Search results for: cardiac monitor

Authors: Eugenia P. Ramirez, Kevin Matthe Caramancion, Mia Eleazar

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Getting the attention of students is a constant challenge to the instructors/lecturers. Although in the computer laboratories some networking and entertainment websites are blocked, yet, these websites have unlimited ways of attracting students to get into it. Thus, when an instructor gives a specific set of instructions, some students may not be able to follow sequentially the steps that are given. The instructor has to physically go to the specific remote terminal and show the student the details. Sometimes, during an examination in laboratory set-up, a proctor may prefer to give detailed and text-written instructions rather than verbal instructions. Even the mere calling of a specific student at any time will distract the whole class especially when activities are being performed. What is needed is : An application software that is able to lock the student's monitor and at the same time display the instructor’s screen; a software that is powerful enough to process in its side alone and manipulate a specific user’s terminal in terms of free configuration that is, without restrictions at the server level is a required functionality for a modern and optimal server structure; a software that is able to send text messages to students, per terminal or in group will be a solution. These features are found in LabSupport. This paper outlines the LabSupport application software framework to efficiently manage computer laboratory sessions and will include different modules: screen viewer, demonstration mode, monitor locking system, text messaging, and class management. This paper's ultimate aim is to provide a system that increases instructor productivity.

Keywords: application software, broadcast messaging, class management, locking system

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Authors: Ateeth Shetty, K. S. Jayappa, Ratheesh Ramakrishnan, A. S. Rajawat

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Suspended Sediment Concentration (SSC) was estimated for the period of four months (November, 2013 to February 2014) using Oceansat-2 (Ocean Colour Monitor) satellite images to understand the coastal dynamics and regional sediment transport, especially distribution and budgeting in coastal waters. The coastal zone undergoes continuous changes due to natural processes and anthropogenic activities. The importance of the coastal zone, with respect to safety, ecology, economy and recreation, demands a management strategy in which each of these aspects is taken into account. Monitoring and understanding the sediment dynamics and suspended sediment transport is an important issue for coastal engineering related activities. A study of the transport mechanism of suspended sediments in the near shore environment is essential not only to safeguard marine installations or navigational channels, but also for the coastal structure design, environmental protection and disaster reduction. Such studies also help in assessment of pollutants and other biological activities in the region. An accurate description of the sediment transport, caused by waves and tidal or wave-induced currents, is of great importance in predicting coastal morphological changes. Satellite-derived SSC data have been found to be useful for Indian coasts because of their high spatial (360 m), spectral and temporal resolutions. The present paper outlines the applications of state‐of‐the‐art operational Indian Remote Sensing satellite, Oceansat-2 to study the dynamics of sediment transport.

Keywords: suspended sediment concentration, ocean colour monitor, sediment transport, case – II waters

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Authors: Kaihong Yu, Tetsui Yamashita, Shigeaki Shingyochi, Kazuo Matsumoto, Makoto Ohta

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During cardiac ablation, high power delivery for deeper lesion formation is limited by electrode-tissue interface overheating which can cause serious complications such as thrombus. To prevent this overheating, temperature control and open irrigation are often used. In temperature control, radiofrequency generator is adjusted to deliver the maximum output power, which maintains the electrode temperature at a target temperature (commonly 55°C or 60°C). Then the electrode-tissue interface temperature is also limited. The electrode temperature is a result of heating from the contacted tissue and cooling from the surrounding blood. Because the cooling from blood is decreased under conditions of low blood flow, the generator needs to decrease the output power. Thus, temperature control cannot deliver high power under conditions of low blood flow. In open irrigation, saline in room temperature is flushed through the holes arranged in the electrode. The electrode-tissue interface is cooled by the sufficient environmental cooling. And high power delivery can also be done under conditions of low blood flow. However, a large amount of saline infusions (approximately 1500 ml) during irrigation can cause other serious complication. When open irrigation cannot be used under conditions of low blood flow, a new overheating prevention may be required. The authors have proposed a new electrode cooling method by making the catheter vibrating. The previous work has introduced that the vibration can make a cooling effect on electrode, which may result form that the vibration could increase the flow velocity around the catheter. The previous work has also proved that increasing vibration frequency can increase the cooling by vibration. However, the effect of the vibration amplitude is still unknown. Thus, the present study investigated the effect of vibration amplitude on tissue temperature and lesion size. An agar phantom model was used as a tissue-equivalent material for measuring tissue temperature. Thermocouples were inserted into the agar to measure the internal temperature. Porcine myocardium was used for lesion size measurement. A normal ablation catheter was set perpendicular to the tissue (agar or porcine myocardium) with 10 gf contact force in 37°C saline without flow. Vibration amplitude of ± 0.5, ± 0.75, and ± 1.0 mm with a constant frequency (31 Hz or 63) was used. A temperature control protocol (45°C for agar phantom, 60°C for porcine myocardium) was used for the radiofrequency applications. The larger amplitude shows the larger lesion sizes. And the higher tissue temperatures in agar phantom are also shown with the higher amplitude. With a same frequency, the larger amplitude has the higher vibrating speed. And the higher vibrating speed will increase the flow velocity around the electrode more, which leads to a larger electrode temperature decrease. To maintain the electrode at the target temperature, ablator has to increase the output power. With the higher output power in the same duration, the released energy also increases. Consequently, the tissue temperature will be increased and lead to larger lesion sizes.

