983 resultados para Bi-Ventricular Assist Device


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A bi-enzymatic biosensor (LACC–TYR–AuNPs–CS/GPE) for carbamates was prepared in a single step by electrodeposition of a hybrid film onto a graphene doped carbon paste electrode (GPE). Graphene and the gold nanoparticles (AuNPs) were morphologically characterized by transmission electron microscopy, X-ray photoelectron spectroscopy, dynamic light scattering and laser Doppler velocimetry. The electrodeposited hybrid film was composed of laccase (LACC), tyrosinase (TYR) and AuNPs entrapped in a chitosan (CS) polymeric matrix. Experimental parameters, namely graphene redox state, AuNPs:CS ratio, enzymes concentration, pH and inhibition time were evaluated. LACC–TYR–AuNPs–CS/GPE exhibited an improved Michaelis–Menten kinetic constant (26.9 ± 0.5 M) when compared with LACC–AuNPs–CS/GPE (37.8 ± 0.2 M) and TYR–AuNPs–CS/GPE (52.3 ± 0.4 M). Using 4-aminophenol as substrate at pH 5.5, the device presented wide linear ranges, low detection limits (1.68×10− 9 ± 1.18×10− 10 – 2.15×10− 7 ± 3.41×10− 9 M), high accuracy, sensitivity (1.13×106 ± 8.11×104 – 2.19×108 ± 2.51×107 %inhibition M− 1), repeatability (1.2–5.8% RSD), reproducibility (3.2–6.5% RSD) and stability (ca. twenty days) to determine carbaryl, formetanate hydrochloride, propoxur and ziram in citrus fruits based on their inhibitory capacity on the polyphenoloxidases activity. Recoveries at two fortified levels ranged from 93.8 ± 0.3% (lemon) to 97.8 ± 0.3% (orange). Glucose, citric acid and ascorbic acid do not interfere significantly in the electroanalysis. The proposed electroanalytical procedure can be a promising tool for food safety control.

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A presente dissertação insere-se no âmbito da unidade curricular “ Dissertação” do 2º ano do mestrado em Engenharia Eletrotécnica – Sistemas Elétricos de Energia. Com o aumento crescente do número de consumidores de energia, é cada vez mais imperioso a adoção de medidas de racionalização e gestão dos consumos da energia elétrica. Existem diferentes tipos de dificuldades no planeamento e implementação de novas centrais produtoras de energia renovável, pelo que também por este motivo é cada vez mais importante adoção de medidas de gestão de consumos, quer ao nível dos clientes alimentados em média tensão como de baixa tensão. Desta forma será mais acessível a criação de padrões de eficiência energética elevados em toda a rede de distribuição de energia elétrica. Também a economia é afetada por uma fraca gestão dos consumos por parte dos clientes. Elevados desperdícios energéticos levam a que mais energia tenha que ser produzida, energia essa que contribui ainda mais para a elevada taxa de dependência energética em Portugal, e para o degradar da economia nacional. Coloca-se assim a necessidade de implementar planos e métodos que promovam a eficiência energética e a gestão racional de consumos de energia elétrica. Apresenta-se nesta dissertação várias propostas, algumas na forma de projetos já em execução, que visam sensibilizar o consumidor para a importância da utilização eficiente de energia e, ao mesmo tempo, disponibilizam as ferramentas tecnológicas adequadas para auxiliar a implementação dos métodos propostos. Embora os planos apresentados, sobejamente conhecidos, tenham imensa importância, a implementação nos vários consumidores de sistemas capazes de efetivamente reduzir consumos tem um papel fundamental. Equipamentos de gestão de consumos, que são apresentados nesta dissertação, permitem ao consumidor aceder diretamente ao seu consumo. Podem aceder não apenas ao consumo global da instalação mas também ao consumo específico por equipamento, permitindo perceber onde se verifica a situação mais desfavorável. Funcionalidades de programação de perfis tipo, com limitações de potência em vários períodos horários, bem como possibilidades de controlo remoto com recurso a aplicações para Smartphones permitem a redução de consumos ao nível da rede de distribuição e, desta forma, contribuir para a redução dos desperdícios e da dependência energética em Portugal. No âmbito do trabalho de dissertação é desenvolvida uma metodologia de comercialização de potência, que é apresentada nesta tese. Esta metodologia propõem que o consumidor, em função dos seus consumos, pague apenas a quantidade de potência que efetivamente necessita num certo período de tempo. Assim, o consumidor deixa de pagar uma tarifa mensal fixa associada á sua potência contratada, e passará a pagar um valor correspondente apenas à potência que efetivamente solicitou em todas as horas durante o mês. Nesta metodologia que é apresentada, o consumidor poderá também fazer uma análise do seu diagrama de cargas e simular uma alteração da sua tarifa, tarifa esta que varia entre tarifa simples, bi-horária semanal, bi-horária diária, tri-horária semanal ou tri-horária diária, de forma a perceber em qual destas pagará um menor valor pela mesma energia. De forma a que o consumidor possa perceber se haverá vantagem de uma alteração para uma potência contratada flexível, ou para uma outra tarifa associada á energia, tem ao seu dispor uma ferramenta, que em função dos seus consumos, permite retirar conclusões sobre o preço final a pagar na fatura, após cada tipo de alteração. Esta ferramenta foi validada com recurso a várias simulações, para diferentes perfis de consumidores. Desta forma, o utilizador fica a perceber que realmente pode poupar com uma potência contratada flexível, ao mesmo tempo que pode identificar-se com um perfil de simulação e, mais facilmente, perceber para que alteração tarifária pode usufruir de uma maior poupança.

