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BACKGROUND Our research team obtained a human heart with the right lung attached from a recent transplantation patient via a research collaboration with LifeSource, a local organ procurement organization. The heart and lungs were not viable for transplant given the patient's medical history and were subsequently offered to the University of Minnesota for research purposes. METHODS Using Visible Heart® methodologies, we reanimated the specimen en bloc and collected multimodal direct visualization from inside the cardiac chambers and great vessels of the functioning heart. RESULTS Video footage, using videoscopic and fluoroscopic imaging, was captured and is presented in this report as supporting material. Multiple still images highlight the surgical suture sites of the transplantation procedures. CONCLUSIONS This multimodal imaging offers unique educational value for medical students, clinicians, and medical device designers for improving transplantation techniques and patient outcomes.

1p36 deletion is the most common terminal deletion syndrome in humans. Herein, we report two cases, a 5-month-old female and a 14.5-year-old female, both with 1p36 deletion and left ventricular non-compaction cardiomyopathy. They presented with severely depressed left ventricle function and underwent heart transplantation with excellent outcomes. Given the incidence of heart defects and cardiomyopathy in 1p36 deletion syndrome, it should be recommended that children with this genetic condition have screening for cardiac disease. These cases add to the current literature by demonstrating the potential therapeutic options for non-compaction in 1p36 deletion syndrome and showed the favorable outcomes.

Online well-being interventions demonstrate great promise in terms of both engagement and outcomes. Fun For Wellness (FFW) is a novel online intervention grounded in self-efficacy theory and intended to improve multidimensional well-being and physical activity through multi-modal methods. These strategies include capability-enhancing opportunities, learning experiences such as games, video vignettes, and self-assessments. RCT studies have suggested that FFW is efficacious in improving subjective and domain-specific well-being, and effective in improving mental health, physical health, physical activity, and self-efficacy in United States. adults who are overweight and in the general population. The present study uses qualitative and quantitative user experience data collected during two RCT trials to understand and evaluate engagement with FFW, its drivers, and its outcomes. Results suggest that FFW is enjoyable, moderately engaging, and easy to use; and contributes to positive outcomes including skill development and enhanced confidence, for both overweight individuals and the general adult population. Drivers of engagement appear to include rewards, gamification, scenario-based learning, visual tracking for self-monitoring, ease of use and simple communications, and the entertaining, interactive nature of program activities. Findings indicate that there are opportunities to streamline and simplify the experience. These results can help improve FFW and contribute to the science of engagement with online interventions designed to improve well-being.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

Background Fun For Wellness (FFW) is an online behavioral intervention designed to promote growth in well-being and physical activity by providing capability-enhancing learning opportunities to participants. The conceptual framework for the FFW intervention is guided by self-efficacy theory. Evidence has been provided for the efficacy of FFW to promote self-reported free-living physical well-being actions in adults who comply with the intervention. The objective of this manuscript is to describe the protocol for a feasibility study designed to address uncertainties regarding the inclusion of accelerometer-based assessment of free-living physical activity within the FFW online intervention among adults with obesity in the United States of America (USA). Method The study design is a prospective, double-blind, parallel group randomized pilot trial. Thirty participants will be randomly assigned to the FFW or usual care (UC) group to achieve a 1:1 group (i.e., FFW:UC) assignment. Recruitment of participants is scheduled to begin on 29 April 2019 at a local bariatric services center within a major healthcare organization in the Midwest of the USA. There are five eligibility criteria for participation in this study: (1) between 18 and 64 years old, (2) a body mass index ≥ 25.00 kg/m2, (3) ability to access the online intervention, (4) the absence of simultaneous enrollment in another intervention program promoting physical activity, and (5) willingness to comply with instructions for physical activity monitoring. Eligibility verification and data collection will be conducted online. Three waves of data will be collected over a 13-week period. Instruments designed to measure demographic information, anthropometric characteristics, acceptability and feasibility of accelerometer-based assessment of physical activity, self-efficacy, and well-being will be included in the study. Data will be analyzed using descriptive statistics (e.g., recruitment rates), Pearson’s correlation coefficient, Bland-Altman analyses, and inferential statistical models under both an intent to treat approach and a complier average causal effect approach. Discussion Results are intended to inform the preparation of a future definitive randomized controlled trial. Trial registration ClinicalTrials.gov, NCT03906942, registered 8 April 2019. Trial funding The Erwin and Barbara Mautner Charitable Foundation and the Michigan State University College of Education. Electronic supplementary material The online version of this article (10.1186/s40814-019-0455-0) contains supplementary material, which is available to authorized users.

Coronary artery disease is a major cause of mortality worldwide. Plaque buildup within an individual’s coronary arteries can lead reduced flows, local ischemia, angina, and even result in a myocardial infarction (heart attack). In the past two decades, coronary stents have become one of the ‘gold standards’ for treating such plaque buildups. Stents are designed to push the plaque up against the vessel walls, so to expand the vessels to its original dimensions; ie., keeping the lumen patent allowing for laminar blood flow. Using the Visible Heart® Laboratories (1) capabilities, we have implanted coronary stents using various clinical protocols in porcine hearts. These hearts were subsequently scanned with a micro-CT, so they could be modeled and rendered in various 3D programs as well as fluid simulations. The ability to render fluid simulations through coronaries which had stenting procedures performed within, may allow clinicians to prescribe which bifurcation technique may be best suited for a given patient’s specific anatomy.