Keywords: cardiac ablation, electrode cooling, lesion size, tissue temperature

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Authors: Francesco Lubrano, Fabrizio Bertone, Federico Stirano

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Modern societies strongly depend on Critical Infrastructures (CI). Hospitals, power supplies, water supplies, telecommunications are just few examples of CIs that provide vital functions to societies. CIs like hospitals are very complex environments, characterized by a huge number of cyber and physical systems that are becoming increasingly integrated. Ensuring a high level of security within such critical infrastructure requires a deep knowledge of vulnerabilities, threats, and potential attacks that may occur, as well as defence and prevention or mitigation strategies. The possibility to remotely monitor and control almost everything is pushing the adoption of network-connected devices. This implicitly introduces new threats and potential vulnerabilities, posing a risk, especially to those devices connected to the Internet. Modern medical devices used in hospitals are not an exception and are more and more being connected to enhance their functionalities and easing the management. Moreover, hospitals are environments with high flows of people, that are difficult to monitor and can somehow easily have access to the same places used by the staff, potentially creating damages. It is therefore clear that physical and cyber threats should be considered, analysed, and treated together as cyber-physical threats. This means that an integrated approach is required. SAFECARE, an integrated cyber-physical security solution, tries to respond to the presented issues within healthcare infrastructures. The challenge is to bring together the most advanced technologies from the physical and cyber security spheres, to achieve a global optimum for systemic security and for the management of combined cyber and physical threats and incidents and their interconnections. Moreover, potential impacts and cascading effects are evaluated through impact propagation models that rely on modular ontologies and a rule-based engine. Indeed, SAFECARE architecture foresees i) a macroblock related to cyber security field, where innovative tools are deployed to monitor network traffic, systems and medical devices; ii) a physical security macroblock, where video management systems are coupled with access control management, building management systems and innovative AI algorithms to detect behavior anomalies; iii) an integration system that collects all the incoming incidents, simulating their potential cascading effects, providing alerts and updated information regarding assets availability.

Keywords: cyber security, defence strategies, impact propagation, integrated security, physical security

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Authors: Beatriz Lafuente Alcázar, Yash Wani, Amit J. Nimunkar

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Cardiovascular Diseases (CVDs) are the leading cause of death globally, and around 80% of sudden cardiac deaths are due to arrhythmias or irregular heartbeats. The majority of these pathologies are revealed by either short-term or long-term alterations in the electrocardiogram (ECG) morphology. The ECG is the main diagnostic tool in cardiology. It is a non-invasive, pain free procedure that measures the heart’s electrical activity and that allows the detecting of abnormal rhythms and underlying conditions. A cardiologist can diagnose a wide range of pathologies based on ECG’s form alterations, but the human interpretation is subjective and it is contingent to error. Moreover, ECG records can be quite prolonged in time, which can further complicate visual diagnosis, and deeply retard disease detection. In this context, deep learning methods have risen as a promising strategy to extract relevant features and eliminate individual subjectivity in ECG analysis. They facilitate the computation of large sets of data and can provide early and precise diagnoses. Therefore, the cardiology field is one of the areas that can most benefit from the implementation of deep learning algorithms. In the present study, a deep learning algorithm is trained following a novel approach, using a combination of different databases as the training set. The goal of the algorithm is to achieve the detection of R-peaks in ECG signals. Its performance is further evaluated in ECG signals with different origins and features to test the model’s ability to generalize its outcomes. Performance of the model for detection of R-peaks for clean and noisy ECGs is presented. The model is able to detect R-peaks in the presence of various types of noise, and when presented with data, it has not been trained. It is expected that this approach will increase the effectiveness and capacity of cardiologists to detect divergences in the normal cardiac activity of their patients.

Keywords: arrhythmia, deep learning, electrocardiogram, machine learning, R-peaks

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Nayira A. Abd Elbaky, Amal J. Fatani, Hazar Yaqub, Nouf M. Al-Rasheed, Naglaa El-Orabi, Mai Osman

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The present work is aimed to evaluate the protective effect of N-acetyl cystiene (NAC), coenzyme Q10 (CoQ10), and their combination against carbon tetrachloride (CCl4)-induced cardiotoxicity in rats. CCl4 treatment significantly elevated the levels of cardiac oxidative stress bio markers including nitric oxide (NO) and malondialdehyde (MDA). A concomitant decrease in the level of reduced glutathione and the activity of membrane bound enzyme, calcium-adenosine triphosphatase were observed in the hearts of rats exposed to CCl4 compared to respective values in normal group. Quantitative analysis of myocardial energy metabolism revealed a significant decrease in the glucose content coupled with depletion in the activities of myocardial glycolytic enzymes as hexokinase (HK), phosphofructokinase (PFK) and lactate dehydrogenase (LDH) after CCl4 treatment. In addition, a significant elevation in myocardial hydroxyproline level was observed in CCl4 intoxicated rats indicating interstitial collagen accumulation. Pretreatment with either NAC, CoQ10 or their combination successively alleviated the alterations in myocardial oxidative stress and antioxidant markers, as well as effectively up-regulated the decrease in cardiac energetic biomarkers in CCl4 intoxicated rats. Moreover, these antioxidants markedly reduced myocardial hydroxyproline level versus that of CCl4-treated animals. In conclusion, the present results illustrated that the prophylactic use of the current antioxidant resulted in a remarkable cardioprotective effect against CCl4 induced myocardial damage, which suggest that they may candidates as prophylactic agents against different cardio-toxins.

Keywords: carbon tetrachloride, lipid peroxidation, antioxidant, energy metabolism, hydroxyproline

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Authors: I. Boroňová, J. Bernasovská, J. Kmec, E. Petrejčíková

