Manifestations électrocardiographiques de l'hyperkaliémie modérée à sévère

L'hyperpotassémie est un désordre électrolytique, qui dans des situations extrêmes, peut conduire au décès. Les premières études effectuées montraient un lien entre la progression du taux de potassium et l'apparition de modifications électrocardiographiques. Certaines études, plus récentes, ont mis en doute cette hypothèse. Notre étude a pour but de chercher quels sont les facteurs associés à l'apparition d'un pattern électrocardiographique typique, en cas d'hyperpotassémie modérée à sévère (≥7mmol/l), dans une population adulte hospitalière, non sélectionnée. Le 2ème objectif est d'estimer la mortalité liée à ce degré d'hyperkaliémie. Etude au design rétrospectif, sélectionnant les patients adultes avec K : ≥ 7mmol/L, entre 2009 et 2010 au CHUV, ayant un électrocardiogramme à disposition entre -1h et +2h de la prise de sang. Recueil des valeurs de laboratoires et des comorbidités de ces patients et analyse des électrocardiogrammes : fréquence cardiaque, durée QRS, durée QTc, amplitudes ondes T et RS, présence d'un trouble de la conduction, d'une fibrillation ou d'un flutter, d'un rythme jonctionnel. Résultats : Sur les 82 patients sélectionnés, l'analyse statistique a mis en évidence que le taux de potassium n'est corrélé ni à l'apparition de modifications électrocardiographiques typiques, ni à la mortalité. Le seul élément pouvant prédire, sur l'électrocardiogramme, l'apparition d'un pattern typique est le degré d'acidémie. Le risque de décès ou de présenter un arrêt cardiorespiratoire en cas d'hyperkaliémie modérée à sévère est principalement déterminé par la présence d'une acidose métabolique.

A biophysical model of atrial fibrillation ablation: what can a surgeon learn from a computer model?

AIMS: Surgical ablation procedures for treating atrial fibrillation have been shown to be highly successful. However, the ideal ablation pattern still remains to be determined. This article reports on a systematic study of the effectiveness of the performance of different ablation line patterns. METHODS AND RESULTS: This study of ablation line patterns was performed in a biophysical model of human atria by combining basic lines: (i) in the right atrium: isthmus line, line between vena cavae and appendage line and (ii) in the left atrium: several versions of pulmonary vein isolation, connection of pulmonary veins, isthmus line, and appendage line. Success rates and the presence of residual atrial flutter were documented. Basic patterns yielded conversion rates of only 10-25 and 10-55% in the right and the left atria, respectively. The best result for pulmonary vein isolation was obtained when a single closed line encompassed all veins (55%). Combination of lines in the right/left atrium only led to a success rate of 65/80%. Higher rates, up to 90-100%, could be obtained if right and left lines were combined. The inclusion of a left isthmus line was found to be essential for avoiding uncommon left atrial flutter. CONCLUSION: Some patterns studied achieved a high conversion rate, although using a smaller number of lines than those of the Maze III procedure. The biophysical atrial model is shown to be effective in the search for promising alternative ablation strategies.

