Artificial

The CardioWest total artificial heart (TAH) is a pneumatic device that is used as a bridge to heart transplantation and the only TAH available that totally replaces the failing ventricles. It has been utilized in selected centers in the U.S.A. with approval from the Food and Drug Administration. Strict criteria have been developed to select candidates to be bridged with the TAH. The patient must be a heart transplant candidate of age >18 and <59 years with a body surface area (BSA) > or = 1.7 m2, cardiac index (CI) <2.0 L/min/m2, and 2 inotropic agents or 1 plus an intraaortic balloon pump (IABP). A total of 24 heat transplant candidates (Group A) met the entry criteria and underwent placement of the TAH between January 1993 and July 1996. Group A consisted of 23 males; 16 patients had an IABP. The control group (Group B) consisted of 18 heart transplant candidates who met the TAH entry criteria but never received a TAH. Group B consisted of 15 males; 14 patients had an IABP. Preimplantation pulmonary vascular resistance (PVR) (Wood units), serum creatinine (mg/dl), and total bilirubin (mg/dl) were determined in both groups. The mean values for Groups A and B were, respectively, age: 47 and 47 years, BSA: 2.01 and 1.93 m2, CI: 1.5 and 1.8 L/min/m2, PVR: 2.88 and 2.47 Wood units, creatinine: 1.5 and 1.6 mg/dl, and bilirubin: 1.8 and 1.4 mg/dl. In Group A, 1 patient died on the TAH, 1 patient died after transplant, and 22 patients reached transplant and were discharged home for a survival rate of 91.7%. In Group B, 10 patients died while waiting for a heart transplant. Of the 8 patients transplanted, 7 survived and were discharged home for a survival rate of 38.9% (p = 0.0003). In summary the CardioWest TAH provided an excellent and successful method of bridging patients to heart transplantation with a reasonable risk.

Results: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan–Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the ...

Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely.

Artificial Intelligence (AI) has developed at a rapid pace and this provides a good chance to enhance the execution of different fields like business, industries, and the transportation sector. In the transportation field, the AI had applied to overcome the challenges of pollution, environmental deterioration, increasing travel demand, and safety concerns. The good understanding of the relationship between the AI and input data on one hand and characteristics of the transportation system leads to a perfect and successful application of AI. This paper provides an overview of the AI methods with a concentration in two methods of AI, Knowledge Base System method (KBS) and Artificial Neural network systems (ANNs). The paper tried to explain in detail the two methods and their application in transportation with advice and points of strength, weakness, and guidelines for application. The second part of the paper deal with AI application areas in Transportation. The overview concludes by a summary of the two methods with a brief of their important application in transportation.

Several studies have reported the asynchronous closure of normal bileaflet valves (NBVs), resulting in a split in its closing sound; however, the clinical significance of this split has never been studied in malfunctioning bileaflet valves (MBVs). The study comprised 218 valves in 184 patients, including normal monoleaflet valves (n = 10), NBVs (n = 198), and MBVs (n = 10). Valve function was confirmed by cinefluoroscopy prior to analysis of the valve sound by the Morlet continuous wavelet transform (CWT). The split interval (SI) for each heartbeat was measured, and the coefficient of variation (CV) of its mean (valve SI) was calculated as a parameter for the fluctuation of the SI. The CWT of monoleaflet valves showed a single spike, whereas NBVs exhibited a clear split. There was no significant difference in valve SI between the aortic and mitral positions; however, the mean of the CV was significantly greater in the mitral position (n = 90, 0.507 +/- 0.254) than in aortic position...

Crise Ambiental: Ponderando a Respeito de um Dilema da Modernidade refere-se a paper elaborado a partir de pesquisas anteriores do autor, fundamentalmente nos campos do saber antropológico e do geográfico, para prover informação em texto-base para os participantes do IX Encontro Anual de Extensão (ENAEXT) e IV Fórum Regional de Meio Ambiente da Universidade do Oeste Paulista (UNOESTE), de Presidente Prudente (SP), aos 20 de Outubro de 2011, material este, posteriormente publicado pela Revista Crítica Histórica, Ano II, Nº 4, Dezembro/2011, pp. 295-313, publicação semestral do Centro de Pesquisa e Documentação Histórica (CPDHis), dos cursos de História da Universidade Federal de Alagoas (UFAL). Em Outubro de 2019, o texto Crise Ambiental: Ponderando a Respeito de um Dilema da Modernidade foi revisado e masterizado, incorporando cautelas modelares de estilo, reformatação textual e ajustes de programação inerentes ao formato PDF, iniciativa realizada com os préstimos da Editora Kotev (Kotev©), visando disponibilizar o material em acesso livre na Internet em formatação modelar própria para consulta por toda sorte de gadgets eletrônicos, inclusive aparelhos celulares. Confira-se que esta edição eletrônica, incorpora revisão ortográfica acatando regras vigentes da norma culta na língua portuguesa, em vigor desde 2009. Retenha-se que o texto de Crise Ambiental: Ponderando a Respeito de um Dilema da Modernidade é um material gratuito, sendo vedada qualquer modalidade de reprodução comercial e igualmente, de divulgação sem consentimento prévio da Editora Kotev (Kotev©). A citação de Crise Ambiental: Ponderando a Respeito de um Dilema da Modernidade deve obrigatoriamente incorporar referências bibliográficas conforme padrão modelar que segue: WALDMAN, Maurício. Crise Ambiental: Ponderando a Respeito de um Dilema da Modernidade. Série Meio Ambiente, Nº. 20. São Paulo (SP): Editora Kotev. 2019.