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Dilated cardiomyopathy (DCM) is a primary myocardial disease, it is characterized by progressive systolic dysfunction due to cardiac chamber dilatation and inefficient myocardial contractility with estimated prevalence of 37 in 100 000 people. It is the most frequent cause of heart failure and cardiac transplantation in young adults. About one-third of all patients have a suspected familial disease indicating a genetic basis of DCM. Many candidate gene studies in humans have tested the association of single nucleotide polymorphisms (SNPs) in various genes coding for proteins with a known cardiovascular function. In our study we present the results of ZBTB17 gene rs10927875 polymorphism genotyping in relation to dilated cardiomyopathy in Slovak population. The study included 78 individuals, 39 patients with DCM and 39 healthy control persons. The mean age of patients with DCM was 50.7±11.5 years; the mean age of individuals in control group was 51.3±9.8 years. Risk factors detected at baseline in each group included age, sex, body mass index, smoking status, diabetes and blood pressure. Genomic DNA was extracted from leukocytes by a standard methodology and screened for rs10927875 polymorphism in intron of ZBTB17 gene using Real-time PCR method (Step One Applied Biosystems). The distribution of investigated genotypes for rs10927875 polymorphism in the group of patients with DCM was as follows: CC (89.74%), CT (10.26%), TT (0%), and the distribution in the control group: CC (92.31%), CT (5.13%), and TT (2.56%). Using the chi-square (χ2) test we compared genotype and allele frequencies between patients and controls. There was no difference in genotype or allele frequencies in ZBTB17 gene rs10927875 polymorphism between patients and control group (χ2=3.028, p=0.220; χ2=0.264, p=0.608). Our results represent an initial study, it can be considered as preliminary and first of its kind in Slovak population. Further studies of ZBTB17 gene polymorphisms of more numerous files and additional functional investigations are needed to fully understand the role of genetic associations.

Keywords: dilated cardiomyopathy, SNP polymorphism, ZBTB17 gene, bioscience

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Authors: Song Zhang, Hui Wang, Johannes Henrich Schleifenbaum

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Due to the increasing demand for quality assurance and reliability for additive manufacturing, the development of an advanced in-situ monitoring system is required to monitor the process anomalies as input for further process control. Optical-based monitoring systems, such as CMOS cameras and NIR cameras, are proved as effective ways to monitor the geometrical distortion and exceptional thermal distribution. Therefore, many studies and applications are focusing on the availability of the optical-based monitoring system for detecting varied types of defects. However, the capability of the monitoring setup is not quantified. In this study, a quantification model to evaluate the capability of the monitoring setups for the LPBF machine based on acquired monitoring data of a designed test artifact is presented, while the design of the relevant test artifacts is discussed. The monitoring setup is evaluated based on its hardware properties, location of the integration, and light condition. Methodology of data processing to quantify the capacity for each aspect is discussed. The minimal capability of the detectable size of the monitoring set up in the application is estimated by quantifying its resolution and accuracy. The quantification model is validated using a CCD camera-based monitoring system for LPBF machines in the laboratory with different setups. The result shows the model to quantify the monitoring system's performance, which makes the evaluation of monitoring systems with the same concept but different setups possible for the LPBF process and provides the direction to improve the setups.

Keywords: data processing, in-situ monitoring, LPBF process, optical system, quantization model, test artifact

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Authors: Fabrice Houngnandan, Celia Fery, Thomas Bockel, Julie Deter

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Getting water cleaner and stopping global biodiversity loss requires indices to measure changes and evaluate the achievement of objectives. The endemic and protected seagrass species Posidonia oceanica is a biological indicator used to monitor the ecological quality of marine Mediterranean waters. One ecosystem index (EBQI), two biotic indices (PREI, Bipo), and several landscape indices, which measure the composition and configuration of the P. oceanica seagrass at the population scale have been developed. While the formers are measured at monitoring sites, the landscape indices can be calculated for the entire seabed covered by this ecosystem. This present work aims to search on the link between these indices and the best scale to be used in order to maximize this link. We used data collected between 2014 to 2019 along the French Mediterranean coastline to calculate EBQI, PREI, and Bipo at 100 sites. From the P. oceanica seagrass distribution map, configuration and composition indices around these different sites in 6 different grid sizes (100 m x 100 to 1000 m x 1000 m) were determined. Correlation analyses were first used to find out the grid size presenting the strongest and most significant link between the different types of indices. Finally, several models were compared basis on various metrics to identify the one that best explains the nature of the link between these indices. Our results showed a strong and significant link between biotic indices and the best correlations between biotic and landscape indices within the 600 m x 600 m grid cells. These results showed that the use of landscape indices is possible to monitor the health of seagrass beds at a large scale.

Keywords: ecological indicators, decline, conservation, submerged aquatic vegetation

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Authors: Sarkawt M. Hama, Paul S. Monks, Rebecca L. Cordell

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Within the Joaquin project, ultrafine particles (UFP) are continuously measured at one urban background site in Leicester. The main aims are to examine the temporal and seasonal variations in UFP number concentration and size distribution in an urban environment, and to try to assess the added value of continuous UFP measurements. In addition, relations of UFP with more commonly monitored pollutants such as black carbon (BC), nitrogen oxides (NOX), particulate matter (PM2.5), and the lung deposited surface area(LDSA) were evaluated. The effects of meteorological conditions, particularly wind speed and direction, and also temperature on the observed distribution of ultrafine particles will be detailed. The study presents the results from an experimental investigation into the particle number concentration size distribution of UFP, BC, and NOX with measurements taken at the Automatic Urban and Rural Network (AURN) monitoring site in Leicester. The monitoring was performed as part of the EU project JOAQUIN (Joint Air Quality Initiative) supported by the INTERREG IVB NWE program. The total number concentrations (TNC) were measured by a water-based condensation particle counter (W-CPC) (TSI model 3783), the particle number concentrations (PNC) and size distributions were measured by an ultrafine particle monitor (UFP TSI model 3031), the BC by MAAP (Thermo-5012), the NOX by NO-NO2-NOx monitor (Thermos Scientific 42i), and a Nanoparticle Surface Area Monitor (NSAM, TSI 3550) was used to measure the LDSA (reported as μm2 cm−3) corresponding to the alveolar region of the lung between November 2013 and November 2015. The average concentrations of particle number concentrations were observed in summer with lower absolute values of PNC than in winter might be related mainly to particles directly emitted by traffic and to the more favorable conditions of atmospheric dispersion. Results showed a traffic-related diurnal variation of UFP, BC, NOX and LDSA with clear morning and evening rush hour peaks on weekdays, only an evening peak at the weekends. Correlation coefficients were calculated between UFP and other pollutants (BC and NOX). The highest correlation between them was found in winter months. Overall, the results support the notion that local traffic emissions were a major contributor of the atmospheric particles pollution and a clear seasonal pattern was found, with higher values during the cold season.