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Patients with Ebstein's anomaly can present after childhood or adolescence with cyanosis, arrhythmias, severe right ventricular dysfunction and frequently with left ventricular dysfunction secondary to the prolonged cyanosis and to the right ventricular interference. At this point conventional repair is accompanied by elevated mortality and morbidity and poor functional results. We report our experience with three patients (8, 16 and 35 years of age) with Ebstein's anomaly, very dilated right atrium, severe tricuspid valve regurgitation (4/4), bi-directional shunt through an atrial septal defect and reduced left ventricular function (mean ejection fraction = 58%, mean shortening fraction = 25%). All underwent one and a half ventricular repair consisting of closure of the atrial septal defect, tricuspid repair with reduction of the atrialised portion of the right ventricle and end-to-side anastomosis of the superior vena cava to the right pulmonary artery. All patients survived, with a mean follow-up of 33 months. In all there was complete regression of the cyanosis and of the signs of heart failure. Postoperative echocardiography showed reduced degree of tricuspid regurgitation (2/4) and improvement of the left ventricular function (mean ejection fraction = 77%, mean shortening fraction = 40%). In patients with Ebstein's anomaly referred late for surgery with severely compromised right ventricular function or even with reduced biventricular function, the presence of a relatively hypoplastic and/or malfunctioning right ventricular chamber inadequate to sustain the entire systemic venous return but capable of managing part of the systemic venous return, permits a one and a half ventricular repair with good functional results.

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This RTD project, 2007-2009, is partly funded by the European Commission, in Framework Programme 6. It aims to assist elderly people for living well, independently and at case. ENABLE will provide a number of services for elderly people based on the new technology provided by mobile phones. The project is developing a Wrist unit with both integrated and external sensors, and with a radio frequency link to a mobile phone. Dedicated ENABLE software running on the wrist unit and mobile phone makes these services fully accessible for the elderly users. This paper outlines the fundamental motivation and the approach which currently is undertaken in order to collect the more detailed user needs and requirements. The general architecture and the design of the ENABLE system are outlined.

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Background—A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion. Objective—To determine the changes of prolonged storage times on donor heart microvasculature and the effects of intermittent antegrade perfusion. Materials and Methods—Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n=13) or 15.6 (0.6) hours (n=11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n=9) given a single antegrade dose, were compared with hearts (group 2, n=8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time. Results—Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P= .00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) (P=.0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio. Conclusion—Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.

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The loss of motor function at the elbow joint can result as a consequence of stroke. Stroke is a clinical illness resulting in long lasting neurological deficits often affecting somatosensory and motor cortices. More than half of those that recover from a stroke survive with disability in their upper arm and need rehabilitation therapy to help in regaining functions of daily living. In this paper, we demonstrated a prototype of a low-cost, ultra-light and wearable soft robotic assistive device that could aid administration of elbow motion therapies to stroke patients. In order to assist the rotation of the elbow joint, the soft modules which consist of soft wedge-like cellular units was inflated by air to produce torque at the elbow joint. Highly compliant rotation can be naturally realised by the elastic property of soft silicone and pneumatic control of air. Based on the direct visual-actuation control, a higher control loop utilised visual processing to apply positional control, the lower control loop was implemented by an electronic circuit to achieve the desired pressure of the soft modules by Pulse Width Modulation. To examine the functionality of the proposed soft modular system, we used an anatomical model of the upper limb and performed the experiments with healthy participants.

