Leakage of mechanical heart valve prostheses of Björk-Shiley type: in vitro investigations using Newtonian fluids

The leakage of mechanical heart valve prostheses with tilting disc occluders was investigated. A U tube apparatus and a quasi-stationary method were used for measuring the backflow pressure characteristics. The method has several advantages over pulsatile or oscillatory techniques described in the literature. We have attemped to interpret the results of our measurements in terms of laminar and turbulent losses of energy. This leads to dimensionless loss numbers for valve leakage which are independent of arbitrary experimental conditions.     

Hydrodynamic in vitro comparison of a new artificial heart valve with the Bj?rk-Shiley valve (standard)

Measurements performed to compare a newly developed tilting disc valve with the Bj?rk-Shiley valve included velocity profiles downstream of the heart valves, valve-induced flow turbulence and pressure drop across the opened valves. The velocity profiles measured with pulsed Doppler ultrasound are similar, although they do not permit a quantitative comparison of the valves. The interpretation of the 90 degrees-component of Doppler signals as a measure of the turbulence permits a quantitative comparison without the need for extensive measurements. However, only large vortices are recorded, so that our turbulent shear stresses are lower than these reported in the literature. The pressure drop across the opened valve is a measure of the energy loss, and important parameters for the valve can be derived from it. The pressure drop is dependent on the test conditions, and is therefore not a characteristic constant of the valve. The transformation of the power law Q = C delta P beta into a relation between Re- and Eu-number gives a nondimensional similarity number that is characteristic for tilting disc valves. Its verification requires more investigations, involving variation of valve size and the viscosity of the test fluid.     

Thrombosis of Bj?rk-Shiley aortic valve prosthesis: report of three cases.

Thrombotic malfunction of a Björk-Shiley aortic valve prosthesis occurred in three patients 6 to 16 months postoperatively. None of the patients had been taking anticoagulants. Although the presentation was acute, prodromal symptoms could be identified retrospectively in two of the patients. Two patients survived thrombectomy. Postoperative anticoagulant therapy is recommended in patients with these prostheses despite factors that may make such therapy riskier in specific patients. Attention to the character of murmurs and of the closure sound of the prosthetic valve must be part of the routine follow-up. In the emergency situation, when delay must be avoided, catheterization and angiography are unnecessary. The operative approach consists of complete thrombectomy without replacement of the valve or any of its components unless there is obvious periprosthetic leak or prosthetic wear.     

In vitro and in silico approaches to quantify the effects of the Mitraclip® system on mitral valve function

Mitraclip^® implantation is widely used as a valid alternative to conventional open-chest surgery in high-risk patients with severe mitral valve (MV) regurgitation. Although effective in reducing mitral regurgitation (MR) in the majority of cases, the clip implantation produces a double-orifice area that can result in altered MV biomechanics, particularly in term of hemodynamics and mechanical stress distribution on the leaflets.In this scenario, we combined the consistency of in vitro experimental platforms with the versatility of numerical simulations to investigate clip impact on MV functioning. The fluid dynamic determinants of the procedure were experimentally investigated under different working conditions (from 40 bpm to 100 bpm of simulated heart rate) on six swine hearts; subsequently, fluid dynamic data served as realistic boundary conditions in a computational framework able to quantitatively assess the post-procedural MV biomechanics. The finite element model of a human mitral valve featuring an isolated posterior leaflet prolapse was reconstructed from cardiac magnetic resonance. A complete as well as a marginal, sub-optimal grasping of the leaflets were finally simulated.The clipping procedure resulted in a properly coapting valve from the geometrical perspective in all the simulated configurations. Symmetrical complete grasping resulted in symmetrical distribution of the mechanical stress, while uncomplete asymmetrical grasping resulted in higher stress distribution, particularly on the prolapsing leaflet.This work pinpointed that the mechanical stress distribution following the clipping procedure is dependent on the cardiac hemodynamics and has a correlation with the proper execution of the grasping procedure, requiring accurate evaluation prior to clip delivery.     