The use of computational modeling and 3D printing to assist in the procedural planning process for the correction of complex congenital heart malformations is becoming the standard of care. However, the use of this technology in planning the placement of ventricular support devices in pediatric patients with non-compaction has been significantly less common. We present the use of a series of models to help guide the sizing and positioning of both the inflow and outflow cannulae in a patient with left ventricular failure as an example of how these technologies can help improve patient outcomes and reduce procedural times.

As the prevalence of mitral and tricuspid valvular disease continues to grow with the aging population [1,2], there is a growing critical need to treat high mortality risk patients using minimally invasive and/or non-surgical percutaneous procedures. However, these transcatheter procedures, especially those aimed at repairing or replacing the mitral and tricuspid valves, are mostly still in development and/or early clinical testing. Catheter delivery, prosthesis fixation, and/or demonstrating device efficacy are major challenges currently being addressed [3,4]. Although in situ animal models can assess catheter systems with clinical imaging, direct visualization of tissue-device interactions in real human heart anatomies are desired. In vitro delivery and implantations of valvular prototypes in human heart specimens can be instrumental for accurate device testing and gaining important design insights. Such investigations can be performed on a pulsatile flow apparatus, utilizing perfusion fixed human hearts with mitral and/or tricuspid valves eliciting coaptation and relative function. The employment of endoscopic cameras provides direct visualization and can be coupled with echocardiography, providing novel insights relative to these transcatheter devices in a dynamic environment. However, these investigative approaches require appropriately fixed human heart specimens that will allow for dynamic valve movement. This study discusses the design, construction, and implementation of a novel fixation apparatus to promote the coaptation of the mitral and tricuspid valves in swine and fresh human heart specimen.

Cardiothoracic transplantation research dates back to the late 1800s, yet the first human heart transplantation did not occur until 1967. Today, more and more centers worldwide are performing such procedures with increasing success, long-term survival rates, and, importantly, with an improved quality of life for recipients. Much work remains to increase the number of available hearts and lungs for these transplants, but progress is being made for many reasons that are discussed in this chapter. The use of ex vivo lung and heart perfusion technologies along with pharmacological advancements (e.g., preservation solutions) has expanded the time available between organ recovery and transplantation, allowing for enhanced functional assessment and providing a platform for therapeutic delivery. In this chapter, we provide a brief history of cardiothoracic transplantation, review the current state of transplantation procedures, and discuss future directions for research and technological advancements.

Transcatheter replacement therapies for the atrioventricular (AV) valves are considered as the next frontier for the treatment of valvular regurgitation. The AV valves, tricuspid and mitral, are the regulators of blood flow from the atria into the ventricles. During diastole, blood flows through the open tricuspid and mitral valves to fill the right and left ventricles, respectively. During systole, the ventricles contract, closing the AV valves, and forcing the blood to exit through their respective ventricular outflow tracts (VOTs) to the arterial circulations. Although the current gold standard for the treatment of valvular regurgitation is surgical replacement or repair, the field of transcatheter therapies is rapidly expanding as new treatment options for patients; especially for those individuals considered to be at greater risks for surgical complications. Market released bioprosthetic devices for replacing the aortic and pulmonary valves have shown great promise and success. However, the advancement of similar therapies for either the mitral and tricuspid valves remain in the early stages of development. This slower progress is attributed to the high complexities and variabilities of the AV valves, which present challenges for both device design and post-implantation functions.

BackgroundInsufficient physical activity in the adult population is a global pandemic. Fun for Wellness (FFW) is a self-efficacy theory- and Web-based behavioral intervention developed to promote growth in well-being and physical activity by providing capability-enhancing opportunities to participants.ObjectiveThis study aimed to evaluate the effectiveness of FFW to increase physical activity in adults with obesity in the United States in a relatively uncontrolled setting.MethodsThis was a large-scale, prospective, double-blind, parallel-group randomized controlled trial. Participants were recruited through an online panel recruitment company. Adults with overweight were also eligible to participate, consistent with many physical activity–promoting interventions for adults with obesity. Also consistent with much of the relevant literature the intended population as simply adults with obesity. Eligible participants were randomly assigned to the intervention (ie, FFW) or the usual care (ie, UC) group via software code that was written to accomplish equal allocations to the FFW and UC groups. Data collection was Web based, fully automated, and occurred at three time points: baseline, 30 days after baseline (T2), and 60 days after baseline (T3). Participants (N=461) who were assigned to the FFW group (nFFW=219) were provided with 30 days of 24-hour access to the Web-based intervention. A path model was fit to the data consistent with the FFW conceptual model for the promotion of physical activity.ResultsThere was evidence for a positive direct effect of FFW on transport-related physical activity self-efficacy (beta=.22, P=.02; d=0.23), domestic-related physical activity self-efficacy (beta=.22, P=.03; d=0.22), and self-efficacy to regulate physical activity (beta=.16, P=.01; d=0.25) at T2. Furthermore, there was evidence for a positive indirect effect of FFW on physical activity at T3 through self-efficacy to regulate physical activity at T2 (beta=.42, 95% CI 0.06 to 1.14). Finally, there was evidence for a null direct effect of FFW on physical activity (beta=1.04, P=.47; d=0.07) at T3.ConclusionsThis study provides some initial evidence for both the effectiveness (eg, a positive indirect effect of FFW on physical activity through self-efficacy to regulate physical activity) and the ineffectiveness (eg, a null direct effect of FFW on physical activity) of the FFW Web-based behavioral intervention to increase physical activity in adults with obesity in the United States. More broadly, FFW is a scalable Web-based behavioral intervention that may effectively, although indirectly, promote physical activity in adults with obesity and therefore may be useful in responding to the global pandemic of insufficient physical activity in this at-risk population. Self-efficacy to regulate physical activity appears to be a mechanism by which FFW may indirectly promote physical activity in adults with obesity.Trial RegistrationClinicalTrials.gov, identifier: NCT03194854; https://clinicaltrials.gov/ct2/show/NCT03194854.

