A pulsatile flow model for in vitro quantitative evaluation of prosthetic valve regurgitation

A pulsatile pressure-flow model was developed for in vitro quantitative color Doppler flow mapping studies of valvular regurgitation. The flow through the system was generated by a piston which was driven by stepper motors controlled by a computer. The piston was connected to acrylic chambers designed to simulate "ventricular" and "atrial" heart chambers. Inside the "ventricular" chamber, a prosthetic heart valve was placed at the inflow connection with the "atrial" chamber while another prosthetic valve was positioned at the outflow connection with flexible tubes, elastic balloons and a reservoir arranged to mimic the peripheral circulation. The flow model was filled with a 0.25% corn starch/water suspension to improve Doppler imaging. A continuous flow pump transferred the liquid from the peripheral reservoir to another one connected to the "atrial" chamber. The dimensions of the flow model were designed to permit adequate imaging by Doppler echocardiography. Acoustic windows allowed placement of transducers distal and perpendicular to the valves, so that the ultrasound beam could be positioned parallel to the valvular flow. Strain-gauge and electromagnetic transducers were used for measurements of pressure and flow in different segments of the system. The flow model was also designed to fit different sizes and types of prosthetic valves. This pulsatile flow model was able to generate pressure and flow in the physiological human range, with independent adjustment of pulse duration and rate as well as of stroke volume. This model mimics flow profiles observed in patients with regurgitant prosthetic valves.

Short-term follow-up of exercise training program and beta-blocker treatment on quality of life in dogs with naturally acquired chronic mitral valve disease

This study aimed to evaluate the effects of carvedilol treatment and a regimen of supervised aerobic exercise training on quality of life and other clinical, echocardiographic, and biochemical variables in a group of client-owned dogs with chronic mitral valve disease (CMVD). Ten healthy dogs (control) and 36 CMVD dogs were studied, with the latter group divided into 3 subgroups. In addition to conventional treatment (benazepril, 0.3-0.5 mg/kg once a day, and digoxin, 0.0055 mg/kg twice daily), 13 dogs received exercise training (subgroup I; 10.3±2.1 years), 10 dogs received carvedilol (0.3 mg/kg twice daily) and exercise training (subgroup II; 10.8±1.7 years), and 13 dogs received only carvedilol (subgroup III; 10.9±2.1 years). All drugs were administered orally. Clinical, laboratory, and Doppler echocardiographic variables were evaluated at baseline and after 3 and 6 months. Exercise training was conducted from months 3-6. The mean speed rate during training increased for both subgroups I and II (ANOVA, P>0.001), indicating improvement in physical conditioning at the end of the exercise period. Quality of life and functional class was improved for all subgroups at the end of the study. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level increased in subgroup I from baseline to 3 months, but remained stable after training introduction (from 3 to 6 months). For subgroups II and III, NT-proBNP levels remained stable during the entire study. No difference was observed for the other variables between the three evaluation periods. The combination of carvedilol or exercise training with conventional treatment in CMVD dogs led to improvements in quality of life and functional class. Therefore, light walking in CMVD dogs must be encouraged.

Altérations de la repolarisation ventriculaire induites par l’exercice dans la sténose congénitale modérée de la valve aortique