Aerodynamical instability of web

Diplomityön tavoitteena oli tutkia miten ilman turbulenttisuus vaikuttaa tasaisesti liikkuvan rainan tilaan. Yhtenä sovelluskohteena teollisuudessa voidaan mainita esimerkiksi leiju-kuivain. Tiedetään, että konenopeuksien kasvu ja siitä johtuva ilmavirran nopeuden kasvu aiheuttaa voimavaikutuksia rainaan ja voi aiheuttaa lepatusta. Lepatus johtaa dynaamiseen epästabiilisuuteen, joka voidaan havaita, kun lineaarinen systeemi tulee epävakaaksi ja joh-taa epälineaariseen, rajoitettuun värähtelyyn. Lepatus huonontaa tuotteiden laatua ja voi johtaa ratakatkoihin. Työssä on esitetty tietoa ilman ja rainan vuorovaikutuksesta, jota hyödyntämällä voidaan kehittää yksinkertaistettu malli, jonka avulla liikkuvaa rainaa voidaan simuloida kuivaimes-sa. Kaasufaasin virtausyhtälöt on ratkaistu eri turbulenttimalleja käyttäen. Myös viskoelas-tisen rainan muodonmuutosta on tarkasteltu. Koska rainalle ei ole kirjallisuudesta saatavilla tarkkoja fysikaalisia ja mekaanisia arvoja, näitä ominaisuuksia testattiin eri arvoilla, jotta rainan käyttäytymistä jännityksen alaisena voidaan tarkastella. Näiden ominaisuuksien tun-teminen on ensiarvoisen tärkeää määritettäessä rainan aeroviskoelastista käyttäytymistä. Virtaussimulointi on kallista ja aikaa vievää. Tämä tarkoittaa uusien tutkimusmenetelmien omaksumista. Tässä työssä vaihtoehtoisena lähestymistapana on esitetty yksinkertaistettu malli, joka sisältää ilman ja rainan vuorovaikutusta kuvaavat ominaisuudet. Mallin avulla saadaan tietoa epälineaarisuuden ja turbulenssin vaikutuksesta sekä monimutkaisesta yh-teydestä stabiilisuuden ja ulkoisesti aikaansaadun värähtelyn sekä itse aiheutetun värähtelyn välillä. Työn lopussa on esitetty havainnollinen esimerkki, jolla voidaan kuvata olosuhteita, jossa rainan tasainen liike muuttuu epävakaaksi. Kun turbulenttisuudesta johtuva painevaih-telu ylittää tietyn rajan, rainan värähtely kasvaa muuttuen satunnaisesta järjestäytyneeksi. Saaduttulokset osoittavat, että turbulenttisuudella on suuri vaikutus eikä sitä voi jättää huomioimatta. Myös rainan viskoelastiset ominaisuudet tulee huomioida, jotta rainan käyt-täytymistä voidaan kuvata tarkasti.

Rôles des polymorphismes génétiques dans la détermination de la dose individuelle de la warfarine chez les patients traités avec de l’amiodarone

Introduction : Bien que la pratique de l’usage de la warfarine se soit améliorée au cours de la dernière décennie, aucune recommandation claire basée sur le dosage de l’amiodarone n’a été jusqu’à maintenant standardisée, ce qui représente un grand obstacle pour les cliniciens. La warfarine a un index thérapeutique étroit nécessitant un suivi régulier et un ajustement individuel de la posologie, ceci afin de déterminer la dose thérapeutique, tout en prévenant les effets secondaires qui pourraient être fatals dans certains cas. La variabilité interindividuelle de la réponse à la warfarine dépend de plusieurs facteurs, dont l’âge, le sexe, le poids, l’alimentation et l’interaction médicamenteuse, mais ceux-ci n’expliquent que partiellement les différences de sensibilité à la warfarine. Les polymorphismes des gènes CYP2C9 et VKORC1 jouent un rôle important dans la réponse à la warfarine et expliquent jusqu’à 50% de la variabilité des doses. L’utilisation d’antiarythmiques telle l’amiodarone peut accentuer considérablement l’effet de la warfarine et nécessite généralement une diminution de 30 à 50% de la dose de la warfarine. Aucune étude à ce jour n’a tenté de déterminer l’utilité du génotypage des polymorphismes des gènes CYP2C9 et VKORC1 chez les patients sous traitement combiné de warfarine et amiodarone. Objectif : Notre étude a pour objectif tout d’abord de déterminer si des facteurs génétiques influencent la première dose de stabilisation de la warfarine chez les patients en FA après l’introduction de l’amiodarone. Nous allons également tenter de confirmer l’association préalablement rapportée entre les facteurs génétiques et la première dose de stabilisation de warfarine dans notre population à l’étude. Méthodes : Un devis de cohorte rétrospective de patients qui fréquentaient la clinique d'anticoagulothérapie de l’Institut de cardiologie de Montréal entre le 1er janvier 2007 et le 29 février 2008 pour l’ajustement de leur dose selon les mesures d'INR. Au total, 1615 patients ont été recrutés pour participer à cette étude de recherche. Les critères de sélection des patients étaient les patients avec fibrillation auriculaire ou flutter, ayant un ECG documenté avec l'un de ces deux diagnostics et âgé de moins de 67 ans, en raison d’une moindre comorbidité. Les patients souffrant d’insuffisance hépatique chronique ont été écartés de l’étude. Tous les patients devaient signer un consentement éclairé pour leur participation au projet et échantillon de sang a été pri pour les tests génétiques. La collecte des données a été effectuée à partir du dossier médical du patient de l’Institut de cardiologie de Montréal. Un formulaire de collecte de données a été conçu à cet effet et les données ont ensuite été saisies dans une base de données SQL programmée par un informaticien expert dans ce domaine. La validation des données a été effectuée en plusieurs étapes pour minimiser les erreurs. Les analyses statistiques utilisant des tests de régression ont été effectuées pour déterminer l’association des variants génétiques avec la première dose de warfarine. Résultats : Nous avons identifié une association entre les polymorphismes des gènes CYP2C9 et VKORC1 et la dose de la warfarine. Les polymorphismes génétiques expliquent jusqu’à 42% de la variabilité de dose de la warfarine. Nous avons également démontré que certains polymorphismes génétiques expliquent la réduction de la dose de warfarine lorsque l’amiodarone est ajoutée à la warfarine. Conclusion : Les travaux effectués dans le cadre de ce mémoire ont permis de démontrer l’implication des gènes CYP2C9 et VKORC1 dans la réponse au traitement avec la warfarine et l’amiodarone. Les résultats obtenus permettent d’établir un profil personnalisé pour réduire les risques de toxicité, en permettant un dosage plus précis de la warfarine pour assurer un meilleur suivi des patients. Dans le futur, d’autres polymorphismes génétiques dans ces gènes pourraient être évalués pour optimiser davantage la personnalisation du traitement.