Purpose Improved utilization of donor hearts would benefit chronic heart failure patients awaiting transplant. Limitations to cardiac allograft preservation include ischemic time, donor organ quality, and accurate graft assessment. We hypothesized that human hearts declined for transplant may be resuscitated after varied ischemic times. The unique studies performed within the Visible Heart® Laboratory for over two decades have provided unique insights relative to optimizing large mammalian functions post-cardioplegia. Methods Human hearts declined for transplant were utilized for research at the Visible Heart® Laboratory in coordination with the local organ procurement organization. Donor hearts were procured in standard fashion using 2L cardioplegia solution, and storage on ice. Hearts were delivered within 4-10 hours and cannulated for perfusion in Langendorf, right-sided, or 4-chamber working modes. Next, hearts were perfused with a warmed, oxygenated Kreb-Henseleit perfusate. These hearts were deemed non-viable for transplant for a variety of factors. Hemodynamic parameters, functional endoscopic videos, and electrocardiographic parameters have been recorded. All hearts were perfusion-fixed in formaldehyde and preserved in the Visible Heart® Library. Results Eighty-three human hearts declined for transplant were reanimated on the Visible Heart® Apparatus: varied hemodynamic functions were recorded. Average donor age was 57 years (7 to 91 yrs). Fifty percent (50%) of donors were female. Average cold ischemic time was 402 minutes (126-678 minutes). All hearts achieved pulsatile perfusion, and evidence of EKG rhythm. Conclusion This work demonstrates the unique capabilities of the Visible Heart® Laboratory: the abilities to reanimate human hearts and investigate relative electrophysioligical and hemodynamic behaviors has utility for determining if some human hearts declined for transplant were in fact viable, or could benefit from post-conditoning. Hence, this work provides encouragement for expanding the utilization of donor hearts available for transplant. Future work will focus on improved preservation techniques (i.e., various cardioplegia agents, warm perfusion vs cold storage), novel pharmacologic pre- and post-conditioning agents, and improved assessment of donor hearts during preservation.

A thorough understanding of valvar anatomy is essential for design engineers and clinicians in the development and/or employment of improved technologies or therapies for treating valvar pathologies. There are two arterial valves in the human heart--pulmonary and aortic valves. Both are complex structures whose normal anatomical components can vary greatly between individuals. We discuss the anatomy, pathology, and challenges relating to transcatheter and surgical repair/replacement of the arterial valves in a translational manner. The high prevalence of aortic valvar pathologies in the burgeoning elderly population, coupled with poor clinical outcomes for patients who go untreated, has resulted in prolific spending in the research and development of more effective and less traumatic therapies. The accelerated development of therapies for treating arterial valves has been guided by anatomical information gathered from high-resolution imaging technologies, which have focused attention on the need for complete understanding of arterial valvar clinical anatomies. This article is part of a JCTR special issue on Cardiac Anatomy.

Objectives To determine the accuracy of calcium-containing rings measurements imaged by three-dimensional echocardiography (3DE), multi-slice CT (MSCT) and cardiac magnetic resonance (CMR) under ideal conditions against the true ring dimensions. To compare the accuracy of aortic annulus (AoA) measurements in ex vivo human hearts using 3DE, MSCT and CMR. To determine the accuracy of AoA measurements in an in vivo human model. Design 3DE, MSCT and CMR imaging were performed on 30 calcium-containing rings and 28 explanted human hearts. Additionally, 15 human subjects with clinical indication for MSCT underwent 3DE. Two experts in each modality measured the images. Main outcome measures Bias and intraclass correlation coefficient for accuracy of imaging measurements when compared with actual ring dimensions. Bias, intraclass correlation coefficient and variability were obtained: (1) when comparing explanted human heart AoA measurements from the two remaining imaging modalities with the most accurate one as determined from the ring measurements and (2) in in vivo human AoA measurements. Analysis was repeated on explanted heart subgroups divided by aortic valve Agatston score. Results Against the known ring dimensions, CMR had the highest accuracy and the lowest variability. MSCT measurements had high accuracy but wider variability and 3DE had the lowest accuracy with the largest variability. When 3DE and MSCT were compared with CMR, 3DE underestimated and MSCT overestimated AoA dimensions, but inter-measurement variability of 3DE and MSCT were similar. When divided by Agatston score, both 3DE and MSCT measurements were larger and showed greater variability with increasing calcium burden. The in vivo study showed that the correlation between 3DE and MSCT measurements was high; however, 3DE measurements were smaller than those measured with MSCT. Conclusions In the in vitro model, CMR measurements were the most accurate for assessing the actual dimensions suggesting that further investigations on its role in AoA measurement in TAVR are needed. However from the in vivo model, MSCT and 3DE are reasonable alternatives with the understanding that they can slightly overestimate and underestimate annular dimensions, respectively.