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The research trend for harvesting energy from the ambient vibration sources has moved from using a linear resonant generator to a non-linear generator in order to improve on the performance of a linear generator; for example, the relatively small bandwidth, intolerance to mistune and the suitability of the device for low-frequency applications. This article presents experimental results to illustrate the dynamic behaviour of a dual-mode non-linear energy-harvesting device operating in hardening and bi-stable modes under harmonic excitation. The device is able to change from one mode to another by altering the negative magnetic stiffness by adjusting the separation gap between the magnets and the iron core. Results for the device operating in both modes are presented. They show that there is a larger bandwidth for the device operating in the hardening mode compared to the equivalent linear device. However, the maximum power transfer theory is less applicable for the hardening mode due to occurrence of the maximum power at different frequencies, which depends on the non-linearity and the damping in the system. The results for the bi-stable mode show that the device is insensitive to a range of excitation frequencies depending upon the input level, damping and non-linearity.

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Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA (R) in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

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Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

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Background: Hypertrophic cardiomyopathy (HCM) is a common cardiac disease caused by a range of genetic and acquired disorders. The most common cause is genetic variation in sarcomeric proteins genes. Current ESC guidelines suggest that particular clinical features (‘red flags’) assist in differential diagnosis. Aims: To test the hypothesis that left ventricular (LV) systolic dysfunction in the presence of increased wall thickness is an age-specific ‘red flag’ for aetiological diagnosis and to determine long-term outcomes in adult patients with various types of HCM. Methods: A cohort of 1697 adult patients with HCM followed at two European referral centres were studied. Aetiological diagnosis was based on clinical examination, cardiac imaging and targeted genetic and biochemical testing. Main outcomes were: all-cause mortality or heart transplantation (HTx) and heart failure (HF) related-death. All-cause mortality included sudden cardiac death or equivalents, HF and stroke-related death and non-cardiovascular death. Results: Prevalence of different aetiologies was as follows: sarcomeric HCM 1288 (76%); AL amyloidosis 115 (7%), hereditary TTR amyloidosis 86 (5%), Anderson-Fabry disease 85 (5%), wild-type TTR amyloidosis 48 (3%), Noonan syndrome 15 (0.9%), mitochondrial disease 23 (1%), Friedreich’s ataxia 11 (0.6%), glycogen storage disease 16 (0.9%), LEOPARD syndrome 7 (0.4%), FHL1 2 (0.1%) and CPT II deficiency 1 (0.1%). Systolic dysfunction at first evaluation was significantly more frequent in phenocopies than sarcomeric HCM [105/409 (26%) versus 40/1288 (3%), (p<0.0001)]. All-cause mortality/HTx and HF-related death were higher in phenocopies compared to sarcomeric HCM (p<0.001, respectively). When considering specific aetiologies, all-cause mortality and HF-related death were higher in cardiac amyloidosis (p<0.001, respectively). Conclusion: Systolic dysfunction at first evaluation is more common in phenocopies compared to sarcomeric HCM representing an age-specific ‘red flag’ for differential diagnosis. Long-term prognosis was more severe in phenocopies compared to sarcomeric HCM and when comparing specific aetiologies, cardiac amyloidosis showed the worse outcomes.