Markov models of aging: theory and practice

We review and structure some of the mathematical and statistical models that have been developed over the past half century to grapple with theoretical and experimental questions about the stochastic development of aging over the life course. We suggest that the mathematical models are in large part addressing the problem of partitioning the randomness in aging: How does aging vary between individuals, and within an individual over the lifecourse? How much of the variation is inherently related to some qualities of the individual, and how much is entirely random? How much of the randomness is cumulative, and how much is merely short-term flutter? We propose that recent lines of statistical inquiry in survival analysis could usefully grapple with these questions, all the more so if they were more explicitly linked to the relevant mathematical and biological models of aging. To this end, we describe points of contact among the various lines of mathematical and statistical research. We suggest some directions for future work, including the exploration of information-theoretic measures for evaluating components of stochastic models as the basis for analyzing experiments and anchoring theoretical discussions of aging.

Renal and cardiovascular effects of Bothrops marajoensis venom and phospholipase A(2)

Bothrops marajoensis is found in the savannah of Marajo Island in the State of Par S and regions of Amapa State, Brazil. The aim of the work was to study the renal and cardiovascular effects of the B. marajoensis venom and phospholipase A(2) (PLA(2)). The venom was fractionated by Protein Pack 5PW. N-terminal amino acid sequencing of sPLA(2) showed amino acid identity with other lysine K49sPLA(2)s of snake venom. B. marajoensis venom (30 mu g/mL) decreased the perfusion pressure, renal vascular resistance, urinary flow, glomerular filtration rate and sodium tubular transport. PLA(2) did not change the renal parameters. The perfusion pressure of the mesenteric bed did not change after infusion of venom. In isolated heart, the venom decreased the force of contraction and increased PP but did not change coronary flow. In the arterial pressure, the venom and PLA(2) decreased mean arterial pressure and cardiac frequency. The presence of atrial flutter and late hyperpolarisation reversed, indicating QRS complex arrhythmia and dysfunction in atrial conduction. In conclusion, B. marajoensis venom and PLA(2) induce hypotension and bradycardia while simultaneously blocking electrical conduction in the heart. Moreover, the decrease in glomerular filtration rate, urinary flow and electrolyte transport demonstrates physiological changes to the renal system. (C) 2009 Elsevier Ltd. All rights reserved.

Projeto de controladores robustos para aplicações em estruturas inteligentes utilizando desigualdades matriciais lineares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Control of Limit Cycle Oscillation in a Three Degrees of Freedom Airfoil Section Using Fuzzy Takagi-Sugeno Modeling

This work presents a strategy to control nonlinear responses of aeroelastic systems with control surface freeplay. The proposed methodology is developed for the three degrees of freedom typical section airfoil considering aerodynamic forces from Theodorsen's theory. The mathematical model is written in the state space representation using rational function approximation to write the aerodynamic forces in time domain. The control system is designed using the fuzzy Takagi-Sugeno modeling to compute a feedback control gain. It useds Lyapunov's stability function and linear matrix inequalities (LMIs) to solve a convex optimization problem. Time simulations with different initial conditions are performed using a modified Runge-Kutta algorithm to compare the system with and without control forces. It is shown that this approach can compute linear control gain able to stabilize aeroelastic systems with discontinuous nonlinearities.