Health-related quality of life in patients with primary Sjögren's syndrome and xerostomia: a comparative study

Objective: To compare the health status of groups of Primary Sjögren's and Xerostomia patients, using the Medical Outcomes Short Form 36 (SF‐36). The SF‐36 is a generic measure, divided into eight domains, used in the assessment of health‐related quality of life. Patients and methods : The SF‐36 was given to 2 groups: Group 1 comprised 43 patients diagnosed with Primary Sjögren's Syndrome (1SS) and an unstimulated whole salivary flow rate (UFR) of <0.1 ml/min). Group 2 (n = 40) reported Xerosiomia but had an UFR >0.2 ml/min. Sub groups of patients in Groups 1 and 2 were compared with community normative data, for the SF‐36 Results: There were trends to suggest lower SF36 scores for 1SS patients but there were no significant differences between the mean domain scores of Groups 1 and 2. 1SS and Xerostomia patients registered lower mean scores across all 8 domains, compared with normative community data. Conclusion: The SF‐36 was unable to detect significant differences between subjects with 1SS and Xerostomia but a larger sample size is required to confirm these findings. The results of this limited study suggest that a disease‐specific measure is required to assess the impact 1SS on health‐related Quality of life (QOL).     

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

Objectives

N-terminal B?type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity.

Methods

In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO₂peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves).

Results

A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77?%) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50?% of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO₂max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO₂peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015).

Conclusions

In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO₂peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.

     

Fast and slow photoreceptors — a comparative study of the functional diversity of coding and conductances in the Diptera

1. From a comparison of the photoresponses and membrane properties of photoreceptors from 20 species of Diptera, we conclude that coding in the time domain is matched to the dictates of visual ecology. This matching involves the dynamics of phototransduction and the use of an appropriate mix of potassium conductances to tune the photoreceptor membrane.
2. Rapidly flying, manoeuvrable diurnal Diptera from several families have fast photoreceptors, with corner frequencies (the frequency at which signal power falls by a half) of between 50 and 107 Hz. The ponderous and predominantly nocturnal tipulids have slow photoreceptors with fully light adapted corner frequencies of 16 to 19 Hz.
3. Dark adapted fast photoreceptors have a lower gain (as indicated by lower noise levels), a lower sensitivity, and light adapt more rapidly than dark adapted slow photoreceptors. Fast cells also have much lower input resistances and shorter time constants.
4. Fast photoreceptors rectify more strongly in the steady state because of a weakly inactivating delayed rectifier potassium conductance with fast and slow components of activation. Slow photoreceptors rectify less strongly in the steady state because their membrane properties are dominated by strongly inactivating outward currents with reversal potentials in the range — 80 to -90 mV.
5. The differences between potassium conductances match the differing functional requirements of fast and slow photoreceptors. The non-inactivating delayed rectifier promotes the rapid response of fast cells by reducing the membrane time constant. This is an expensive strategy, involving large conductances and currents. Slowly flying nocturnal insects do not require a high speed of response. The potassium conductances in their slow photoreceptors inactivate to avoid costly and unnecessary ion fluxes.
6. Both the dynamics of the photoresponse and photoreceptor membrane properties exhibit sexual dimorphism. Light adapted photoreceptors in the enlarged male dorsal eye of Bibio markii have a corner frequency of 42 Hz, compared with 27 Hz for cells in the smaller female eye. This difference in frequency response correlates with the male's higher spatial acuity and is accompanied by consistent differences in potassium conductance activation rate. We conclude that the divison between fast and slow cells is the product of cellular constraints, metabolic costs and the requirements of coding efficiency at different light levels and retinal image velocities.