Keywords: size distribution, traffic emissions, UFP, urban area

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Authors: Hamilton V. Niculescu

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Following a three year study conducted on eighteen Irish people that are involved in growing vegetables in various community gardens around Dublin, Republic of Ireland, it was revealed that addition of some automated features aimed at improving agricultural practices represented a process which was regarded as potentially beneficial, and as a great tool to closely monitor climate conditions inside the greenhouses. The participants were provided with a free custom-built mobile app through which they could remotely monitor and control features such as irrigation, air ventilation, and windows to ensure optimal growing conditions for vegetables growing inside purpose-built greenhouses. While the initial interest was generally high, within weeks, the participants' level of interaction with the enclosures slowly declined. By employing a constructivist grounded theory methodology, following focus group discussions, in-depth semi-structured interviews, and observations, it was revealed that participants' trust in newer technologies, and renewables, in particular, was low. There are various reasons for this, but because the participants in this study consist of mainly working-class people, it can be argued that lack of education and knowledge are the main barriers acting against the adoption of innovations. Consequently, it was revealed that most participants eventually decided to "set and forget" the systems in automatic working mode, indicating that the immediate effect of introducing people to assisting technologies also introduced some unintended consequences into their lifestyle. It is argued that this occurrence also indicates the fact that people initially "read" newer technologies and only adopt those features that they find useful and less intrusive in regards to their current lifestyle.

Keywords: automation, communication, greenhouse, sustainable

Procedia PDF Downloads 100

Authors: Taikchan Lildar, Ayesha Samad, Suraj Sookhu

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Atrial fibrillation with rapid ventricular response results in the loss of atrial kick and shortened ventricular filling time, which often leads to decompensated heart failure. Pharmacologic rhythm control is the treatment of choice, and patients frequently benefit from the restoration of sinus rhythm. When pharmacologic treatment is unsuccessful or a patient declines hemodynamically, direct cardioversion is the treatment of choice. Torsades de pointes or “twisting of the points'' in French, is a rare but under-appreciated risk of cardioversion therapy and accounts for a significant number of sudden cardiac death each year. A 61-year-old female with no significant past medical history presented to the Emergency Department with worsening dyspnea. An electrocardiogram showed atrial fibrillation with rapid ventricular response, and a chest X-ray was significant for bilateral pulmonary vascular congestion. Full-dose anticoagulation and diuresis were initiated with moderate improvement in symptoms. A transthoracic echocardiogram revealed biventricular systolic dysfunction with a left ventricular ejection fraction of 30%. After consultation with an electrophysiologist, the consensus was to proceed with the restoration of sinus rhythm, which would likely improve the patient’s heart failure symptoms and possibly the ejection fraction. A transesophageal echocardiogram was negative for left atrial appendage thrombus; the patient was treated with a loading dose of amiodarone and underwent successful direct current cardioversion with 200 Joules. The patient was placed on telemetry monitoring for 24 hours and was noted to have frequent premature ventricular contractions with subsequent degeneration to torsades de pointes. The patient was found unresponsive and pulseless; cardiopulmonary resuscitation was initiated with cardioversion, and return of spontaneous circulation was achieved after four minutes to normal sinus rhythm. Post-cardiac arrest electrocardiogram showed sinus bradycardia with heart-rate corrected QT interval of 592 milliseconds. The patient continued to have frequent premature ventricular contractions and required two additional cardioversions to achieve a return of spontaneous circulation with intravenous magnesium and lidocaine. An automatic implantable cardioverter-defibrillator was subsequently implanted for secondary prevention of sudden cardiac death. The backup pacing rate of the automatic implantable cardioverter-defibrillator was set higher than usual in an attempt to prevent premature ventricular contractions-induced torsades de pointes. The patient did not have any further ventricular arrhythmias after implantation of the automatic implantable cardioverter-defibrillator. Overdrive pacing is a method utilized to treat premature ventricular contractions-induced torsades de pointes by preventing a patient’s susceptibility to R on T-wave-induced ventricular arrhythmias. Pacing at a rate of 90 beats per minute succeeded in controlling the arrhythmia without the need for traumatic cardiac defibrillation. In our patient, conversion of atrial fibrillation with rapid ventricular response to normal sinus rhythm resulted in a slower heart rate and an increased probability of premature ventricular contraction occurring on the T-wave and ensuing ventricular arrhythmia. This case highlights direct current cardioversion for atrial fibrillation with rapid ventricular response resulting in persistent ventricular arrhythmia requiring an automatic implantable cardioverter-defibrillator placement with overdrive pacing to prevent a recurrence.

Keywords: refractory atrial fibrillation, atrial fibrillation, overdrive pacing, torsades de pointes

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Authors: Vedant Janapaty

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Estuaries are wetlands where fresh water from streams mixes with salt water from the sea. Also known as “kidneys of our planet”- they are extremely productive environments that filter pollutants, absorb floods from sea level rise, and shelter a unique ecosystem. However, eutrophication and loss of native species are ailing our wetlands. There is a lack of uniform data collection and sparse research on correlations between satellite data and in situ measurements. Remote sensing (RS) has shown great promise in environmental monitoring. This project attempts to use satellite data and correlate metrics with in situ observations collected at five estuaries. Images for satellite data were processed to calculate 7 bands (SIs) using Python. Average SI values were calculated per month for 23 years. Publicly available data from 6 sites at ELK was used to obtain 10 parameters (OPs). Average OP values were calculated per month for 23 years. Linear correlations between the 7 SIs and 10 OPs were made and found to be inadequate (correlation = 1 to 64%). Fourier transform analysis on 7 SIs was performed. Dominant frequencies and amplitudes were extracted for 7 SIs, and a machine learning(ML) model was trained, validated, and tested for 10 OPs. Better correlations were observed between SIs and OPs, with certain time delays (0, 3, 4, 6 month delay), and ML was again performed. The OPs saw improved R² values in the range of 0.2 to 0.93. This approach can be used to get periodic analyses of overall wetland health with satellite indices. It proves that remote sensing can be used to develop correlations with critical parameters that measure eutrophication in situ data and can be used by practitioners to easily monitor wetland health.