Introduction: La surcharge de pression ventriculaire augmente à l’exercice chez les patients avec une sténose de valve aortique (SVA). Lorsqu’il n’y a aucun symptôme apparent, il est cependant difficile d’indiquer l’intervention chirurgicale en utilisant seulement les indices de surcharge de pression ventriculaire. D’autres paramètres, tels que la dispersion de la repolarisation ventriculaire (d-QT), qui augmentent avec le gradient de pression transvalvulaire (GPT), n’ont pas été étudiés dans la SVA. L’objectif de l’étude était de déterminer le modèle de réponse du segment QT et de la d-QT à l’épreuve d’effort chez des enfants avec une SVA congénitale modérée afin d’évaluer l’impact de la surcharge de pression ventriculaire selon une perspective électrophysiologique. Matériel et méthodes: 15 patients SVA modérés ont été comparés à 15 sujets contrôles appariés pour l’âge (14.8±2.5 ans vs. 14.2±1.5 ans) et pour le sexe (66,7% de sujets mâles). Tous les sujets ont fait une épreuve d’effort avec enregistrement électrocardiographique à 12 dérivations. Le segment QT a été mesuré à partir du début du complexe QRS jusqu’à l’apex de l’onde T (QTa) au repos, à l’effort maximal ainsi qu’après 1 et 3 minutes de récupération. La longueur du segment QT a été corrigée selon l’équation de Fridericia et la d-QT a été calculée. Résultats: La longueur du segment QT corrigée (QTc) était similaire au repos entre les groupes d’étude, mais était significativement élevée chez les SVA en comparaison avec le groupe contrôle à l’effort maximal (p=0.004) ainsi qu’après 1 (p<0.001) et 3 (p<0.001) minutes de récupération. Une interaction significative a été identifiée entre les groupes pour la d-QT (p=0.034) et les tests post hoc ont révélé une différence significative seulement au repos (p=0.001). Conclusions: Les anomalies de repolarisation ventriculaire peuvent être révélées par l’évaluation de la repolarisation électrique lors de l’épreuve d’effort chez les SVA modérées asymptomatiques. L’utilisation de la réponse du QT à l’effort pourrait être bénéfique pour l’optimisation de la stratification du risque chez ces patients.

Sélection in vivo par phage display dans un modèle de sténose valvulaire aortique chez la souris pour la découverte de nouveaux peptides ciblant la valve aortique

La sténose valvulaire aortique (SVA) est la maladie des valves cardiaques la plus répandue dans les pays développés qui touche les personnes âgées. La SVA est un processus actif caractérisé par des dépôts de lipides, de l’inflammation, de la fibrose et une calcification active des feuillets qui progresse vers un épaississement et durcissement de la valve aortique et une diminution de l’aire de la valve aortique. Nous avons émis l’hypothèse que la pathogénèse de la SVA modifie progressivement l’endothélium de la valve aortique, ce qui engendre l’expression de biomarqueurs spécifiques aux tissus et à la maladie. On rapporte dans cet étude, l’utilisation de la technique de sélection in vivo par phage display d’une librairie de peptides aléatoires afin de trouver de nouveaux peptides candidats qui se lieraient à des biomarqueurs spécifiques à la valve aortique malade d’une souris. Des souris ATX (LDLr-/-;Tg(hApoB+/+)) âgées atteintes de la SVA ont été utilisées pour la sélection in vivo d’une librairie de peptides aléatoires de 7 acides aminés contraints ou linéaires. Après 4 tours de criblage, on a caractérisé 14 phages différents qui ont été séparés en 5 motifs consensus pour la librairie linéaire et 11 phages différents qui représentent 5 différents motifs consensus pour la libraire de peptides contraints. La spécificité de 4 phages candidats de la librairie linéaire et de 5 phages de la librairie contrainte a été étudiée par l’immunomarquage des peptides d’intérêt exprimés par les phages sur les coupes de tissus de la valve aortique malade par rapport aux tissus contrôles du foie, du rein, de la rate, du ventricule et du poumon. Parmi eux, 6 phages représentent des peptides candidats intéressants qui ont besoin d’être testés davantage pour évaluer leur spécificité in vivo à la valve. Bien qu’il reste encore de la validation à effectuer, les peptides candidats spécifiques trouvés peuvent représenter des agents moléculaires d’imagerie utiles ou des transporteurs dans la livraison de drogue qui ciblent la valve aortique malade.

Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Piezoresistive cantilevers with an integrated bimorph actuator

Scanning Probe Microscopy (SPM) has become of fundamental importance for research in area of micro and nano-technology. The continuous progress in these fields requires ultra sensitive measurements at high speed. The imaging speed limitation of the conventional Tapping Mode SPM is due to the actuation time constant of piezotube feedback loop that keeps the tapping amplitude constant. In order to avoid this limit a deflection sensor and an actuator have to be integrated into the cantilever. In this work has been demonstrated the possibility of realisation of piezoresistive cantilever with an embedded actuator. Piezoresistive detection provides a good alternative to the usual optical laser beam deflection technique. In frames of this thesis has been investigated and modelled the piezoresistive effect in bulk silicon (3D case) for both n- and p-type silicon. Moving towards ultra-sensitive measurements it is necessary to realize ultra-thin piezoresistors, which are well localized to the surface, where the stress magnitude is maximal. New physical effects such as quantum confinement which arise due to the scaling of the piezoresistor thickness was taken into account in order to model the piezoresistive effect and its modification in case of ultra-thin piezoresistor (2D case). The two-dimension character of the electron gas in n-type piezoresistors lead up to decreasing of the piezoresistive coefficients with increasing the degree of electron localisation. Moreover for p-type piezoresistors the predicted values of the piezoresistive coefficients are higher in case of localised holes. Additionally, to the integration of the piezoresistive sensor, actuator integrated into the cantilever is considered as fundamental for realisation of fast SPM imaging. Actuation of the beam is achieved thermally by relying on differences in the coefficients of thermal expansion between aluminum and silicon. In addition the aluminum layer forms the heating micro-resistor, which is able to accept heating impulses with frequency up to one megahertz. Such direct oscillating thermally driven bimorph actuator was studied also with respect to the bimorph actuator efficiency. Higher eigenmodes of the cantilever are used in order to increase the operating frequencies. As a result the scanning speed has been increased due to the decreasing of the actuation time constant. The fundamental limits to force sensitivity that are imposed by piezoresistive deflection sensing technique have been discussed. For imaging in ambient conditions the force sensitivity is limited by the thermo-mechanical cantilever noise. Additional noise sources, connected with the piezoresistive detection are negligible.

Design and Control of a Closed-Loop Brushless Torque Actuator

This report explores the design and control issues associated with a brushless actuator capable of achieving extremely high torque accuracy. Models of several different motor - sensor configurations were studied to determine dynamic characteristics. A reaction torque sensor fixed to the motor stator was implemented to decouple the transmission dynamics from the sensor. This resulted in a compact actuator with higher bandwidth and precision than could be obtained with an inline or joint sensor. Testing demonstrated that closed-loop torque accuracy was within 0.1%, and the mechanical bandwidth approached 300 Hz.

Granular Attrition due to Rotary Valve in a Pneumatic Conveying System

The rotary valve is a widely used mechanical device in many solids-handling industrial processes. However, it may also be responsible for most of the attrition effects occurring in a typical process. In this study, the attrition effects occurring in a rotary valve operating as a stand-alone device and as part of a pneumatic conveying system were investigated. In the former case granular attrition was carried out at three different rotary valve speeds and the experimental results obtained were found to be in good agreement with the Gwyn correlation. In the latter case three typical air flow rates were used in the pneumatic conveying system. The size distribution of the attrition product obtained at the lowest air flow rate used was not adequately described by the Gwyn correlation. The attrition process and mechanisms involved were analysed and the minimum size of the attrition product obtained from both modes of operations was found to be similar.

Active control of structures with uncertain coupled subsystems and actuator dynamics

This paper deals with the problem of stabilizing a class of structures subject to an uncertain excitation due to the temporary coupling of the main system with another uncertain dynamical subsystem. A Lyapunov function based control scheme is proposed to attenuate the structural vibration. In the control design, the actuator dynamics is taken into account. The control scheme is implemented by using only feedback information of the main system. The effectiveness of the control scheme is shown for a bridge platform with crossing vehicle

Robust Control of Systems Subjected to Uncertain Disturbances and Actuator Dynamics

