Thesis (M.S.)--California Polytechnic State University, 2009. / Title from PDF title page; viewed on March 11, 2009. "February 2009." "In partial fulfillment of the requirements for the degree [of] Master of Science in Engineering with Specializations in Biomedical Engineering." "Presented to the faculty of California Polytechnic State University, San Luis Obispo." Major professor: Lanny Griffin, Ph.D. Includes bibliographical references (p. 42). Also available on microfiche.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaves 156-176) Also available in print.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaves 156-176) Also available online.

Cardiac output, the volume of blood pumped by the heart over time, is a powerful clinical metric used by physicians to assess overall cardiac health and patient well-being. However, current cardiac output estimation methods are typically invasive, time-consuming, expensive, or some combination of all three. Patients that receive artificial cardiac pacemaker devices are particularly susceptible to cardiac dysfunction and often require long-term cardiac monitoring support. This thesis proposes a novel cardiac output monitoring solution which leverages an implantable intracardiac medical device. The principles of traditional impedance cardiography, an established cardiac output monitoring technique in practice for over fifty years, have been adapted to incorporate a leadless artificial cardiac pacemaker, an implantable medical device contained entirely within the heart. This novel method, colloquially referred to as Z-Cardio, monitors time-varying intracardiac impedance modulation to assess changes in cardiac output. In this study, technologies both old and new are synthesized to produce a novel and effective method of monitoring a critical metric of cardiac health.

Software testing, specifically in the medical device field, has become increasingly complex over the last decade. Technological enhancements to simulate clinical scenarios and advancements in communicating to medical devices have created the need for better testing strategies and methodologies. Typical medical device companies have depended on manual testing processes to fulfill Food and Drug Administration (FDA) submission requirements specifically Class III devices which are life supporting, life sustaining devices. At St. Jude Medical, software testing of Class III devices such as implantable cardioverter-defibrillators (ICDs), pacemakers, and pacing analyzers are given top priority to ensure the highest quality in each product. High emphasis is made on improving software testing for ease of use and for catching more software errors in each device. A significant stride in testing has automated the process and has provided software verification teams with the tools they need to successfully test and deliver high quality products. By creating software libraries which interact with communication to the other interfaces needed to test medical devices, test engineers can focus on fully testing device requirements and will not be concerned with how each test will interact with the device or any other testing tools. The main focus will be a specific St. Jude Medical device known as the Pacing System Analyzer (PSA). The PSA device will be used to demonstrate how verification engineers are able to benefit from software libraries and allow the testing process and test development to be fully automated. New technologies and standards will be created to simulate clinical scenarios and to communicate to new devices. The goal is to use software engineering principles to create standard test libraries which sustain these changes while still allowing testers to focus on finding issues for each device.

An object of this diploma thesis is a study of daily rhythms of municipalities in the Central Bohemian Region. The aim is to bring new insights into the daily rhythms of the suburban zone of the Prague Metropolitan Area and the Central Bohemian Region. The work has three main objectives. The first objective is to create a typology of the Central Bohemian municipalities according to their daily rhythms. Mobile phone location data is used to create the typology. There was used a method called cluster analysis. The second objective is to evaluate the daily rhythms in selected municipalities (Kněževes, Ořech, Tochovice) in detail with other data (mobile phone location data from Prague Institute of Planning and Development and commuting data from the Census 2011). Using these sources, I want to highlight the obstacles, but also the benefits of using mobile phone location data in studying of daily rhythms. The last objective is to describe in these three municipalities the pacemakers which influent their timing. The results show that in the Central Bohemian region dominate municipalities with a residential type of daily rhythm. Most of these municipalities are located in the suburban zone of Prague, while in other municipalities of the Central Bohemian region is the rhythm often almost balanced. Large...

Nous sommes sur le point de montrer que le muscle squelettique adulte contient une population de cellules souches capables de se différencier in vitro en cellules cardiaques présentant des battements automatiques. Ces cellules pulsantes différenciées en culture, possèdent toutes les caractéristiques d’un type de cellules spécialisées dans la conduction cardiaque : les cellules pacemaker du sinus atrial De même, lorsque ces cellules souches sont transplantées chez des souris mutantes qui présentent des troubles de la conduction cardiaque, elles sont retrouvées différentiées en cellules pacemaker dans le cœur et améliorent significativement les troubles du rythme de ces souris. Ces résultats indiquent qu’il est important d’isoler une population avec le même potentiel à partir du muscle squelettique humain étant donné le potentiel réparateur extrêmement prometteur de ces cellules souches adultes pour leur utilisation en thérapie cellulaire des dysfonctionnements du rythme cardiaque. Une analyse préliminaire sur le microcèbe, modèle primate, nous a d’ores et déjà permis de valider la différentiation in vitro des cellules souches dérivées du muscle squelettique en cellules pacemaker. / We show that adult multipotent Muscle-Derived Stem Cells (MDSC) have the ability to differentiate into cardiac pacemaker cells in vitro and in vivo. In vitro, differentiated beating pacemaker-like cells remain active for months and express all the markers of native cardiac pacemakers. They show both hyperpolarization-activated “funny” current (If) and b-adrenergic- and cholinergic-responsive spontaneous Ca2+ transients. In vivo, systemic injection of MDSC from wt muscle significantly improved heart rhythm in severely bradycardic mutant CaV1.3-/- mice. This functional recovery was accompanied by differentiation of donor-derived CaV1.3-expressing cells in the sinoatrial node. MDSC from the primate Microcebe revealed a similar ability to differentiate in vitro into functional pacemaker-like cells. MDSC thus represent a unique, non-tumorigenic and directly transplantable stem cell source shown to efficiently engraft in mutant mouse heart and correct human-mirrored severe rhythm disorders.