Keywords: estuary, remote sensing, machine learning, Fourier transform

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Authors: Brock Liden, Eric Janowitz

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Introduction: Diabetic peripheral neuropathy (DPN) affects 70% of individuals with diabetes1. DPN causes a loss of protective sensation, which can lead to tissue damage and diabetic foot ulcer (DFU) formation2. These ulcers can result in infections and lower-extremity amputations of toes, the entire foot, and the lower leg. Even after a DFU is healed, recurrence is common, with 49% of DFU patients developing another ulcer within a year and 68% within 5 years3. This case series examines the use of sensory insoles and newly available plantar data (pressure, temperature, step count, adherence) and remote patient monitoring in patients at risk of DFU. Methods: Participants were provided with custom-made sensory insoles to monitor plantar pressure, temperature, step count, and daily use and were provided with real-time cues for pressure offloading as they went about their daily activities. The sensory insoles were used to track subject compliance, ulceration, and response to feedback from real-time alerts. Patients were remotely monitored by a qualified healthcare professional and were contacted when areas of concern were seen and provided coaching on reducing risk factors and overall support to improve foot health. Results: Of the 40 participants provided with the sensory insole system, 4 presented with a DFU. Based on flags generated from the available plantar data, patients were contacted by the remote monitor to address potential concerns. A standard clinical escalation protocol detailed when and how concerns should be escalated to the provider by the remote monitor. Upon escalation to the provider, patients were brought into the clinic as needed, allowing for any issues to be addressed before more serious complications might arise. Conclusion: This case series explores the use of innovative sensory technology to collect plantar data (pressure, temperature, step count, and adherence) for DFU detection and early intervention. The results from this case series suggest the importance of sensory technology and remote patient monitoring in providing proactive, preventative care for patients at risk of DFU. This robust plantar data, with the addition of remote patient monitoring, allow for patients to be seen in the clinic when concerns arise, giving providers the opportunity to intervene early and prevent more serious complications, such as wounds, from occurring.

Keywords: diabetic foot ulcer, DFU prevention, digital therapeutics, remote patient monitoring

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Authors: Faisal AlShammari, Abdulmajid Addali, Mosab Alrashed

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It is widely acknowledged that bearing failures are the primary reason for breakdowns in rotating machinery. These failures are extremely costly, particularly in terms of lost production. Roller bearings are widely used in industrial machinery and need to be maintained in good condition to ensure the continuing efficiency, effectiveness, and profitability of the production process. The research presented here is an investigation of the use of acoustic emission (AE) to monitor bearing conditions at low speeds. Many machines, particularly large, expensive machines operate at speeds below 100 rpm, and such machines are important to the industry. However, the overwhelming proportion of studies have investigated the use of AE techniques for condition monitoring of higher-speed machines (typically several hundred rpm, or even higher). Few researchers have investigated the application of these techniques to low-speed machines ( < 100 rpm). This paper addressed this omission and has established which, of the available, AE techniques are suitable for the detection of incipient faults and measurement of fault growth in low-speed bearings. The first objective of this paper program was to assess the applicability of AE techniques to monitor low-speed bearings. It was found that the measured statistical parameters successfully monitored bearing conditions at low speeds (10-100 rpm). The second objective was to identify which commonly used statistical parameters derived from the AE signal (RMS, kurtosis, amplitude and counts) could identify the onset of a fault in the out race. It was found that these parameters effectually identify the presence of a small fault seeded into the outer races. Also, it is concluded that rotational speed has a strong influence on the measured AE parameters but that they are entirely independent of the load under such load and speed conditions.

Keywords: acoustic emission, condition monitoring, NDT, statistical analysis

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Authors: I. Ibrahim, A. Mann

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Phytochemical screening of crude Chrysanthlum Indicum revealed the presence of carbohydrates, flavonoids, saponins, tannins, alkanoids, steroidal nucleus and cardiac glycosides. The extract was evaluated against some pathogenic organisms by agar dilution method. The minimum inhibitory concentration and minimum bacteriocidal concentration (MBC) of the active extract of Chrysanthlum Indicum shows that its extract could be a potential source of antimicrobial agents.

Keywords: extract, phytochemicals, antimicrobial, antibacterial, Chrysanthlum indicum

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Mehrdad Sheikhvatan, Mohammad Ali Boroumand, Mehrdad Behmanesh, Shayan Ziaee

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Contradictory results have been obtained regarding the role of integrin, beta 3 (ITGB3) gene polymorphisms in occurrence of acute myocardial infarction (MI) in patients with coronary artery disease (CAD). Hence, we aimed to assess the association between 1565C/T polymorphism of ITGB3 gene and increased risk for acute MI in patients who suffered premature CAD in Iranian population. Our prospective study included 1000 patients (492 men and 508 women aged 21 to 55 years) referred to Tehran Heart center during a period of four years from 2008 to 2011 with the final diagnosis of premature CAD and classified into two groups with history of MI (n = 461) and without of MI (n = 539). The polymorphism variants were determined by PCR-RFLP technique by entering 10% of randomized samples and then genotyping of the polymorphism was also conducted by High Resolution Melting (HRM) method. Among study samples, 640 were followed with a median follow-up time 45.74 months for determining association of long-term major adverse cardiac events (MACE) and genotypes of polymorphisms. There was no significant difference in the frequency of 1565C/T polymorphism between the MI and non-MI groups. The frequency of wild genotype was 69.2% and 72.2%, the frequency of homozygous genotype was 21.3% and 18.4%, and the frequency of mutant genotype was 9.5% and 9.5%, respectively (p=0.505). Results were also similar when adjusted for covariates in a multivariate logistic regression model. No significant difference was also found in total-MACE free survival rate between the patients with different genotypes of 1565C/T polymorphism in both MI and non-MI group. The carriage of the 1565C/T polymorphism of ITGB3 gene seems unlikely to be a significant risk factor for the development of MI in Iranian patients with premature CAD. The presence of this ITGB3 gene polymorphism may not also predict long-term cardiac events.