     

Physiology of trans-translation deficiency in Bacillus subtilis – a comparative proteomics study

trans-Translation is the most effective ribosome rescue system known in bacteria. While it is essential in some bacteria, Bacillus subtilis possesses two additional alternative ribosome rescue mechanisms that require the proteins BrfA or RqcH. To investigate the physiology of trans-translation deficiency in the model organism B. subtilis, we compared the proteomes of B. subtilis 168 and a ΔssrA mutant in the mid-log phase using gel-free label-free quantitative proteomics. In chemically defined medium, the growth rate of the ssrA deletion mutant was 20% lower than that of B. subtilis 168. An ³⁵S-methionine incorporation assay demonstrated that protein synthesis rates were also lower in the ΔssrA strain. Alternative rescue factors were not detected. Among the 34 proteins overrepresented in the mutant strain were eight chemotaxis proteins. Indeed, both on LB agar and minimal medium the ΔssrA strain showed an altered motility and chemotaxis phenotype. Despite the lower growth rate, in the mutant proteome ribosomal proteins were more abundant while proteins related to amino acid biosynthesis were less abundant than in the parental strain. This overrepresentation of ribosomal proteins coupled with a lower protein synthesis rate and down-regulation of precursor supply reflects the slow ribosome recycling in the trans-translation-deficient mutant.     

Evaluation of a transient,simultaneous, arbitrary Lagrange–Euler based multi-physics method for simulating the mitral heart valve

A transient multi-physics model of the mitral heart valve has been developed, which allows simultaneous calculation of fluid flow and structural deformation. A recently developed contact method has been applied to enable simulation of systole (the stage when blood pressure is elevated within the heart to pump blood to the body). The geometry was simplified to represent the mitral valve within the heart walls in two dimensions. Only the mitral valve undergoes deformation. A moving arbitrary Lagrange–Euler mesh is used to allow true fluid–structure interaction (FSI). The FSI model requires blood flow to induce valve closure by inducing strains in the region of 10–20%. Model predictions were found to be consistent with existing literature and will undergo further development.     

On the in vivo function of the mitral heart valve leaflet: insights into tissue–interstitial cell biomechanical coupling

There continues to be a critical need for developing data-informed computational modeling techniques that enable systematic evaluations of mitral valve (MV) function. This is important for a better understanding of MV organ-level biomechanical performance, in vivo functional tissue stresses, and the biosynthetic responses of MV interstitial cells (MVICs) in the normal, pathophysiological, and surgically repaired states. In the present study, we utilized extant ovine MV population-averaged 3D fiducial marker data to quantify the MV anterior leaflet (MVAL) deformations in various kinematic states. This approach allowed us to make the critical connection between the in vivo functional and the in vitro experimental configurations. Moreover, we incorporated the in vivo MVAL deformations and pre-strains into an enhanced inverse finite element modeling framework (Path 1) to estimate the resulting in vivo tissue prestresses \((\sigma _\mathrm{CC}\cong \sigma _\mathrm{RR}\cong \, 30\,\hbox {kPa})\) and the in vivo peak functional tissue stresses \((\sigma _\mathrm{CC}\cong 510\, \hbox {kPa}, \sigma _\mathrm{RR}\cong 740\, \hbox {kPa})\). These in vivo stress estimates were then cross-verified with the results obtained from an alternative forward modeling method (Path 2), by taking account of the changes in the in vitro and in vivo reference configurations. Moreover, by integrating the tissue-level kinematic results into a downscale MVIC microenvironment FE model, we were able to estimate, for the first time, the in vivo layer-specific MVIC deformations and deformation rates of the normal and surgically repaired MVALs. From these simulations, we determined that the placement of annuloplasty ring greatly reduces the peak MVIC deformation levels in a layer-specific manner. This suggests that the associated reductions in MVIC deformation may down-regulate MV extracellular matrix maintenance, ultimately leading to reduction in tissue mechanical integrity. These simulations provide valuable insight into MV cellular mechanobiology in response to organ- and tissue-level alternations induced by MV disease or surgical repair. They will also assist in the future development of computer simulation tools for guiding MV surgery procedure with enhanced durability and improved long-term surgical outcomes.     