This study demonstrates the capabilities of MRI in the assessment of cardiac pacing induced ventricular dyssynchrony, and the findings support the need for employing more physiological pacing. A human donor heart deemed non-viable for transplantation, was reanimated using an MR compatible, four-chamber working perfusion system. The heart was imaged using a 1.5T MR scanner while being paced from the right ventricular apex (RVA) via an epicardial placed lead. Four-chamber, short-axis, and tagged short-axis cines were acquired in order to track wall motion and intramyocardial strain during pacing. The results of this study revealed that the activation patterns of the left ventricle (LV) during RVA pacing demonstrated intraventricular dyssynchrony; as the left ventricular mechanical activation proceeded from the septum and anterior wall to the lateral wall, with the posterior wall being activated last. As such, the time difference to peak contraction between the septum and lateral wall was approximately 125 msec. Likewise, interventricular dyssynchrony was demonstrated from the four-chamber cine as the time difference between the peak LV and RV free wall motion was 180 msec. With the ongoing development of MR safe and MR compatible pacing systems, we can expect MRI to be added to the list of imaging modalities used to optimize cardiac resynchronization therapy (CRT) and/or alternate site pacing.

This paper reports on a new generation of aircraft-based rotating-vane-style electric field mills designed and built at NASA’s Marshall Space Flight Center. The mills have individual microprocessors that digitize the electric field signal at the mill and respond to commands from the data system computer. The mills are very sensitive (1 V m−1 bit−1), have a wide dynamic range (115 dB), and are very low noise (±1 LSB). Mounted on an aircraft, these mills can measure fields from ±1 V m−1 to ±500 kV m−1. Once-per-second commanding from the data collection computer to each mill allows for precise timing and synchronization. The mills can also be commanded to execute a self-calibration in flight, which is done periodically to monitor the status and health of each mill.

This report describes the unusual appearance seen on a panoramic radiograph of an orthodontic patient which the authors argue may represent ectopia or concomitant hypohyperdontia of the mandibular premolar teeth. A literature review describes the frequency of such anomalies in this area from previous studies. The presenting features of the patient and the differential diagnoses are explored. Treatment planning is discussed and treatment carried out in this particular case is detailed. The unusual symmetrical bilateral anomalies in this patient may point to a genetic determinant of tooth germ position and/or movement.

Objective—To compare health performance during the first 28 days in the feedlot for vaccinated or conditioned feeder calves sold through special auctions in Ontario with health performance for calves sold through conventional auctions in the province. Design—Cohort study. Animals—12,313 calves sold through conventional and special auctions at the Keady Livestock Market during the fall of 1999 and 2000. Procedure—Buyers of calf groups were approached at the auction market or contacted by telephone and asked to record the number of calves requiring treatment for bovine respiratory tract disease (BRD) during the first 28 days after purchase. Results—211 calf groups (≥ 20 calves/group) were followed up for 28 days after purchase. Multivariate logistic analysis indicated that vaccinated calves purchased through special auctions were 0.68 (95% confidence interval, 0.50 to 0.93) times as likely to receive treatment for BRD as were calves purchased at conventional auctions and that conditioned calves were 0.22 (95% confidence interval, 0.12 to 0.38) times as likely to receive treatment. Groups that received antimicrobials by injection on arrival at the feedlot were 0.64 (95% confidence interval, 0.43 to 0.96) times as likely to be treated as were groups that did not. Conclusions and Clinical Relevance—Results suggest that vaccinated and conditioned calves were less likely to receive treatment for BRD during the first 28 days in the feedlot; however, there was no difference in mortality rate. (J Am Vet Med Assoc 2003;223: 677–683)

Medical devices are rapidly advancing and changing the medical field. Progress has been demonstrated in many fields such as minimally invasive surgical techniques for valve replacement and 3D cardiac mapping of arrhythmias. These medical device advances allow physicians to help more patients quicker and more efficiently. The field of cardiac device development can be considered as relatively new, beginning in the early 1950s, and today new technologies in this field are presented at ever increasing rates. Many times, these advances come from an unmet clinical need. In some ways, physicians are unable to treat (or are at best ineffectively treating) certain types of patients in this aging society. Motivated by these needs, medical device designers—scientists, physicians, patients, or simply individuals with good ideas—choose to undergo the rigorous, yet rewarding, path of medical device development.