Keywords: coronary artery disease, myocardial infarction, gene, integrin, beta 3, polymorphism

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Authors: Saurabh Shukla, G. N. Pandey

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In recent times, oil exploration and monitoring in on-shore areas have gained much importance considering the fact that in India the oil import is 62 percent of the total imports. Thus, architectural model like wireless sensor network to monitor on-shore deep sea oil well is being developed to get better estimate of the oil prospects. The problem we are facing nowadays that we have very few restricted areas of oil left today. Countries like India don’t have much large areas and resources for oil and this problem with most of the countries that’s why it has become a major problem when we are talking about oil exploration in on-shore areas also the increase of oil prices has further ignited the problem. For this the use of wireless network system having relative simplicity, smallness in size and affordable cost of wireless sensor nodes permit heavy deployment in on-shore places for monitoring oil wells. Deployment of wireless sensor network in large areas will surely reduce the cost it will be very much cost effective. The objective of this system is to send real time information of oil monitoring to the regulatory and welfare authorities so that suitable action could be taken. This system architecture is composed of sensor network, processing/transmission unit and a server. This wireless sensor network system could remotely monitor the real time data of oil exploration and monitoring condition in the identified areas. For wireless sensor networks, the systems are wireless, have scarce power, are real-time, utilize sensors and actuators as interfaces, have dynamically changing sets of resources, aggregate behaviour is important and location is critical. In this system a communication is done between the server and remotely placed sensors. The server gives the real time oil exploration and monitoring conditions to the welfare authorities.

Keywords: sensor, wireless sensor network, oil, sensor, on-shore level

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Authors: Andreea Campu, Ilinica Muresan, Simona Cainap, Simion Astilean, Monica Focsan

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Acute myocardial infarction (AMI) is the most severe cardiovascular disease, which has threatened human lives for decades, thus a continuous interest is directed towards the detection of cardiac biomarkers such as cardiac troponin I (cTnI) in order to predict risk and, implicitly, fulfill the early diagnosis requirements in AMI settings. Microfluidics is a major technology involved in the development of efficient sensing devices with real-time fast responses and on-site applicability. Microfluidic devices have gathered a lot of attention recently due to their advantageous features such as high sensitivity and specificity, miniaturization and portability, ease-of-use, low-cost, facile fabrication, and reduced sample manipulation. The integration of gold nanoparticles into the structure of microfluidic sensors has led to the development of highly effective detection systems, considering the unique properties of the metallic nanostructures, specifically the Localized Surface Plasmon Resonance (LSPR), which makes them highly sensitive to their microenvironment. In this scientific context, herein, we propose the implementation of a novel detection device, which successfully combines the efficiency of gold bipyramids (AuBPs) as signal transducers and thermal generators with the sample-driven advantages of the microfluidic channels into a miniaturized, portable, low-cost, specific, and sensitive test for the dual LSPR-thermographic cTnI detection. Specifically, AuBPs with longitudinal LSPR response at 830 nm were chemically synthesized using the seed-mediated growth approach and characterized in terms of optical and morphological properties. Further, the colloidal AuBPs were deposited onto pre-treated silanized glass substrates thus, a uniform nanoparticle coverage of the substrate was obtained and confirmed by extinction measurements showing a 43 nm blue-shift of the LSPR response as a consequence of the refractive index change. The as-obtained plasmonic substrate was then integrated into a microfluidic “Y”-shaped polydimethylsiloxane (PDMS) channel, fabricated using a Laser Cutter system. Both plasmonic and microfluidic elements were plasma treated in order to achieve a permanent bond. The as-developed microfluidic plasmonic chip was further coupled to an automated syringe pump system. The proposed biosensing protocol implicates the successive injection inside the microfluidic channel as follows: p-aminothiophenol and glutaraldehyde, to achieve a covalent bond between the metallic surface and cTnI antibody, anti-cTnI, as a recognition element, and target cTnI biomarker. The successful functionalization and capture of cTnI was monitored by LSPR detection thus, after each step, a red-shift of the optical response was recorded. Furthermore, as an innovative detection technique, thermal determinations were made after each injection by exposing the microfluidic plasmonic chip to 785 nm laser excitation, considering that the AuBPs exhibit high light-to-heat conversion performances. By the analysis of the thermographic images, thermal curves were obtained, showing a decrease in the thermal efficiency after the anti-cTnI-cTnI reaction was realized. Thus, we developed a microfluidic plasmonic chip able to operate as both LSPR and thermal sensor for the detection of the cardiac troponin I biomarker, leading thus to the progress of diagnostic devices.

Keywords: gold nanobipyramids, microfluidic device, localized surface plasmon resonance detection, thermographic detection

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Authors: Engida Yisma, Berhanu Dessalegn, Ayalew Astatkie, Nebreed Fesseha

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Background: The use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. Methods: A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. Results: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) [Adjusted OR = 3.63(95%CI: 1.81, 7.28)]. Conclusions: A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.

Keywords: partograph, knowledge, utilization, obstetric care givers, public health institutions

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Authors: Yi-Ting Liu, Pei-Ying Wen

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In order to improve the overall safety of chemotherapy, safety-protecting net was established for the whole process from prescribing by physicians, transcribing by nurses, dispensing by pharmacists to administering by nurses. The information system was used to check and monitor whole process of administration and related sheets were computerized to simplify the paper work.

