During the last two decades, since the heart has become a direct target for various surgical procedures for the correction of several abnormalities, interest in understanding its basic regulatory mechanisms and performance has increased considerably. Many experiments have been devised to study cardiac performance, under different circumstances, as an isolated preparation or as an integrated part of a functioning system. The results derived from these investigations not only proved to be important conceptual tools in making many observed phenomena more readily comprehensible, but also provided us with valuable basic principles to treat cardiac patients before and after open heart operations. The purpose of this paper is to investigate the control of the function of the heart in dogs with the chest and pericardium open, and under strictly controlled conditions. In spite of all the work j done in this field, there still exists some degree of confusion regarding the relative importance of autoregulatory mechanisms and extrinsic factors governing cardiac performance. Without trying to take sides as to the priority of either of these mechanisms, we have made an effort to confine our interest mainly to the intrinsic autoregulation of the heart.

BACKGROUND: In India, an estimated 200,000 congenital heart defects are diagnosed each year but only 50 pediatric cardiac health centers exist with capacity to perform pediatric cardiac surgeries (PCS). Majority of the centers are private and have high cost of care. Hrudaya Foundation, a non-profit, was started to cover in-hospital costs of pediatric cardiac surgery for poor families. For the study, risk factors of post-operative infection (major outcome of PCS) were evaluated and gaps in care faced by Hrudaya Foundation patients were identified. METHODS: To identify risk factors associated with POI, retrospective cohort study was conducted. Medical records and foundation notes of 1028 interventional CATH and open heart surgery patients were examined. Chisq tests and logistic regressions on socio-economic and clinical factors were run to identify risk factors of POI for open heart surgery patients. The study also tested associations of patients’ community characteristics with pre-operative conditions and POI, like lack of access to improved latrines, distance to hospital, under & unemployment rate, and maternal illiteracy rates. To identify gaps in care, the study collected and analyzed interviews with 11 staff and 27 parents. The semi-structured interviews focused on care pathway from birth to post-discharge follow-up, financial obstacles, and an asset assessment. RESULTS: Pediatric open heart surgery patients had a 19% post-operative infection rate and a 5% mortality rate. Post-operative infections were significantly associated with age of 12 months and under, severely underweight, history of prior cardiac intervention, high risk surgery (RACHS-1 score 3 & 4), delayed sternal closure, and re-operation within same admission when the other risk factors were kept constant. POI did not have a statistically significant correlation with community level characteristics. The study found several gaps in care. Parents had difficulty getting a referral to affordable specialty cardiac care after diagnosis. Even after a referral to Hrudaya Foundation, parents still had to borrow large sums of money due to travel, lodging, and follow-up expenses. Financial constraints created barriers to maintain wellness before and after intervention. Most parents did not have consistent income and they were not aware of many assets in their communities. CONCLUSION: Patients with significant risk factors for POI should have more aggressive infection management. Though close to 41% of the sample were severely underweight, the risk factor was not recognized as actionable. Patients should get nutrition supplementation prior to surgery admission and parents should be notified of their child’s malnutrition status at discharge. Additionally, BPL parents need additional resource and system navigation assistance to reduce financial constraints and maintain their child’s follow-up care and nutrition. / 2021-05-12T00:00:00Z