In recent years, the use of perfusion-fixed cadaveric specimens and isolated heart models has helped to develop an improved understanding of the device-tissue interface and has also contributed to the rapid evolution of surgically and percutaneously delivered cardiac therapies. This chapter describes a novel series of techniques utilized within the Visible Heart® laboratory by engineers, scientists, and anatomists to visualize and analyze the heart and assess potential repair or replacement therapies. The study of reanimated large mammalian hearts (including human hearts) and specially prepared anatomical specimens, using various clinical and nonclinical imaging modalities, has provided feedback for design engineers and clinicians that seek to develop and/or employ cardiac therapies for patients with acquired or congenital heart disease.

The use of high-resolution noninvasive imaging in modern cardiac clinics to collect detailed images of valve function has dramatically accelerated the understanding of functional human heart anatomy. In the healthy human, the cardiac valves determine the passage of blood through the heart. The atrioventricular valves open during diastole to allow the filling of the ventricles and close during systole (ventricular contraction), directing blood through the semilunar valves to the body; these valves, in turn, close during diastole to prevent the flow of blood back into the ventricle. By presenting a comprehensive review of the histology, functional anatomy, and morphology of the cardiac valves, this chapter promotes an understanding of the valve features that is required for valvar repair or replacement via either surgical or minimally invasive (transcatheter) means.

The objective of this field trial was to compare the effect of intrauterine (i.u.) antibiotic or intramuscular (i.m.) prostaglandin F2 alpha (PGF2 alpha) on time to pregnancy in dairy cows diagnosed with clinical endometritis between 20 and 33 days in milk (DIM). The case definition of endometritis was the presence of purulent uterine discharge or cervical diameter > 7.5 cm, or the presence of muco-purulent discharge after 26 DIM. There were 316 cows with endometritis from 27 farms assigned randomly within herd to receive 500 mg of cephapirin benzathine intrauterine (i.u.), 500 micrograms of cloprostenol i.m., or no treatment. The rate of resolution of clinical signs 14 d after treatment was 77% and was not affected by treatment. Reproductive performance was monitored for a minimum of 7 mo after treatment. Survival analysis (multivariable proportional hazards regression) was used to measure the effect of treatment on time to pregnancy. There was no benefit of treatment of endometritis before 4 wk postpartum. Administration of PGF2 alpha between 20 and 26 DIM to cows with endometritis that did not have a palpable corpus luteum was associated with a significant reduction in pregnancy rate. Between 27 and 33 DIM, cows with endometritis treated with cephapirin i.u. had a significantly shorter time to pregnancy than untreated cows (hazard ratio = 1.63). In this time period, there was no difference in pregnancy rate between PGF2 alpha and untreated cows, but the difference in pregnancy rate between cows treated with cephapirin i.u. and with PGF2 alpha was not statistically significant. Treatment of postpartum endometritis should be reserved for cases diagnosed after 26 DIM, based on criteria that are associated with subsequent pregnancy rate.

The objective of this study was to investigate parenteral vitamin E for the prevention of peripartum disease in dairy cows. A randomized clinical trial was conducted in 21 commercial dairy herds. Cows (n = 1142) were randomly assigned to receive either a single subcutaneous injection of 3000 IU of vitamin E, or placebo, 1 wk before expected calving. Serum alpha-tocopherol was significantly increased in treated cows at 7 and 14 d, but not at 21 d after injection. Overall, there were no significant differences between treatment groups in the incidence of retained placenta, clinical mastitis, metritis, endometritis, ketosis, displaced abomasum, or lameness. However, there was a conditional benefit of treatment for reduction of the incidence of retained placenta. Cows with marginal pretreatment vitamin E status (serum alpha-tocopherol to cholesterol mass ratio < 2.5 x 10(-3)) that received an injection of vitamin E tended to have reduced risk of retained placenta. However, in cows with adequate serum vitamin E, there was no reduction in the incidence of any disease. For clinical application, primiparous animals were most likely to benefit from prepartum injection of vitamin E.

Lactating Holstein cows (n=288) were grouped as pairs at parturition and randomly assigned to two treatments (control, C vs intervenient treatment, T). The reproductive management of the Group C cows (n=130) consisted of the intramuscular administration of 500 microg PGF2alpha analogue (PG) on Days 28 and 63 postpartum and breeding on the basis of estrus signs with the a.m.-p.m. rule after Day 63. Cows that were not bred by 77 d postpartum received another injection of PG and were bred at estrus or 84 h after PG treatment. Pregnancy diagnoses were perfomed by palpation of the uterus per rectum 42 to 48 d after AI. Cows in the T group (n=139) received intramuscular injections of 100 microg GnRH 14 d and PG 28 d after calving. On Day 56 postpartum, cows were given a second dose of GnRH followed by PG on Day 63 postpartum and a third GnRH injection 48 h after PG (OvSynch). Cows were inseminated at a fixed time (22+/-1 h) after GnRH. Five days after the fixed-time insemination cows were given 1500 IU hCG i.m.. Group C and T cows that returned to service or were diagnosed as non-pregnant continued to receive PG at intervals of 14 d with breeding at estrus or 84 h after the second PGF2alpha dose. A sustained increase in milk progesterone concentration was observed in 59.0% of T cows after GnRH administration on Day 14. A similar rise in milk progesterone concentrations was observed in 53.8% of C cows. The PG on Day 28 induced luteolysis more in Group T cows (53.2%) than in Group C cows (36.9%). The PG on Day 63 reduced milk progesterone concentrations to basal levels in 50.7% of T and 49.2% of Group C animals. The first service pregnancy rates (T, 40.3% vs C, 36.2%) and the overall pregnancy rates (all services, T, 83.5% vs C, 86.9%) were not different between the two groups. The two treatments did not differ in the interval from first service to pregnancy, calving to pregnancy or in calving interval, number of services per pregnancy or culling rates.