Keywords: chemotherapy, bar code medication administration, medication safety

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Elena C. Tamaş, Grațiela M. Țârlea, Gianni Flamaropol, Dragoș Hera

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This article is referring to a comparative study regarding the electrical energy consumption for lighting on diverse types of big sizes commercial buildings built in Romania after 2007, having 3, 4, 5 versus 8, 9, 10 operational years. Some buildings have installed building management systems (BMS) to monitor also the lighting performances starting with the opening days till the present days but some have chosen only local meters to implement. Firstly, for each analyzed building, the total required energy power and the energy power consumption for lighting were calculated depending on the lamps number, the unit power and the average daily running hours. All objects and installations were chosen depending on the destination/location of the lighting (exterior parking or access, interior or covering parking, building interior and building perimeter). Secondly, to all lighting objects and installations, mechanical counters were installed, and to the ones linked to BMS there were installed the digital meters as well for a better monitoring. Some efficient solutions are proposed to improve the power consumption, for example the 1/3 lighting functioning for the covered and exterior parking lighting to those buildings if can be done. This type of lighting share can be performed on each level, especially on the night shifts. Another example is to use the dimmers to reduce the light level, depending on the executed work in the respective area, and a 30% power energy saving can be achieved. Using the right BMS to monitor, the energy consumption depending on the average operational daily hours and changing the non-performant unit lights with the ones having LED technology or economical ones might increase significantly the energy performances and reduce the energy consumption of the buildings.

Keywords: commercial buildings, energy performances, lightning consumption, maintenance

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Authors: Junior Akunzi

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In the matter of patient treatment planning quality assurance in 3D conformational therapy (3D-CRT) and volumetric arc therapy (VMAT or RapidArc), the independent monitor unit verification calculation (MUVC) is an indispensable part of the process. Concerning 3D-CRT treatment planning, the MUVC can be performed manually applying the standard ESTRO formalism. However, due to the complex shape and the amount of beams in advanced treatment planning technic such as RapidArc, the manual independent MUVC is inadequate. Therefore, commercially available software such as RadCalc can be used to perform the MUVC in complex treatment planning been. Indeed, RadCalc (version 6.3 LifeLine Inc.) uses a simplified Clarkson algorithm to compute the dose contribution for individual RapidArc fields to the isocenter. The purpose of this project is the validation of RadCalc in 3D-CRT and RapidArc for treatment planning dosimetry quality assurance at Antoine Lacassagne center (Nice, France). Firstly, the interfaces between RadCalc and our treatment planning systems (TPS) Isogray (version 4.2) and Eclipse (version13.6) were checked for data transfer accuracy. Secondly, we created test plans in both Isogray and Eclipse featuring open fields, wedges fields, and irregular MLC fields. These test plans were transferred from TPSs according to the radiotherapy protocol of DICOM RT to RadCalc and the linac via Mosaiq (version 2.5). Measurements were performed in water phantom using a PTW cylindrical semiflex ionisation chamber (0.3 cm³, 31010) and compared with the TPSs and RadCalc calculation. Finally, 30 3D-CRT plans and 40 RapidArc plans created with patients CT scan were recalculated using the CT scan of a solid PMMA water equivalent phantom for 3D-CRT and the Octavius II phantom (PTW) CT scan for RapidArc. Next, we measure the doses delivered into these phantoms for each plan with a 0.3 cm³ PTW 31010 cylindrical semiflex ionisation chamber (3D-CRT) and 0.015 cm³ PTW PinPoint ionisation chamber (Rapidarc). For our test plans, good agreements were found between calculation (RadCalc and TPSs) and measurement (mean: 1.3%; standard deviation: ± 0.8%). Regarding the patient plans, the measured doses were compared to the calculation in RadCalc and in our TPSs. Moreover, RadCalc calculations were compared to Isogray and Eclispse ones. Agreements better than (2.8%; ± 1.2%) were found between RadCalc and TPSs. As for the comparison between calculation and measurement the agreement for all of our plans was better than (2.3%; ± 1.1%). The independent MU verification calculation software RadCal has been validated for clinical use and for both 3D-CRT and RapidArc techniques. The perspective of this project includes the validation of RadCal for the Tomotherapy machine installed at centre Antoine Lacassagne.

Keywords: 3D conformational radiotherapy, intensity modulated radiotherapy, monitor unit calculation, dosimetry quality assurance

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Authors: Elizabeth M. Annoni, Elena G. Tolkacheva

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that is a known prognostic marker for stroke, heart failure and death. Reentrant mechanisms of rotor formation, which are stable electrical sources of cardiac excitation, are believed to cause AF. No existing commercial mapping systems have been demonstrated to consistently and accurately predict rotor locations outside of the pulmonary veins in patients with persistent AF. There is a clear need for robust spatio-temporal techniques that can consistently identify rotors using unique characteristics of the electrical recordings at the pivot point that can be applied to clinical intracardiac mapping. Recently, we have developed four new signal analysis approaches – Shannon entropy (SE), Kurtosis (Kt), multi-scale frequency (MSF), and multi-scale entropy (MSE) – to identify the pivot points of rotors. These proposed techniques utilize different cardiac signal characteristics (other than local activation) to uncover the intrinsic complexity of the electrical activity in the rotors, which are not taken into account in current mapping methods. We validated these techniques using high-resolution optical mapping experiments in which direct visualization and identification of rotors in ex-vivo Langendorff-perfused hearts were possible. Episodes of ventricular tachycardia (VT) were induced using burst pacing, and two examples of rotors were used showing 3-sec episodes of a single stationary rotor and figure-8 reentry with one rotor being stationary and one meandering. Movies were captured at a rate of 600 frames per second for 3 sec. with 64x64 pixel resolution. These optical mapping movies were used to evaluate the performance and robustness of SE, Kt, MSF and MSE techniques with respect to the following clinical limitations: different time of recordings, different spatial resolution, and the presence of meandering rotors. To quantitatively compare the results, SE, Kt, MSF and MSE techniques were compared to the “true” rotor(s) identified using the phase map. Accuracy was calculated for each approach as the duration of the time series and spatial resolution were reduced. The time series duration was decreased from its original length of 3 sec, down to 2, 1, and 0.5 sec. The spatial resolution of the original VT episodes was decreased from 64x64 pixels to 32x32, 16x16, and 8x8 pixels by uniformly removing pixels from the optical mapping video.. Our results demonstrate that Kt, MSF and MSE were able to accurately identify the pivot point of the rotor under all three clinical limitations. The MSE approach demonstrated the best overall performance, but Kt was the best in identifying the pivot point of the meandering rotor. Artifacts mildly affect the performance of Kt, MSF and MSE techniques, but had a strong negative impact of the performance of SE. The results of our study motivate further validation of SE, Kt, MSF and MSE techniques using intra-atrial electrograms from paroxysmal and persistent AF patients to see if these approaches can identify pivot points in a clinical setting. More accurate rotor localization could significantly increase the efficacy of catheter ablation to treat AF, resulting in a higher success rate for single procedures.

