Regeneration of an adult peripheral nerve preparation in culture

The methods used to maintain the vagus nerve from the adult rat in culture and how regeneration is studied in this preparation are described. A hypothesis is presented on the triggering of the cell body reaction. It is suggested that this reaction is initiated by proteins synthesized in nonneuronal cells at the site of a nerve lesion. These proteins, referred to as regenerins, reach the nerve cell body by retrograde axonal transport, where they initiate the regeneration process.     

Halo-shape technique for leadless pacemaker implantations: A case report

A 92-year-old woman underwent an implantation of a leadless pacemaker (Micra; Medtronic, Inc, Minneapolis, MN) for complete atrioventricular block after a transvenous lead extraction due to a pocket infection of a dual chamber pacemaker. Marked scoliosis and a humpback due to an advanced age made it impossible to direct the tip of the pacemaker delivery catheter towards the right ventricular septum or apex and shape the catheter into a gooseneck-shape. Thus, by attaining a halo-catheter shape of the delivery catheter, the catheter tip could be directed toward the infero-basal portion of the right ventricular septum. The pacemaker was successfully deployed at that site without any complications, and good device parameters were achieved. The halo-shape technique may be also an alternative method for delivering a leadless pacemaker in patients with an unsuccessful delivery of a leadless pacemaker to the right ventricular septum using the conventional gooseneck-shape technique.     

Hemodynamic monitoring by intracardiac impedance measured by cardiac resynchronization defibrillators: Evaluation in a controlled clinical setting (BIO.Detect HF II study)

BackgroundIn patients with cardiac resynchronization therapy defibrillators (CRT-Ds), intracardiac impedance measured by dedicated CRT-D software may be used to monitor hemodynamic changes. We investigated the relationship of hemodynamic parameters assessed by intracardiac impedance and by echocardiography in a controlled clinical setting.MethodsThe study enrolled 68 patients (mean age, 66 ± 9 years; 74% males) at 12 investigational sites. The patients had an indication for CRT-D implantation, New York Heart Association class II/III symptoms, left ventricular ejection fraction 15%–35%, and a QRS duration ≥150 ms. Two months after a CRT-D implantation, hemodynamic changes were provoked by overdrive pacing. Intracardiac impedance was recorded at rest and at four pacing rates ranging from 10 to 40 beats/min above the resting rate. In parallel, echocardiography measurements were performed. We hypothesized that a mean intra-individual correlation coefficient (r_mean) between stroke impedance (difference between end-systolic and end-diastolic intracardiac impedance) measured by CRT-D and the aortic velocity time integral (i.e., stroke volume) determined by echocardiography would be significantly larger than 0.65.ResultsThe hypothesis was evaluated in 40 patients with complete data sets. The r_mean was 0.797, with a lower confidence interval bound of 0.709. The study hypothesis was met (p = 0.007). A stepwise reduction of stroke impedance and stroke volume was observed with increasing heart rate.ConclusionsIntracardiac impedance measured by implanted CRT-Ds correlated well with the aortic velocity time integral (stroke volume) determined by echocardiography. The impedance measurements bear potential and are readily available technically, not requiring implantation of additional material beyond standard CRT-D system.     

Computational fluid dynamics of flow regime and hydrodynamic forces generated by a gliding North Atlantic right whale (Eubalaena glacialis)

Accurate estimates of drag on marine animals are required to investigate the locomotive cost, propulsive efficiency, and the impacts of entanglement if the animal is carrying fishing gear. In this study, we performed computational fluid dynamics analysis of a 10 m (length over all) right whale to obtain baseline measurements of drag on the animal. Swimming speeds covering known right whale speed range (0.125 m/s to 8 m/s) were tested. We found a weak dependence between drag coefficient and Reynolds number. At a swimming speed of 2 m/s, we analyzed the boundary layer thicknesses, the flow regimes, and drag components. We found the thickest boundary layer at the lateral sides of the peduncle, whereas the boundary layer thickness over the outer part of the flukes was less than 1.7 cm. Laminar flow occurred over the anterior ~0.6 LoA and turbulent flow from ~0.8 LoA to the fluke notch. On the surfaces of the flukes outside of the body wake region, flow was laminar. Our most significant finding is that the drag coefficient (0.0071–0.0059) of a right whale for swimming speeds ranging from 0.25 m/s to 2 m/s is approximately twice that of many previous estimates for cetaceans.     

Vagus nerve bundle stimulation using 1505-nm laser irradiation in an in-vivo rat model

Laser nerve stimulation using near-infrared laser irradiation has recently been studied in the peripheral nervous system as an alternative method to conventional electrical nerve stimulation. Bringing this method to the vagus nerve model could leverage this emerging stimulation approach to be tested in broader preclinical applications. Here, we report the capability of the laser nerve stimulation method on the rat vagus nerve bundle with a 1505-nm diode laser operated in continuous-wave mode. Studies of the stimulation threshold and laser-induced acute thermal injury to the nerve bundle were also performed to determine a temperature window for safe, reliable and reproducible laser stimulation of the rat vagus nerve bundle. The results show that laser stimulation of the vagus nerve bundle provides reliable and reproducible nerve stimulation in a rat model. These results also confirm a threshold temperature of >42°C with acute nerve damage observed above 46°C. A strong correlation was obtained between the laser time required to raise the nerve temperature above the stimulation threshold and the mean arterial pressure response. Advantages of the method such as non-contact delivery of external stimulus signals at mm scaled distance in air, enhanced spatial selectivity and electrical artefact-free measurements may indicate its potential to counteract the side effects of conventional electrical vagus nerve stimulation.     