We have designed a new instrument to measure the current flowing along balloon rigging line during flights through thunderstorms. This instrument was tested in a high voltage facility and used to collect line current data during one balloon flight into a thunderstorm. Using these data, worst-case calculations are made; as such, we claim that they are the upper limits of any alteration .to the measured electric field or particle charge that may occur, and the real number is likely much less. It is postulated the rigging-line current could have two separate effects on the measured . .

This paper describes how the Atlas of Human Cardiac Anatomy website can be used to improve cardiac device design throughout the process of development. The Atlas is a free-access website featuring novel images of both functional and fixed human cardiac anatomy from over 250 human heart specimens. This website provides numerous educational tutorials on anatomy, physiology and various imaging modalities. For instance, the ‘device tutorial’ provides examples of devices that were either present at the time of in vitro reanimation or were subsequently delivered, including leads, catheters, valves, annuloplasty rings and stents. Another section of the website displays 3D models of the vasculature, blood volumes and/or tissue volumes reconstructed from computed tomography and magnetic resonance images of various heart specimens. The website shares library images, video clips and computed tomography and MRI DICOM files in honor of the generous gifts received from donors and their families.

Objective To assess the characteristics and rates of complications for operative laparoscopy and diagnostic laparoscopy. Design Retrospective review. Setting Tertiary-care university hospital. Patients Two thousand three hundred twenty-four patients undergoing operative laparoscopy or diagnostic laparoscopy. Interventions Operative laparoscopy including lysis of adhesions, tubal surgery, ovarian surgery, uterine surgery, or destruction of endometriosis. Main Outcome Measures Complication rates for operative and diagnostic laparoscopies were tabulated and compared. Results The overall major complication rate for this series of 2,324 laparoscopies was 0.22%. There were five major and 15 minor complications. In the operative laparoscopy group, there were more complications from Veress needle and trocar insertion (n=15) than from the actual operative procedures (n=3). There were more total complications in the operative laparoscopy group (n=18) than in the diagnostic laparoscopy group (n=3). Conclusion Operative laparoscopy is efficacious for a variety of gynecologic surgical procedures.

In the current regulatory climate, the Food and Drug Administration requires that all invasive cardiac devices are subjected to in vivo testing prior to human clinical trials and/or medical use. The most effective method for assessing the in vivo performance, durability, and biocompatibility of a novel heart valve therapy is through testing within the appropriate animal model. For replacement heart valves, preclinical testing is performed under strict regulatory guidelines to critically assess the performance of the device and the response of the host, by accurately replicating the intended human implantation procedure. This ensures the collection of relevant data and minimizes the potential for distress or discomfort to the test subject. The fundamental goals of a preclinical study are to report any detectable pathological consequences of the procedure, to report any macro- or microscopically detectable structural alterations in the device itself, and to histologically assess any thromboembolic material, inflammatory reactions, or degenerative processes. The success of a preclinical trial relies on careful protocol design, choosing the appropriate animal model, and adhering to the regulatory guidelines for Good Laboratory Practices. Importantly, the continued use of animal models in cardiac research has also benefited the field of veterinary science and, until in vitro and in silico methods provide suitable alternatives, will continue to be the most accurate assessment for the next generations of valve therapies.

The semilunar valves determine the passage of blood between the ventricles and the main arteries, transporting blood away from the heart to the vital organs. In a healthy individual these valves are defined by three leaflets attached in a semilunar fashion within a supporting sinus making up an arterial root positioned between their respective outflow tracts and arterial trunks. During systole, when the ventricles are contracting, the semilunar valve leaflets open to allow blood to flow to the body, i.e., ventricular ejection. As the myocardium starts to relax, prior to ventricular end diastole, the pressure within the right and left ventricles drops below the pressures in the arterial system causing the valves to snap shut. This chapter covers the histological, structural, and functional features of both the aortic and pulmonic semilunar valves and discusses the use of echocardiography to image the structures. A detailed understanding of the semilunar valve anatomy provides the foundation of knowledge critical to physicians and engineers developing future clinical therapies for the treatment of congenital and degenerative diseases.

Medical devices, particularly those for cardiac valves, are rapidly advancing and changing the medical field. Progress has been demonstrated by improved less-invasive surgical techniques for valve replacement to total transcatheter technologies. These medical device advances allow physicians to help more patients quicker and more efficiently. The field of cardiac device development can be considered as relatively new, beginning in the early 1950s, and yet today newer technologies in this field are presented at ever increasing rates.