Characterization of the nonlinear behavior of a F-16 aircraft using discrete-time Volterra series

The linearity assumption in the structural dynamics analysis is a severe practical limitation. Further, in the investigation of mechanisms presented in fighter aircrafts, as for instance aeroelastic nonlinearity, friction or gaps in wing-load-payload mounting interfaces, is mandatory to use a nonlinear analysis technique. Among different approaches that can be used to this matter, the Volterra theory is an interesting strategy, since it is a generalization of the linear convolution. It represents the response of a nonlinear system as a sum of linear and nonlinear components. Thus, this paper aims to use the discrete-time version of Volterra series expanded with Kautz filters to characterize the nonlinear dynamics of a F-16 aircraft. To illustrate the approach, it is identified and characterized a non-parametric model using the data obtained during a ground vibration test performed in a F-16 wing-to-payload mounting interfaces. Several amplitude inputs applied in two shakers are used to show softening nonlinearities presented in the acceleration data. The results obtained in the analysis have shown the capability of the Volterra series to give some insight about the nonlinear dynamics of the F-16 mounting interfaces. The biggest advantage of this approach is to separate the linear and nonlinear contributions through the multiple convolutions through the Volterra kernels.

Representation and analysis of control surface freeplay nonlinearity

Different representations for a control surface freeplay nonlinearity in a three degree of freedom aeroelastic system are assessed. These are the discontinuous, polynomial and hyperbolic tangent representations. The Duhamel formulation is used to model the aerodynamic loads. Assessment of the validity of these representations is performed through comparison with previous experimental observations. The results show that the instability and nonlinear response characteristics are accurately predicted when using the discontinuous and hyperbolic tangent representations. On the other hand, the polynomial representation fails to predict chaotic motions observed in the experiments. (c) 2012 Elsevier Ltd. All rights reserved.

RHYTHM-AF: design of an international registry on cardioversion of atrial fibrillation and characteristics of participating centers

Background: Atrial fibrillation is a serious public health problem posing a considerable burden to not only patients, but the healthcare environment due to high rates of morbidity, mortality, and medical resource utilization. There are limited data on the variation in treatment practice patterns across different countries, healthcare settings and the associated health outcomes. Methods/design: RHYTHM-AF was a prospective observational multinational study of management of recent onset atrial fibrillation patients considered for cardioversion designed to collect data on international treatment patterns and short term outcomes related to cardioversion. We present data collected in 10 countries between May 2010 and June 2011. Enrollment was ongoing in Italy and Brazil at the time of data analysis. Data were collected at the time of atrial fibrillation episode in all countries (Australia, Brazil, France, Germany, Italy, Netherlands, Poland, Spain, Sweden, United Kingdom), and cumulative follow-up data were collected at day 60 (+/- 10) in all but Spain. Information on center characteristics, enrollment data, patient demographics, detail of atrial fibrillation episode, medical history, diagnostic procedures, acute treatment of atrial fibrillation, discharge information and the follow-up data on major events and rehospitalizations up to day 60 were collected. Discussion: A total of 3940 patients were enrolled from 175 acute care centers. 70.5% of the centers were either academic (44%) or teaching (26%) hospitals with an overall median capacity of 510 beds. The sites were mostly specialized with anticoagulation clinics (65.9%), heart failure (75.1%) and hypertension clinics (60.1%) available. The RHYTHM-AF registry will provide insight into regional variability of antiarrhythmic and antithrombotic treatment of atrial fibrillation, the appropriateness of such treatments with respect to outcomes, and their cost-efficacy. Observations will help inform strategies to improve cardiovascular outcomes in patients with atrial fibrillation.

Simulazione numerica di fenomeni aeroelastici con applicazione alle strutture civili