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Die Arbeit beschäftigt sich mit der Kontrolle von Selbstorganisation und Mikrostruktur von organischen Halbleitern und deren Einsatz in OFETs. In Kapiteln 3, 4 und 5 eine neue Lösungsmittel-basierte Verabeitungsmethode, genannt als Lösungsmitteldampfdiffusion, ist konzipiert, um die Selbstorganisation von Halbleitermolekülen auf der Oberfläche zu steuern. Diese Methode als wirkungsvolles Werkzeug erlaubt eine genaue Kontrolle über die Mikrostruktur, wie in Kapitel 3 am Beispiel einer D-A Dyad bestehend aus Hexa-peri-hexabenzocoronene (HBC) als Donor und Perylene Diimide (PDI) als Akzeptor beweisen. Die Kombination aus Oberflächenmodifikation und Lösungsmitteldampf kann die Entnetzungseffekte ausgleichen, so dass die gewüschte Mikrostruktur und molekulare Organisation auf der Oberfläche erreicht werden kann. In Kapiteln 4 und 5 wurde diese Methode eingesetzt, um die Selbstorganisation von Dithieno[2, 3-d;2’, 3’-d’] benzo[1,2-b;4,5-b’]dithiophene (DTBDT) und Cyclopentadithiophene -benzothiadiazole copolymer (CDT-BTZ) Copolymer zu steuern. Die Ergebnisse könnten weitere Studien stimulieren und werfen Licht aus andere leistungsfaähige konjugierte Polymere. rnIn Kapiteln 6 und 7 Monolagen und deren anschlieβende Mikrostruktur von zwei konjugierten Polymeren, Poly (2,5-bis(3-alkylthiophen-2-yl)thieno[3,2-b]thiophene) PBTTT und Poly{[N,N ′-bis(2-octyldodecyl)-naphthalene-1,4,5,8-bis (dicarboximide)-2,6-diyl]-alt-5,5′- (2,2′-bithiophene)}, P(NDI2OD-T2)) wurden auf steife Oberflächen mittels Tauchbeschichtung aufgebracht. Da sist das erste Mal, dass es gelungen ist, Polymer Monolagen aus der Lösung aufzubringen. Dieser Ansatz kann weiter auf eine breite Reihe von anderen konjugierten Polymeren ausgeweitet werden.rnIn Kapitel 8 wurden PDI-CN2 Filme erfolgreich von Monolagen zu Bi- und Tri-Schichten auf Oberflächen aufgebracht, die unterschiedliche Rauigkeiten besitzen. Für das erste Mal, wurde der Einfluss der Rauigkeit auf Lösungsmittel-verarbeitete dünne Schichten klar beschrieben.rn

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The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).

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Image overlay projection is a form of augmented reality that allows surgeons to view underlying anatomical structures directly on the patient surface. It improves intuitiveness of computer-aided surgery by removing the need for sight diversion between the patient and a display screen and has been reported to assist in 3-D understanding of anatomical structures and the identification of target and critical structures. Challenges in the development of image overlay technologies for surgery remain in the projection setup. Calibration, patient registration, view direction, and projection obstruction remain unsolved limitations to image overlay techniques. In this paper, we propose a novel, portable, and handheld-navigated image overlay device based on miniature laser projection technology that allows images of 3-D patient-specific models to be projected directly onto the organ surface intraoperatively without the need for intrusive hardware around the surgical site. The device can be integrated into a navigation system, thereby exploiting existing patient registration and model generation solutions. The position of the device is tracked by the navigation system’s position sensor and used to project geometrically correct images from any position within the workspace of the navigation system. The projector was calibrated using modified camera calibration techniques and images for projection are rendered using a virtual camera defined by the projectors extrinsic parameters. Verification of the device’s projection accuracy concluded a mean projection error of 1.3 mm. Visibility testing of the projection performed on pig liver tissue found the device suitable for the display of anatomical structures on the organ surface. The feasibility of use within the surgical workflow was assessed during open liver surgery. We show that the device could be quickly and unobtrusively deployed within the sterile environment.

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Despite the growing recognition of the patent foramen ovale (PFO), particularly when associated with an atrial septal aneurysm, as risk factor for several disease manifestations (above all paradoxical embolism), the optimal treatment strategy for symptomatic patients remains controversial. Percutaneous PFO closure is a minimally invasive procedure which can be performed with high success and low morbidity. For secondary prevention of recurrent embolic events, it appears to be clinically at least as effective as oral anticoagulation. Ventricular septal defects (VSDs) are the most common congenital heart defects. Percutaneous VSD closure is more intricate than PFO closure. It is associated with a significant risk of both peri-interventional and mid-term complications. In suitable patients with congenital VSD, device closure may well be the preferred treatment both for muscular or perimembranous VSDs and for residual defects after surgical VSD closure. The risk of complete atrioventricular conduction block remains a concern in the perimembranous group. The history, technique and clinical role of percutaneous PFO and VSD closure are discussed, with emphasis on current problems and future developments.

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Implantable Cardioverter Defibrillator (ICD) implantation is the only established therapy for primary or secondary prevention of sudden cardiac death in patients with Hypertrophic Cardiomyopathy (HCM). Ineffectiveness of shock therapy for the termination of potentially fatal ventricular arrhythmias in ICD recipients is rare in the presence of appropriate arrhythmia detection by the device. We report the case of a 48-year-old woman with HCM and a single chamber ICD, who received five inefficient high-energy (35 Joules) shocks for the termination of an appropriately detected episode of Ventricular Tachycardia (VT). The episode was safely terminated with a subsequent application of Antitachycardia Pacing (ATP) by the device. At the following ICD control, an acceptable defibrillation threshold was detected.