The use of high resolution noninvasive imaging in modern cardiac clinics to collect detailed images of valve function has dramatically accelerated the understanding of functional human heart anatomy. This, in turn, has brought new nomenclature aligning the anatomical features of the heart with the overall anatomy of the body, a concept known as attitudinally correct anatomy. The mitral and tricuspid valves determine the passage of blood between the atria and ventricles and are defined by an annulus, valve leaflets, and a sub-valvar apparatus. The valves allow filling of the ventricles during diastole and close during systole, ventricular contraction, directing blood through the ventricular outflow tracts. By presenting a comprehensive review of the histology, functional anatomy and morphology of the atrioventricular valves, the following chapter promotes an understanding of the valve features that is required for valvar repair or replacement via either surgical or minimally invasive (transcatheter) means.

In recent years the use of perfusion-fixed cadaveric specimens and isolated heart models has helped develop an improved understanding of the device-tissue interface and contributed to the rapid evolution of surgically and percutaneously delivered valve therapies. This chapter describes a novel series of techniques utilized within the Visible Heart® laboratory by engineers, scientists, and anatomists to visualize and analyze the form and function of the four cardiac valves and assess potential repair or replacement therapies. The study of reanimated large mammalian hearts (including human) and specially prepared anatomical specimens using various clinical and nonclinical imaging modalities has provided feedback for both design engineers and clinicians that seek to develop and/or employ valve repair approaches for patients with acquired or congenital heart valve defects.

Objective To compare the surgical management and follow-up of patients with endometriomas managed by endoscopic surgery versus laparotomy using a retrospective case control format. Design Endoscopic oophorocystectomies were performed on 36 patients. Chart review of laparotomy oophorocystectomies from 21 patients was conducted. Six-week and 12-month follow-up for evaluation of symptoms, evidence of recurrence, and fertility was available on all subjects. Results In the endoscopy group, 39 patients had screening laparoscopy for possible endoscopic surgery. Three of this group required laparotomy and 36 patients underwent endoscopic surgery. Chart review identified 21 patients who had undergone primary laparotomy for endometriomas. Patient groups were matched for age, severity of disease, presence of other infertility factors, and absence of perioperative medical suppression. Outcome parameters for each group were: operating time—endoscopy 2.8hours (±1.2), laparotomy 3.1hours (±1.8); estimated blood loss—endoscopy 40cc (±45); laparotomy, 240cc (±107); recovery time—endoscopy, 6.2days (±2.5), laparotomy 30days (±6.8); endometrioma recurrence rate—endoscopy 11.1%, laparotomy 19%; and pregnancy rate—endoscopy 42.8%, laparotomy 46.6%. Conclusion A high percentage of patients with endometriomas associated with advanced endometriosis can be managed effectively by endoscopic surgery.

A new balloon-borne instrument created by the authors and referred to as the q-d instrument that measures the charge q and size d of precipitation particles is discussed. The instrument measures charge with an induction cylinder size with an optical sensor, and fall speed by the time difference between the two. A second induction cylinder at the top serves as the entry point and detects precipitation that splashes off the entry. In this way, particles contaminated by splashing are removed from the data. It is capable of measuring particle sizes ranging from 0.8 to 8.0 mm in diameter and charges ranging from ±4 to ±400 pC. Since the size is measured optically, one can detect uncharged particles and measure their size. The q-d instrument does not show evidence of corona at its extremities until the electric field is as large as 100 kV m−1 at 700 mb.

The detailed assessment of cardiac anatomy using multiple imaging modalities is essential to understand the high degree of variations that exist in human hearts (i.e., with and without pathologies). Additionally, such information should provide one with important insights regarding which imaging modality will best provide the required visualization of device placement via a given transcatheter approach. We describe here an unique set of such studies performed on either preserved heart specimens or within reanimated large mammalian hearts, including human (using Visible Heart(®) methodologies). Such anatomical and device-tissue interface knowledge is critical for both design engineers and clinicians that seek to develop and/or employ less invasive cardiac repair approaches for patients with acquired or congenital structural heart defects.

From the earliest reported cardiac surgeries in the late 19th century, exponential improvements in surgical techniques and operating times have opened the door for the development of novel cardiac devices. The design and development of cardiac devices in the 21st century is driven by the innovation and resources of an industry forecast to be worth $ 266 billion by 2012. This market growth is demonstrated by the many patent applications submitted each year to create novel devices or embellish existing products.