ESTIMATION OF PREY DENSITIES REQUIRED BY WESTERN NORTH ATLANTIC RIGHT WHALES

The apparent lack of significant recovery of western North Atlantic right whale populations may be related to the availability of prey in exploitable densities. We have attempted to estimate the concentration of zooplankton required by right whales to obtain a net energetic benefit over the long term, using estimated values for body weight, metabolic rate, assimilation efficiency, time spent feeding, mouth size and swimming speed. The estimated range of required energy densities is 7.57 to 2,394 kcal m⁻³ (3.17 × 10⁴ to 1.00 × 10⁷ joule m⁻³). These values are from one to more than three orders of magnitude greater than the densest concentration sampled in the vicinity of right whale aggregations in the Great South Channel. Right whales must seek out and exploit extremely dense patches of prey organisms in order to feed efficiently. The presence of such dense patches of zooplankton is likely to be a primary characteristic of spring, summer and fall right whale habitats.     

RELATIVE ABUNDANCE OF LARGE WHALES AROUND SOUTH GEORGIA (1979–1998)1

To assess large-whale stocks following the cessation of land-based South Georgia whaling in 1965, we report three independent sighting databases: a cruise in 1997, observations from Bird Island (NW of South Georgia) between 1979 and 1998, and mariner sightings between 1992 and 1997. All species were rare, with sightings of southern right whales being the most common event. Two right whales photographed off South Georgia matched animals known from Peninsula Valdés, Argentina, a population known to be growing at 7%per annum. In contrast, blue and fin whales appeared to be less abundant. A single blue whale mother-calf pair was observed off the Shag Rocks in February 1997. Extirpation of animals from this particular feeding ground is the most likely reason for ongoing low numbers of all species. Other factors may include competition for krill by traditional predators such as penguins and seals and more recently by humans, an unusually high rate of natural mortality, habitat change such as alteration in sea ice coverage, and/or the impact of ongoing whaling. The history of this critical area of large-whale habitat and this report demonstrate the need for improved, consistent longterm monitoring of population trends for these depleted stocks.     

Paraxial left-sided nodal expression and the start of left–right patterning in the early chick embryo

A common element during early left–right patterning of the vertebrate body is left-sided nodal expression in the early-somite stage lateral plate mesoderm. Leftward cell movements near the node of the gastrulating chick embryo recently offered a plausible mechanism for breaking the presomite-stage molecular symmetry in those vertebrates which lack rotating cilia on the notochord or equivalent tissues. However, the temporal and functional relationships between generation of the known morphological node asymmetry, onset of leftward cell movements and establishment of stable molecular asymmetry in the chick remain unresolved. This study uses high-resolution light microscopy and in situ gene expression analysis to show that intranodal cell rearrangement during the phase of counter-clockwise node torsion at stage 4+ is immediately followed by symmetry loss and rearrangement of shh and fgf8 expression in node epiblast between stages 5− and 5+. Surprisingly, left-sided nodal expression starts at stage 5−, too, but lies in the paraxial mesoderm next to the forming notochordal plate, and can be rendered symmetrical by minimal mechanical disturbance of distant tissue integrity at stage 4. The “premature” paraxial nodal expression together with morphological and molecular asymmetries in, and near, midline compartments occurring at defined substages of early gastrulation help to identify a new narrow time window for early steps in left–right patterning in the chick and support the concept of a causal relationship between a—still enigmatic—chiral (motor) protein, cell movements and incipient left–right asymmetry in the amniote embryo.     

Usefulness of a lead delivery system consisting of a fixed-shaped sheath and a lumenless bipolar lead in a patient with absent right and persistent left superior vena cava: A case report

We report the case of an 84-year-old female with symptomatic bradycardia due to a complete atrioventricular block, who carried absent right and persistent left superior vena cava (SVC). Implantation of a pacing lead, particularly within the right ventricle (RV) in a patient with this venous anomaly is accompanied by technical difficulties. However, the apparatus consisting of a fixed-curve sheath (Model C315-S10, Medtronic, Inc., Minneapolis, MN, USA) and a lumenless fixed-screw pacing lead (Model 3830, Medtronic), allowed a rapid delivery into the RV without any complications. By rotating the Model C315-S10 sheath in the counterclockwise direction in the right atrium, its tip faced the tricuspid orifice, advanced across the tricuspid valve and confronted the RV lower septum near the apex. Then the RV-lead was fixed with acceptable pacing and sensing parameters. Utilizing a lumenless pacing lead and a preformed sheath to deliver it is a novel approach that could be helpful in pacemaker implantation in patients with absent right and persistent left SVC.     

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.