Keywords: Atrial Fibrillation, Optical Mapping, Signal Processing, Rotors

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Authors: Bianca W. O. Silva, Adriana C. M. Andrade, Gustavo C. M. Lucena, Virna M. S. Lima

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Introduction: Basic life support (BLS) involves the immediate recognition of cardiopulmonary arrest. Each year, 359.400 and 275.000 individuals with cardiac arrest are attended in emergency departments in USA and Europe. Brazilian data shows that 200.000 cardiac arrests occur every year, and half of them out of the hospital. Medical schools around the world teach BLS in the first years of the course, but studies show that there is a decline of the knowledge as the years go by, affecting the chain of survival. The objective was to analyze the knowledge of medical students about BLS and the retention of this learning throughout the course. Methods: This study included 150 students who were at the second and third year of a medical school in Salvador, Bahia, Brazil. The instrument of data collection was a structured questionnaire composed of 20 questions based on the 2015 American Heart Association guideline. The Pearson Chi-square test was used in order to study the association between previous training, sex and semester with the degree of knowledge of the students. The Kruskal-Wallis test was used to evaluate the different yields obtained between the various semesters. The number of correct answers was described by average and quartiles. Results: Regarding the degree of knowledge, 19.6% of the female students reached the optimal classification, a better outcome than the achieved by the male participants. Of those with previous training, 33.33% were classified as good and optimal, none of the students reached the optimal classification and only 2.2% of them were classified as bad (those who did not have 52.6% of correct answers). The analysis of the degree of knowledge related to each semester revealed that the 5th semester had the highest outcome: 30.5%. However, the acquaintance presented by the semesters was generally unsatisfactory, since 50% of the students, or more, demonstrated knowledge levels classified as bad or regular. When confronting the different semesters and the achieved scores, the value of p was 0.831. Conclusion: It is important to focus on the training of medical professionals that are capable of facing emergency situations, improving the systematization of care, and thereby increasing the victims' possibility of survival.

Keywords: basic life support, cardiopulmonary ressucitacion, education, medical students

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Authors: Syed Dawood Md. Taimur, Md. Hasanur Rahman, Syeda Fahmida Afrin, Farzana Islam

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The concept of myocardial injury, although first recognized from animal studies, is now recognized as a clinical phenomenon that may result in microvascular damage, no-reflow phenomenon, myocardial stunning, myocardial hibernation and ischemic preconditioning. The final consequence of this event is left ventricular (LV) systolic dysfunction leading to increased morbidity and mortality. The typical clinical case of reperfusion injury occurs in acute myocardial infarction (MI) with ST segment elevation in which an occlusion of a major epicardial coronary artery is followed by recanalization of the artery. This may occur either spontaneously or by means of thrombolysis and/or by primary percutaneous coronary intervention (PCI) with efficient platelet inhibition by aspirin (acetylsalicylic acid), clopidogrel and glycoprotein IIb/IIIa inhibitors. In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing the safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of the acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

Keywords: coronary artery disease, percutaneous coronary intervention, myocardial injury, pharmacology

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Authors: R. Fardid, R. Coppes

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Introduction: In mediastinal radiotherapy and to a lesser extend also in total-body irradiation (TBI) radiation exposure may lead to development of cardiac diseases. Radiation-induced heart disease is dose-dependent and it is characterized by a loss of cardiac function, associated with progressive heart cells degeneration. We aimed to determine the in-vivo radiation effects on fibronectin, ColaA1, ColaA2, galectin and TGFb1 gene expression levels in left ventricle heart tissues of rats after irradiation. Material and method: Four non-treatment adult Wistar rats as control group (group A) were selected. In group B, 4 adult Wistar rats irradiated to 20 Gy single dose of 150 Mev proton beam locally in heart only. In heart plus lung irradiate group (group C) 4 adult rats was irradiated by 50% of lung laterally plus heart radiation that mentioned in before group. At 8 weeks after radiation animals sacrificed and left ventricle heart dropped in liquid nitrogen for RNA extraction by Absolutely RNA® Miniprep Kit (Stratagen, Cat no. 400800). cDNA was synthesized using M-MLV reverse transcriptase (Life Technologies, Cat no. 28025-013). We used Bio-Rad machine (Bio Rad iQ5 Real Time PCR) for QPCR testing by relative standard curve method. Results: We found that gene expression of fibronectin in group C significantly increased compared to control group, but it was not showed significant change in group B compared to group A. The levels of gene expressions of Cola1 and Cola2 in mRNA did not show any significant changes between normal and radiation groups. Changes of expression of galectin target significantly increased only in group C compared to group A. TGFb1 expressions in group C more than group B showed significant enhancement compared to group A. Conclusion: In summary we can say that 20 Gy of proton exposure of heart tissue may lead to detectable damages in heart cells and may distribute function of them as a component of heart tissue structure in molecular level.

Keywords: gene expression, heart damage, proton irradiation, radiotherapy

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