Cette thèse s’inscrit dans un contexte d’activité en forte croissance dans le domaine des implants médicaux, stimulée par de nombreux progrès dans le domaine des micro-capteurs et de la micro-électronique. L’autonomie en énergie des implants demeure cependant un facteur limitant. Notre travail a pour objectif de repousser les limites actuelles en termes de miniaturisation et de durée de vie. Il contribue au développement d’une solution basée sur la récupération d’énergie mécanique du cœur pour alimenter durablement un pacemaker miniaturisé sans sonde de nouvelle génération, dit « pacemaker leadless ».Le microsystème de récupération d’énergie étudié est composé d’un résonateur mécanique de type masse-ressort associé à un transducteur électrostatique. Il a pour particularité une architecture tridimensionnelle, dont la forme permet de profiter au maximum de l’espace disponible dans la capsule cylindrique du pacemaker. L'utilisation de la troisième dimension associée à un design original permet en outre d’obtenir un effet de pseudo multiplication de fréquence qui doit conduire, d’après les modèles que nous avons développés, à des densités de puissance nettement supérieures à celles présentées dans l'état de l'art. Pour réaliser ce microsystème tridimensionnel, nous avons développé un procédé de fabrication additif qui repose sur des étapes de micro moulage d'un matériaux structurel obtenu par croissance électrolytique (nickel), de croissance d'un matériau sacrificiel (cuivre) et de polissage. L’identification d’imperfections géométriques dues au procédé et aux matériaux utilisés nous a amené à améliorer la conception du transducteur. Par ailleurs, de nombreux verrous de fabrication ont été levés au cours de cette thèse grâce à la mise en œuvre d’une instrumentation dédiée. Ce procédé nous a permis de fabriquer un premier prototype tridimensionnel du micro-transducteur électrostatique composé de 10 couches de nickel. D’autres métaux élaborés par croissance électrolytique pourraient être envisagés pour réaliser des microsystèmes tridimensionnels, suivant les besoins de l’application considérée. Afin d’anticiper d’éventuels problèmes de compatibilité des micro-dispositifs avec l'imagerie par résonance magnétique, nous avons mis au point le procédé de croissance électrolytique d’un matériau non-magnétique à base de nickel dopé au phosphore. / This thesis contributes to the medical implants field, which is stimulated by many advances in the fields of microelectronics and microsensors. However, electrical energy lifespan of implants and large size of batteries are still a problem. Our work aims at pushing back these limits. It contributes to the development of a solution based on mechanical energy harvesting from the heart motion. The objective is to sustainably power a new generation of pacemakers without lead, so-called "leadless pacemakers."The studied energy harvesting microsystem consists in a spring-mass-type mechanical resonator associated with an electrostatic transducer. Its originality comes from a three-dimensional architecture, whose shape fits pretty well with the cylindrical shape of the pacemaker capsule. The use of the third dimension combined with an original design enables to get a pseudo multiplication frequency effect. Thanks to this effect, our simulation models predict power densities significantly higher than state-of-the-art figures reported in literature. To fabricate this three-dimensional microsystem, we have developed an additive manufacturing process based on steps of micro-molding of a structural material (electroplated nickel), electroplating of a sacrificial material (copper) and planarization. Identification of imperfections related to the fabrication process and the materials used allowed us to improve the design of the transducer. Moreover, many manufacturing obstacles were overcome during this thesis through the implementation of dedicated instrumentation. This new process has enabled us to fabricate a first three-dimensional prototype of the electrostatic micro-transducer made of 10 layers of nickel. Other electroplated metals can be envisaged to achieve three-dimensional microsystems, depending on the application requirements. In order to anticipate any compatibility issue of our microsystem with magnetic resonance imaging, we have developed the electrodeposition process of a nonmagnetic material: phosphorous doped nickel.