Esta tesis está enfocada al diseño y validación de controladores robustos que pueden reducir de una manera efectiva las vibraciones structurales producidas por perturbaciones externas tales como terremotos, fuertes vientos o cargas pesadas. Los controladores están diseñados basados en teorías de control tradicionalamente usadas en esta area: Teoría de estabilidad de Lyapunov, control en modo deslizante y control clipped-optimal, una técnica reciente mente introducida : Control Backstepping y una que no había sido usada antes: Quantitative Feedback Theory. La principal contribución al usar las anteriores técnicas, es la solución de problemas de control estructural abiertos tales como dinámicas de actuador, perturbaciones desconocidas, parametros inciertos y acoplamientos dinámicos. Se utilizan estructuras típicas para validar numéricamente los controladores propuestos. Especificamente las estructuras son un edificio de base aislada, una plataforma estructural puente-camión y un puente de 2 tramos, cuya configuración de control es tal que uno o mas problemas abiertos están presentes. Se utilizan tres prototipos experimentales para implementar los controladores robustos propuestos, con el fin de validar experimentalmente su efectividad y viabilidad. El principal resultado obtenido con la presente tesis es el diseño e implementación de controladores estructurales robustos que resultan efectivos para resolver problemas abiertos en control estructural tales como dinámicas de actuador, parámetros inciertos, acoplamientos dinámicos, limitación de medidas y perturbaciones desconocidas.

A conceptual design of a wireless sensor actuator system for optimising energy and well-being in a building

This article presents a prototype model based on a wireless sensor actuator network (WSAN) aimed at optimizing both energy consumption of environmental systems and well-being of occupants in buildings. The model is a system consisting of the following components: a wireless sensor network, `sense diaries', environmental systems such as heating, ventilation and air-conditioning systems, and a central computer. A multi-agent system (MAS) is used to derive and act on the preferences of the occupants. Each occupant is represented by a personal agent in the MAS. The sense diary is a new device designed to elicit feedback from occupants about their satisfaction with the environment. The roles of the components are: the WSAN collects data about physical parameters such as temperature and humidity from an indoor environment; the central computer processes the collected data; the sense diaries leverage trade-offs between energy consumption and well-being, in conjunction with the agent system; and the environmental systems control the indoor environment.

Upper limb tremor suppression in ADL via an orthosis incorporating a controllable double viscous beam actuator

Neuromuscular disorders affect millions of people world-wide. Upper limb tremor is a common symptom, and due to its complex aetiology it is difficult to compensate for except, in particular cases by surgical intervention or drug therapy. Wearable devices that mechanically compensate for limb tremor could benefit a considerable number of patients, but the technology to assist suffers in this way is under-developed. In this paper we propose an innovative orthosis that can dynamically suppress pathological tremor, by applying viscous damping to the affected limb in a controlled manner. The orthosis design utilises a new actuator design based on Magneto-Rheological Fluids that efficiently deliver damping action in response to the instantaneous tremor frequency and amplitude.

Novel actuator design to overcome stiction and backlash for low-velocity applications

This paper presents a novel actuator design that ameliorates or eliminates the effects of non-linearities that are characteristically present in geared actuator systems and which are very problematic for low velocity applications. The design centres on the providing an internal rotational element within a single actuator to ensure operation of actuator away from the stiction region, whilst allowing zero velocity external output of the actuator. The construction has the added advantage of substantially reducing backlash. The prototype comprises two commercially available servo-actuators to test the principle of operation and results presented indicate that the concept is worth exploring further.

Dual drive series actuator

Industrial robotic manipulators can be found in most factories today. Their tasks are accomplished through actively moving, placing and assembling parts. This movement is facilitated by actuators that apply a torque in response to a command signal. The presence of friction and possibly backlash have instigated the development of sophisticated compensation and control methods in order to achieve the desired performance may that be accurate motion tracking, fast movement or in fact contact with the environment. This thesis presents a dual drive actuator design that is capable of physically linearising friction and hence eliminating the need for complex compensation algorithms. A number of mathematical models are derived that allow for the simulation of the actuator dynamics. The actuator may be constructed using geared dc motors, in which case the benefits of torque magnification is retained whilst the increased non-linear friction effects are also linearised. An additional benefit of the actuator is the high quality, low latency output position signal provided by the differencing of the two drive positions. Due to this and the linearised nature of friction, the actuator is well suited for low velocity, stop-start applications, micro-manipulation and even in hard-contact tasks. There are, however, disadvantages to its design. When idle, the device uses power whilst many other, single drive actuators do not. Also the complexity of the models mean that parameterisation is difficult. Management of start-up conditions still pose a challenge.