Atherosclerosis accounts of 50% of the deaths in the western world leading to a plethora of diseases that include myocardial infarction, stroke, and peripheral artery disease. Currently available imaging modalities have inherent limitations, including ionizing radiation, lack of compositional information, and difficulty acquiring volumetric data that constrain their use in studying cardiovascular disease. Photoacoustic Tomography (PAT) has emerged as a promising modality that could address these limitations to improve the characterization and diagnosis of atherosclerosis-related conditions. Non-ionizing pulsed laser light is delivered to tissue leading to thermoelastic expansion followed by propagation of a pressure transient that can be detected with an ultrasound transducer. The magnitude of the ultrasonic PAT signal is proportional to the optical absorption at that location, revealing physiologically relevant compositional information of the tissue. The objective of this work is to therefore develop advanced volumetric imaging techniques to characterize disease progression in a murine model of atherosclerosis. The novelty of this work lies in the methodology and validation presented towards characterization of small animal vascular lipid accumulation with a high-resolution PAT system that utilizes the second near-infrared window (1100-1300nm). Additionally, we utilized <i>in situ </i>PAT to cross-sectionally assess lipid deposition and <i>in vivo</i>ultrasound to longitudinally assess hemodynamic, kinematic, and morphological changes during atherosclerosis progression. Together, this dissertation lays the foundation towards utilizing dual-modality PAT and ultrasound for various applications including understanding atherosclerosis pathophysiology, evaluation of novel therapeutics, and translation of clinically relevant techniques.

No description available.

<p>Lower extremity peripheral artery disease (PAD) is an increasingly prevalent manifestation of atherosclerosis that substantially limits mobility and increases mortality. Few options currently exists for practical conservative treatment of individuals with PAD. We have previously demonstrated that lower limb heat therapy (HT) can improve leg blood flow and reduce systolic blood pressure in patient with lower extremity PAD. Using three unique clinical trials, we sought to test the hypothesis that repeated exposure to HT would improve walking tolerance and vascular function in patients with lower extremity PAD. In these trials, we have sought to examine the clinical efficacy of HT, the physiological mechanisms which may underpin changes in walking endurance in this population, and also the practicality of employing HT in a home-based setting. The primary finding from these trials was that daily application of leg HT improved walking endurance in patients with lower-extremity PAD. Furthermore, the treatment adherence rate was excellent (<96%) and was not associated with severe adverse events. The changes in walking tolerance were consistently not associated with positive changes in vascular function, suggesting an alternative mechanism should be examined in future studies. </p>

Mitte des Jahres 2009 wurden an 30 Tagen am neu installierten Herzkatheterarbeitsplatz der Abteilung für Kardiologie und Angiologie, der Klinik für Innere Medizin Messungen durchgeführt um die Exposition von Untersucher und assistierender Pflegekraft während koronarangiographischer und –interventioneller Prozeduren an einer der modernsten Herzkatheterarbeitsplätze zu erfassen. Dazu wurden an 8 Körperteilen des Untersuchers und Assistenzpersonals (jeweils Auge, Schulter, Handrücken und Unterschenkel beidseits) Thermolumeszenzdosimeter angebracht und diese dann nach einem Untersuchungstag ausgewertet. Bei den Ergebnissen stellte sich heraus, dass die empfohlenen jährlichen Expositionswerte unter den vorherrschenden Bedingungen nicht erreicht werden und die Arbeit an einem modernen Herzkatheterarbeitsplatz als sicher gilt. Jedoch ist das Strahlenfeld als solches sehr inhomogen und weist auch starke Schwankungen je nach Art der Untersuchung, der Erfahrung des Untersuchers und auch der Komplexität des Falles auf. Desweiteren muss beachtet werden, dass die technischen Neuerungen der letzten Jahre erheblich zur Verminderung der Exposition geführt haben und somit an älteren Anlage eine Überschreitung der jährliche empfohlenen Teilkörperdosis als wahrscheinlich gilt.

A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.