Il presente lavoro tratta lo studio dei fenomeni aeroelastici di interazione fra fluido e struttura, con il fine di provare a simularli mediante l’ausilio di un codice agli elementi finiti. Nel primo capitolo sono fornite alcune nozioni di fluidodinamica, in modo da rendere chiari i passaggi teorici fondamentali che portano alle equazioni di Navier-Stokes governanti il moto dei fluidi viscosi. Inoltre è illustrato il fenomeno della formazione di vortici a valle dei corpi tozzi dovuto alla separazione dello strato limite laminare, con descrizione anche di alcuni risultati ottenuti dalle simulazioni numeriche. Nel secondo capitolo vengono presi in rassegna i principali fenomeni di interazione fra fluido e struttura, cercando di metterne in luce le fondamenta della trattazione analitica e le ipotesi sotto le quali tale trattazione è valida. Chiaramente si tratta solo di una panoramica che non entra in merito degli sviluppi della ricerca più recente ma fornisce le basi per affrontare i vari problemi di instabilità strutturale dovuti a un particolare fenomeno di interazione con il vento. Il terzo capitolo contiene una trattazione più approfondita del fenomeno di instabilità per flutter. Tra tutti i fenomeni di instabilità aeroelastica delle strutture il flutter risulta il più temibile, soprattutto per i ponti di grande luce. Per questo si è ritenuto opportuno dedicargli un capitolo, in modo da illustrare i vari procedimenti con cui si riesce a determinare analiticamente la velocità critica di flutter di un impalcato da ponte, a partire dalle funzioni sperimentali denominate derivate di flutter. Al termine del capitolo è illustrato il procedimento con cui si ricavano sperimentalmente le derivate di flutter di un impalcato da ponte. Nel quarto capitolo è presentato l’esempio di studio dell’impalcato del ponte Tsing Ma ad Hong Kong. Sono riportati i risultati analitici dei calcoli della velocità di flutter e di divergenza torsionale dell’impalcato e i risultati delle simulazioni numeriche effettuate per stimare i coefficienti aerodinamici statici e il comportamento dinamico della struttura soggetta all’azione del vento. Considerazioni e commenti sui risultati ottenuti e sui metodi di modellazione numerica adottati completano l’elaborato.

Energy harvesting from piezoelectric devices embedded in a 3D printed wing

This thesis work has been carried out at Clarkson University in Potsdam NY, USA and involved the design of a low elongation wing, consisting of parts made by polylactide (PLA) using the fused deposition model (FDM) technology of Rapid Prototyping, then assembled together in a thin aluminum spar. The aim of the research is to evaluate the feasibility of collecting electrical energy by converting mechanical energy from the vibration of the wing flutter. With this aim piezoelectric stripes were glued in the inner part of the wing, as well as on the aluminum spar, as monomorphic configuration. During the phases of the project, particular attention was given to the geometry and the materials used, in order to trigger the flutter for low flow velocity. The CAD software SolidWorks® was used for the design of the wing and then the drawings were sent to the Clarkson machine shop in order to to produce the parts required by the wing assembly. FEM simulations were performed, using software MSC NASTRAN/PATRAN®, to evaluate the stiffness of the whole wing as well as the natural vibration modes of the structure. These data, in a first approximation, were used to predict the flutter speed. Finally, experimental tests in the Clarkson wind tunnel facility were carried out in order to validate the results obtained from FEM analysis. The power collected by the piezoelectrics under flutter condition was addressed by tuning the resistors downstream the electronic circuit of the piezoelectrics.

Comparison of pro-atrial natriuretic peptide and atrial remodeling in marathon versus non-marathon runners

Long-term endurance sports are associated with atrial remodeling and an increased risk for atrial fibrillation (AF) and atrial flutter. Pro-atrial natriuretic peptide (pro-ANP) is a marker of atrial wall tension and elevated in patients with AF. The aim of this study was to test the hypothesis that atrial remodeling would be perpetuated by repetitive episodes of atrial stretching during strenuous competitions, reflected by elevated levels of pro-ANP. A cross-sectional study was performed on nonelite runners scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race. Four hundred ninety-two marathon and nonmarathon runners applied for participation, 70 were randomly selected, and 56 entered the final analysis. Subjects were stratified according to former marathon participations: a control group (nonmarathon runners, n = 22), group 1 (1 to 4 marathons, n = 16), and group 2 (≥5 marathons, n = 18). Results were adjusted for age, training years, and average weekly endurance training hours. The mean age was 42 ± 7 years. Compared to the control group, marathon runners in groups 1 and 2 had larger left atria (25 ± 6 vs 30 ± 6 vs 34 ± 7 ml/m(2), p = 0.002) and larger right atria (27 ± 7 vs 31 ± 8 vs 35 ± 5 ml/m(2), p = 0.024). Pro-ANP levels at baseline were higher in marathon runners (1.04 ± 0.38 vs 1.42 ± 0.74 vs 1.67 ± 0.69 nmol/L, p = 0.006). Pro-ANP increased significantly in all groups after the race. In multiple linear regression analysis, marathon participation was an independent predictor of left atrial (β = 0.427, p <0.001) and right atrial (β = 0.395, p = 0.006) remodeling. In conclusion, marathon running was associated with progressive left and right atrial remodeling, possibly induced by repetitive episodes of atrial stretching. The altered left and right atrial substrate may facilitate atrial arrhythmias.