Isolated mammalian hearts have been used to study cardiac physiology, pharmacology, and biomedical devices in order to separate myocardial characteristics from the milieu of the intact animal and to allow for increased control over experimental conditions. Considering these benefits and that MRI is the “gold” standard for measuring myocardial function, it was considered desirable to have a system which would allow simultaneous MR imaging of an isolated beating heart. Here we describe a unique portable system, which enables physiologic perfusion of an isolated heart during simultaneous MR imaging. A two unit system was designed to physiologically support a large mammalian isolated heart during MR imaging were a modified Krebs-Henseleit perfusate was used as a blood substitute. The first unit, which resides in an adjacent support room next to the scanner, contains all electronically powered equipment and components (with ferromagnetic materials) which cannot operate safely near the magnet, including (1) a thermal module and custom tube in tube heat exchanger warming the perfusate to 38°C; (2) a carbogen tank (95% O2 5% CO2) and hollow fiber oxygenator; and (3) two centrifugal blood pumps which circulates and pressurizes the left and right atrial filling chambers. The second unit, which resides next to the magnet and is free of ferromagnetic materials, receives warmed, oxygenated perfusate from the first unit via PVC tubing. The isolated hearts were connected to the second unit via four cannulae sutured to the great vessels. A support system placed inside the scanner on the patient bed secured the hearts and cannulae in the correct anatomical position. To date, this system was tested in a 1.5 T Siemens scanner using swine hearts (n=2). The hearts were arrested with St. Thomas cardioplegia and removed via a medial sternotomy. After cannulation of the great vessels, reperfusion, and defibrillation, four-chamber and tagged short-axis cine loops were acquired using standard ECG gating. Tagged short-axis images obtained at the base, mid-ventricle, and apex were used to measure the following functional parameters for one heart: LV end-diastolic volume=38.84 ml, LV end-systolic volume=23.23 ml, LV stroke volume=15.6 ml, LV ejection fraction=40.18%, and peak LV circumferential strain=16%. The feasibility of MR imaging an isolated, four-chamber working large mammalian heart was demonstrated using a custom designed and built portable MRI compatible perfusion system. This system will be useful in studying in vitro cardiac function (including human hearts) and developing MRI safe biomedical devices and MRI guided therapies in a controlled setting.

Using Visible Heart® methodologies we imaged coronary artery bypass grafts (CABGs) and coronary stents in isolated beating human hearts and perfusion fixed human hearts. Due to the varying cardiac health of the donor hearts it has been possible to see progressive levels of stent endothelialization and vascular calcification. The isolated heart model uses a clear Krebs–Henseleit buffer in place of blood, allowing for the unique opportunity to image the coronary vessels. In the isolated human heart a fiberscope was inserted into either the native coronary artery or the CABG with the heart in sinus rhythm. In order to verify cardiac function during the imaging process the following measurements were read at a sampling rate of 5 kHz: ECG, aortic flow, and ventricular pressures. Perfusion fixed hearts were fixed in an end diastolic state achieved by applying pressures comparable to physiological conditions. This process causes the coronary arteries to fix in a dilated state. CABGs of human hearts were then imaged using fluoroscopy (angiograms) and fiberscopic techniques. The stented native coronary arteries of human hearts were imaged via fluoroscopy and by dissection. Through a variety of imaging techniques and using Visible Heart® methodologies we have obtained a unique visualization of a CABG and a coronary artery stent in a beating human heart during sinus rhythm. Investigative studies in perfusion fixed human hearts have provided a more complete anatomical imaging study of stent endothelialization in the native coronary arteries and vascular calcification in bypass grafts.

This project aims to investigate the performance of edge-to-edge mitral valve repair (MVR) within reanimated swine hearts. Direct imaging and hemodynamic data of the mitral valve during normal cardiac function (Normal), after an induced prolapse (Prolapse), and post surgical repair (E2E) was obtained. Isolated swine hearts (n=6) were reanimated using a clear Krebs–Henseleit buffer. Mitral prolapse, and regurgitation, in the P2 region was induced by cutting chordae tendinae of the posterior leaflet. An edge-to-edge MVR procedure was performed, suturing the prolapsed P2 region to the A2 region of the anterior leaflet. The mitral valve was imaged using endoscopic cameras in the left atrium and ventricle allowing verification of stitch placement and leaflet coaptation. Analysis of the endoscopic images provided measures of annulus area, orifice area, and regurgitant area. Echocardiography, the standard clinical imaging modality, was used to determine the hemodynamic performance of the valve. Additionally, ECG and left chamber pressures were recorded at a sample rate of 5 kHz. Prolapse of the P2 region was consistently created, and edge-to-edge repair of the mitral leaflet showed full leaflet coaptation. The annulus area of the valve was tracked throughout the procedure and did not show significant variation. The orifice area, defined as the area of the annulus that does not contain leaflets, normalized to the corresponding annulus area for Normal, Prolapse and E2E were: 41±13%, 44±14% and 21±13%, p=0.02. The regurgitant area, normalized to the corresponding annulus area, increased from 2±2% for Normal to 8±3% for the Prolapse and then decreased to 1±1% for the E2E group. The regurgitant fraction, normalized against the maximum observed, for Normal, Prolapse and E2E was 10±6%, 57±26% and 13±13%, p

The objective structured clinical examination (OSCE) has been used for 10 years at the Ontario Veterinary College, University of Guelph, to evaluate the clinical competencies in ruminant health management of final-year DVM students. The performance of these students in the summative assessment, which includes the use of OSCEs, was compared to their formative assessment, given at the end of the rotation. Specifically, classification of students’ performance as poor (bottom 10% of the grade range versus “serious deficits”) or superior (“A grade” versus “exceeds expectations”) was compared. Agreement between the two types of assessment is slight, regardless of whether assessing diagnostic process skills or technical skills—and regardless of whether all students were assessed or only those enrolled in food-animal or mixed streams in their final year—which suggests that the two assess different types of skills. OSCEs are a useful and viable tool for objectively assessing clinical skills in ruminant health management.