Introduction: Traumatic Brain Injury (TBI) remains a significant public health burden in the United States. Persons afflicted with more severe TBIs are usually admitted to an ICU, where they are at risk for a number of complications throughout their hospitalization. Recent literature has attempted to describe such complications from a cardiovascular perspective as part of a “cardio-cerebral syndrome.” We described the frequency of cardiac complications in the ICU among patients with a TBI and compared patients with and without measured cardiac dysfunction. We investigated the potential impact of cardiac dysfunction on in-hospital mortality. Methods: This was a retrospective review of a prospective cohort study in adult ICU patients with moderate-to-severe TBI (GCS≤12). We measured cardiac dysfunction using initial EKG echocardiography findings and peak serum troponin levels during hospitalization. Primary outcome was in-hospital mortality for patients with and without cardiac dysfunction using multivariable adjusted Cox Proportional Hazards Regression. Secondary outcomes examined the relationship between severity of brain injury and degree of cardiac dysfunction. Results: Ordinal logistic regression showed patients with more indicators of cardiac injury were significantly more likely to have greater brain injury as reflected by lower GCS scores (OR 0.76; 95%CI 0.58-0.99). There was a significantly increased multivariable adjusted risk of dying for each increase in measured cardiac injury (HR 2.41; 95% CI 1.29-4.53). Conclusions: Cardiac dysfunction was frequently observed in patients with TBI and we showed an association between increasing TBI severity and development of cardiac injury. Cardiovascular dysfunction was associated with an increased risk of in-hospital death. Adverse outcomes from TBI could potentially be mediated by cardiac injury, which could be used as a target for therapeutic intervention.

Background: The initial systolic blood pressure (SBP) in patients with acute heart failure (AHF) can be used as a guide when choosing specific pharmacologic treatments by helping identify the underlying type of HF (e.g., HF with preserved ejection fraction). Clinical experience and research data from our medical center suggests that AHF with elevated SBP may be presenting less frequently than in the past. This may call into question the utility of initial SBP as a clinical guide. The goal of this Master’s Thesis is to test the hypothesis that the frequency of AHF patients with a SBP>160mmhg has declined over time. Methods: This observational study compares data from 4 cohorts of adult patients admitted with AHF in central MA. Data were obtained from a contemporary (2011-2013) study of patients with AHF as well as from the 1995, 2000, 2006 Worcester Heart Failure Study (WHFS) cohorts. The Framingham criteria the diagnostic criterion for AHF. The main outcome was the proportion of patients with AHF with a SBP > 160 mmHg who presented in each of the 4 study cohorts and was examined by multivariate logistic regression. Results: 2,366 patients comprised the study population. The average age was 77 years, 55% were female, 94% white, and 75% had prior HF. In 1995 33.6% of AHF patients had a SBP >160 mmHg compared to 19.5% in 2011-2013 (p160 mmHg in 2006 (0.64, (0.42-0.96)) and 2011-13 (0.46, (0.28-0.74)). Conclusion: The proportion of patients with AHF and an initial SBP >160 mmHg has significantly declined over time. This may warrant a reexamination of the utility of SBP to inform diagnosis and treatment in patients with AHF.

Acute damage to the heart, as in the case of myocardial infarction (MI), triggers a robust inflammatory response to the sterile injury and requires a complex and highly organized wound healing processes for survival. Cortical bone stem cell (CBSC) therapy has been shown to attenuate the decline in cardiac function associated with MI in both mouse and swine models. However, the cellular changes brought about by CBSC treatment and their relationship to inflammation and the wound healing process are unknown. We observed that CBSCs secrete paracrine factors known to have immunomodulatory properties, most notably Macrophage Colony Stimulating Factor (M-CSF) and Transforming Growth Factor-b, but not IL-4. Macrophages treated with CBSC medium containing these factors polarized to a hybrid M2a/M2c phenotype characterized by increased CD206 expression but not CD206 and CD163 co-expression, increased efferocytic ability, increased IL-10, TGF-b and IL-1RA secretion, and increased mitochondrial respiration in the absence of IL-4. Media from these macrophages increased proliferation and decreased a-Smooth Muscle Actin expression in fibroblasts in vitro. In addition, CBSC therapy increased macrophages, CD4+ T-cells, and fibroblasts while decreasing myocyte, macrophage, and total apoptosis in an in vivo swine model of MI. From these data, we conclude that CBSCs are modulating the immune response to MI in favor of an anti-inflammatory reparative response, ultimately reducing cell death and altering fibroblast populations resulting in smaller scar and preserved cardiac geometry and function. / Biomedical Sciences