This study investigated whether the anatomical differences between right and left internal jugular vein catheterization (RJVC and LJVC) would lead to differences in the frequency of complications, in particular, central vein occlusion (CVO). A group of 479 jugular vein catheterizations, 403 RJVC and 77 LJVC done in 294 prevalent hemodialysis patients were analyzed. A right-sided carotid pseudoaneurysm was the only major puncture-related complication. A total of 78 RJVC and 17 LJVC were inserted more than once in the same position. Of the RJVC, 44 (10.9%) of 403 were removed because of infection compared with 16 (20.8%) of 77 LJVC (P < 0.02). The overall incidence of infections was 1.58 episodes of infection per 1000 catheter days, 1.57 for RJVC and 3.72 for LJVC, respectively. Catheter dwell times were not different. A group of 127 patients with former RJVC and 44 with LJVC had ipsilateral arteriovenous access (RJVC+ and LJVC+ group, respectively). Four diabetic LJVC+ developed severe arm swelling secondary to CVO leading ultimately to access ligation. The RJVC+ group had no access ligated. LJVC may cause CVO in diabetics.

The Levitronix UltraMag blood pump is a next generation, magnetically suspended centrifugal pump and is designed to provide circulatory support for pediatric and adult patients. The aim of this study is to investigate the hemodynamic and hemolytic characteristics of this pump using the computational fluid dynamics (CFD) approach. The computational domain for CFD analysis was constructed from the three-dimensional geometry (3D) of the UltraMag blood pump and meshed into 3D tetrahedral/hybrid elements. The governing equations of fluid flow were computationally solved to obtain a blood flow through the blood pump. Further, hemolytic blood damage was calculated by solving a scalar transport equation where the scalar variable and the source term were obtained utilizing an empirical power-law correlation between the fluid dynamic variables and hemolysis. To obtain mesh independent flow solution, a comparative examination of vector fields, hydrodynamic performance, and hemolysis predictions were carried out. Different sizes of tetrahedral and tetrahedral/hexahedral mixed hybrid models were considered. The mesh independent solutions were obtained by a hybrid model. Laminar and SST κ–ω turbulence flow models were used for different operating conditions. In order to pinpoint the most significant hemolytic region, the flow field analysis was coupled to the hemolysis predictions. In summary, computational characterization of the device was satisfactorily carried out within the targeted operating conditions of the device, and it was observed that the UltraMag blood pump can be safely operated for its intended use to create a circulatory support for both pediatric and adult-sized patients. 

Previous studies have demonstrated the potential advantages of pulsatile flow as compared with continuous flow. However, to date, physiologic pumps have been technically complex and their application has therefore remained in the experimental field. We have developed a new type of centrifugal pump, which can provide pulsatile as well as continuous flow. The inner wall of a centrifugal pump is pulsed by means of a flexible membrane, which can be accurately controlled by means of either a hydraulic or pneumatic driver. The aim of this study was to assess the hydraulic behavior of the new pump in terms of surplus hemodynamic energy (SHE). We conducted experiments using a mock circulatory system including a membrane oxygenator. No differences were found in the pressure-flow characteristics between the new pump and a conventional centrifugal pump, suggesting that the inclusion of the flexible membrane does not alter hydraulic performance. The value of SHE rose when systolic volume was increased. However, SHE dropped when the percentage of ejection time was reduced and also when the continuous flow (programmed by the centrifugal console) increased. Mean flow matched well with the continuous flow set by the centrifugal console, that is, the pulsatile component of the flow was exclusively controlled by the pulsatile console, and was therefore independent of the continuous flow programmed by the centrifugal console. The pulsatility of the new pump was approximately 25% of that created with a truly pulsatile pump.