Pulmonary edema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. When the heart is not able to pump blood to the body efficiently, fluid can back up into the veins that take blood through the lungs to the left atrium. This then builds up the pressure in the blood vessels and fluid is pushed into the alveoli in the lungs. The fluid reduces normal oxygen movement through the lungs and can cause impaired gas exchange and respiratory failure. There are many causes of congestive heart failure that may lead to pulmonary edema such as heart attack, any diseases of the heart that weaken or stiffen the heart muscle, a leaking or narrowed heart valve, and sudden, severe high blood pressure. Pulmonary edema is a strong indicator of congestive heart failure in patients and therefore can be used as a gauge for congestive heart failure. One way to diagnose cardiogenic pulmonary edema constantly is through the continuous monitoring of the transthoracic impedance throughout the day. One method to achieve this constant monitoring is through the use of a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). Many patients who are at risk of heart failure have these medical devices implanted already. In these implantable cardiac devices, the connected cardiac leads can be utilized to continually screen several impedance vectors for decreases in impedance in the thoracic cavity. A pacemaker or ICD that implements Pulmonary Edema Monitoring is designed to continuously monitor these impedance vectors and alert the patient to seek medical attention. This thesis will discuss the implementation of Pulmonary Edema Monitoring via screening of multiple impedance vectors in a pacemaker or implantable cardioverter defibrillator and the effectiveness of this monitoring method. Furthermore, the design, implementation, and testing of this feature will be explored in greater detail.

Encore en 2015, un grand nombre d’individus décèdent de pathologies du rythme cardiaque non contrôlées ou d’un manque de disponibilité de donneurs d’organes compatibles. Le génie tissulaire en créant, réparant ou améliorant la fonction des tissus est une option prometteuse afin de diminuer la mortalité associée à ces pathologies. L’objectif global de mon projet de recherche était de développer des outils et d’étudier l’impact fonctionnel des différents stimuli (mécanique et électrique) de l’environnement cardiaque dans le but de définir des conditions optimisées de culture pour la fabrication de tissu de remplacement par génie tissulaire. Cette thèse présente le développement d’un bioréacteur; un système qui optimise les conditions pour la culture cellulaire. L’efficacité du bioréacteur est validée par des expériences de culture cellulaire qui se concentrent sur la prolifération cellulaire, l’organisation cellulaire, l’expression génique et protéique de même que sur l’activité contractile spontanée. En premier lieu, nos résultats montrent, bien que la fréquence de contraction moyenne mesurée reste inchangée, une augmentation significative du nombre de cas de réentrées pour les cultures sur verre comparativement aux cultures sur Polydimethylsiloxane. Une augmentation de l’instabilité spatiotemporelle a été démontrée lorsque les cardiomyocytes étaient déposés sur un support de Polydimethylsiloxane et cette dernière corrèle avec une diminution non-significative de l’ARNm de la connexine-43 et une augmentation significative de l’ARNm pour CaV3.1 et HCN2. La culture sur Polydimethylsiloxane est également associée avec une plus forte réponse à l’isoprotérénol (β-adrénergique) et à l’acétylcholine (parasympathique). En second lieu, nous présentons les résultats du développement de notre bioréacteur en mettant l’emphase sur les caractéristiques (composantes accessibles, étirement uniaxial, électrode de carbone, stimulation biphasique) tout en validant notre approche pour optimiser les conditions de culture et améliorer la rentabilité des étapes de production du tissu de remplacement. Pour finir, nous partageons une nouvelle approche d’évaluation des caractéristiques contractiles de cellules cardiaques en culture. Nous avons développé des algorithmes qui utilisent les données de vidéomicroscopie pour valider l’impact de stimuli, évaluer l’hétérogénéité du signal enregistré et détecter des conditions favorables au développement d’arythmies. / In 2015, there are still a large number of people who die due to diseases of uncontrolled heart rhythm or due to lack of availability of compatible donor organs. Tissue engineering aim to create, repair or improve the function by different techniques. Tissue engineering is a viable option to reduce the mortality associated with many heart conditions. The overall goal of my PhD research was to study the functional impact of different stimuli in cardiac environment (mechanical and electrical stimulation) on cardiac cell cultures. This, in order to define optimized culture conditions for the production of replacement tissue using tissue engineering. This thesis presents the stages of creation and development of a bioreactor; a system that permits the culture of cardiac cells by integrating various stimuli. The optimization of culture conditions by using the bioreactor was confirmed by cell culture experiments that focus on cell proliferation, cell organization, gene and protein expression as well as on spontaneous activity. In the first place, our results show that although mean frequency of spontaneous activity remained unaltered, incidence of reentrant activity was significantly higher in samples cultured on glass compared to PDMS substrates. Higher spatial and temporal instability of the spontaneous rate activation was found when cardiomyocytes were cultured on PDMS, and correlated with decreased connexin-43 (unsignificant) and a significant increased CaV3.1 and HCN2 mRNA levels. Compared to cultures on glass, cultures on PDMS were associated with the strongest response to isoproterenol (β-adrenergic) and acetylcholine (parasympathetic). Secondly, we present the design of our bioreactor with an emphasis on its characteristics and by putting in perspective the relevance of our approach to optimize culture conditions and to improve profitability culture experiences and production stages of replacement heart tissue. Finally, a new approach is proposed to evaluate the characteristics of the contractile cells in culture which allows to validate the functional impact of stimuli, evaluate the heterogeneity in the beating behavior of the cells and to detect localized abnormal activity that could favour arrhythmia.