with reference to a case study, represented by an academic building used by the University of Pisa for educational purposes, whose extensive and variable occupancy can help to emphasize the importance of comfort in the operation of HVAC systems in different climatic conditions and with different occupancy profiles. We show how this optimization brings interesting results in terms of energy-saving (up to 30%), obtaining an increased comfort level (of more than 25%) compared to the operating conditions suggested by technical standards. [ABSTRACT FROM AUTHOR]

Worldwide increasing awareness of energy sustainability issues has been the main driver in developing the concepts of (Nearly) Zero Energy Buildings, where the reduced energy consumptions are (nearly) fully covered by power locally generated by renewable sources. At the same time, recent advances in Internet of Things technologies are among the main enablers of Smart Homes and Buildings. The transition of conventional buildings into active environments that process, elaborate and react to online measured environmental quantities is being accelerated by the aspects related to COVID-19, most notably in terms of air exchange and the monitoring of the density of occupants. In this paper, we address the problem of maximizing the energy efficiency and comfort perceived by occupants, defined in terms of thermal comfort, visual comfort and air quality. The case study of the University of Pisa is considered as a practical example to show preliminary results of the aggregation of environmental data. [ABSTRACT FROM AUTHOR]

Heparins are useful for the protection of residual renal function in several nephropathies, but the anticoagulant action and the need of parenteral administration are two main drawbacks limiting their use in chronic renal failure patients. Heparan sulphate (HS) is a heparin-like mucopolysaccharide devoid of anticoagulant action and active orally. In this study, the effects of HS oral administration have been evaluated in 18 subtotally nephrectomized rats;18 untreated remnant kidney rats served as control. No mortality was observed in the HS-treated rats, whereas in the control rats the survival rate was 72.2% at 18 weeks. At the end of the study, HS-treated rats showed lower urinary protein excretion (44 ± 22 vs. 80 ± 54 mg/24 h , p < 0.01), lower urea plasma levels (75 ± 34 vs. 134 ± 105 mg/dl, p < 0.01) and higher creatinine clearance (66 ± 15 vs. 47 ± 21 ml/min · 10[sup 2] , p < 0.05) than control rats. Remnant kidney weight (2.3 ± 1.1 vs. 1.3 ± 0.2 g, p < 0.01) and heart weight (1.3 ± 0.2 vs. 1.1 ± 0.1 g, p < 0.05) were greater in the control than in the HS-treated rats, as well as the systemic blood pressure values (167 ± 19 vs. 115 ± 32 mm Hg, respectively, p < 0.001).The remnant kidney histological examination in the HS-treated rats showed a lower prevalence of glomerular sclerosis, mesangial proliferation, and a much less evident tubulointerstitial damage than in controls. The antiproliferative and anti-inflammatory actions of HS together with its protective action on the endothelium are the putative mechanisms that could account for our findings.In conclusion, the present study supports evidence of an antiproteinuric and a renoprotective effect of orally administered HS in subtotally nephrectomized rats. This is in keeping with the well-known effects exerted also by other heparins, but the effectiveness of an orally available heparin-like product in this animal model could suggest the possibility of a clinical use also in progressing chronic renal failure patients. [ABSTRACT FROM AUTHOR]

We describe a 36-year-old male with a HeartWare LVAD and a Medtronic Virtuoso DR pacemaker in whom increased intrathoracic impedance preceded suction events, low LVAD flows, symptoms of a heart failure exacerbation, and hospitalization. Measurement of intrathoracic impedance may identify fluid shifts prior to symptoms and predict adverse events in patients with an LVAD. doi: 10.1111/jocs.12191 (J Card Surg 2013;28:616-618) [ABSTRACT FROM AUTHOR]

A response by Carlo R. Bartoli and colleagues to a letter to the editor about their article "A Novel Subcutaneous Counterpulsation Device: Acute Hemodynamic Efficacy During Pharmacologically Induced Hypertension, Hypotension, and Heart Failure," in the 2010 issue is presented.

Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40–65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1–5 mm3) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% ( p < 0.0001), left common carotid artery by 79.8% ( p < 0.0001), and left subclavian artery by 89.7% ( p < 0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. [ABSTRACT FROM AUTHOR]

Estimating and optimizing the dynamic performance of a heat pump system coupled to a building is a paramount yet complex task, especially under intermittent conditions. This paper presents the "hardware-in-the-loop" experimental campaign of an air-source heat pump serving a typical dwelling in Pisa (Italy). The experimental apparatus uses real pieces of equipment, together with a thermal load emulator controlled by a full energy dynamic simulation of the considered building. Real weather data are continuously collected and used to run the simulation. The experimental campaign was performed from November 2019 to February 2020, measuring the system performances under real climate and load dynamics. With a water set point equal to 40 °C, the average heat pump coefficient of performance was about 3, while the overall building-plant performance was around 2. The deviation between the two performance indexes can be ascribed to the continuous on-off signals given by the zone thermostat due to the oversized capacity of the heat emission system. The overall performance raised to 2.5 thanks to a smoother operation obtained with reduced supply temperature (35 °C) and fan coil speed. The paper demonstrates the relevance of a dynamic analysis of the building-HVAC system and the potential of the "hardware-in-the-loop" approach in assessing actual part-load heat pump performances with respect to the standard stationary methodology. [ABSTRACT FROM AUTHOR]

Left ventricular assist devices (LVADs) constitute a recent advance in heart failure (HF) therapeutics. As the rigorous experimental assessment of LVADs in HF requires large animal models, our objective was to develop a bovine model of cardiomyopathy. Male calves (n = 8) were used. Four animals received 1.2 mg/kg intravenous doxorubicin weekly for seven weeks and four separate animals were studied as controls. Doxorubicin-treated animals were followed with weekly echocardiography. Target LV dysfunction was defined as an ejection fraction <= 35%. Sixty days after initiating doxorubicin, a terminal study was performed to determine hemodynamic, histological, biochemical, and molecular parameters. All four doxorubicin-treated animals exhibited significant (P < 0.05) contractile dysfunction, with target LV dysfunction achieved in three animals. Doxorubicin-treated hearts exhibited significantly reduced coronary blood flow and interstitial fibrosis and significantly increased apoptosis and myocyte size. Gene expression of atrial natriuretic factor increased more than 3-fold. Plasma norepinephrine and epinephrine levels were significantly increased early and late during the development of cardiomyopathy, respectively. We conclude that sequential administration of intravenous doxorubicin in calves induces a cardiomyopathy with many phenotypic hallmarks of the failing human heart. This clinically-relevant model may be useful for testing pathophysiologic responses to LVADs in the context of HF. [ABSTRACT FROM AUTHOR]