Dynamical transition of myoglobin in a crystal: comparative studies of X-ray crystallography and Mössbauer spectroscopy

The crystallographic normal mode refinements of myoglobin at a wide range of temperature from 40 K to 300 K were carried out to study the temperature dependence of the internal atomic fluctuations. The refinement method decomposes the mean square displacement from the average position, (deltar2), into the contributions from the internal degrees of freedom and those from the external degrees of freedom. The internal displacements show linear temperature dependence as (deltar2)=alphaT+beta, throughout the temperature range measured here, and exhibit no obvious change in the slope alpha at the dynamical transition temperature (Tc=ca. 180 K). The slope alpha is practically the same as the value predicted theoretically by normal mode analysis. Such linear dependence is considered to be due to the following reason. The crystallographic Debye-Waller factor represents the static distribution caused by convolution of temperature-dependent normal mode motions and a temperature-independent set of the conformational substates. In contrast, M?ssbauer absorption spectroscopy shows a clear increase in the gradient alpha at Tc. This difference from X-ray diffraction originates from the incoherent nature of the M?ssbauer effect together with its high-energy resolution, which yields the self-correlation, and the temporal behavior of individual Fe atoms in the myoglobin crystal.     

α- and β-adrenoceptors of zebrafish in melanosome movement: a comparative study between embryo and adult melanophores

Zebrafish, like other teleosts, display rapid skin color change in response to the background through sympathetic nerves. Here, the α- and β-adrenoceptors of melanophores were studied pharmacologically both in zebrafish embryo and adult scale. In vitro experiments on adult scale melanophores demonstrated that both α₁- and α₂-adrenoceptors are functional in melanosome aggregation, the α₂ subtype being predominant. Most melanophores in zebrafish embryos were able to concentrate melanosomes to α₂-adrenergic agonist α-methylnorepinephrine when they first appeared. This ability increased at least in the following 48 h, showing melanophores at these stages have developed functional adrenoceptors and these receptors increase independently before sympathetic innervation. However, even high concentration (10⁻³ M) of α₁-adrenoceptor agonist phenylephrine was not able to evoke any paling of the embryos. In adult scales, propranolol enhanced the melanosome-aggregating response of epinephrine and isoproterenol, but not norepinephrine, indicating β-adrenoceptor mediates melanosome-dispersing response in adult zebrafish. Similar response was not observed in embryos until 60 h post-fertilization (hpf). The melanophore adrenoceptor blocking effects of phentolamine and propranolol in embryos were much lower than that in adult zebrafish, suggesting these adrenoceptors in developing melanophores are less sensitive to the classical antagonists.     

A comparative study of hematological parameters of α and β thalassemias in a high prevalence zone: Saudi Arabia

BACKGROUND AND AIMS:

Saudi Arabia falls in the high prevalent zone of αα and β thalassemias. Early screening for the type of thalassemia is essential for further investigations and management. The study was carried out to differentiate the type of thalassemia based on red cell indices and other hematological parameters.

MATERIALS AND METHODS:

The study was carried out on 991 clinically suspected cases of thalassemias in Riyadh, Saudi Arabia. The hematological parameters were studied on Coulter STKS. Cellulose acetate hemoglobin electrophoresis and high-performance liquid chromatography (HPLC) were performed on all the blood samples. Gene deletion studies were carried out by restriction fragment length polymorphism (RFLP) technique using the restriction endonucleases Bam HI.

STATISTICAL ANALYSIS:

Statistical analysis was performed on SPSS 11.5 version.

RESULTS:

The hemoglobin electrophoresis and gene studies revealed that there were 406 (40.96%) and 59 (5.95 %) cases of β thalassemia trait and β thalassemia major respectively including adults and children. 426 cases of various deletion forms of α thalassemias were seen. Microcytosis was a common feature in β thalassemias trait and (-α/-α) and (--/αα) types of α thalassemias. MCH was a more significant distinguishing feature among thalassemias. β thalassemia major and α thalassemia (-α/αα) had almost normal hematological parameters.

CONCLUSION:

MCV and RBC counts are not statistically significant features for discriminating between α and β thalassemias. There is need for development of a discrimination index to differentiate between α and β thalassemias traits on the lines of discriminatory Indices available for distinguishing β thalassemias trait from iron deficiency anemia.     

Electronic and utermöhl comparative techniques in quantitative analysis of freshwater particulates

The Coulter Counter Model B and the Millipore Particle Measurement Computer System were compared with the Utermöhl technique in counting and sizing test objects and suspended freshwater particulate matter. Replicate samples of lake water and pulp mill effluent were analyzed with the electronic instruments for an estimate of counting error % MathType!MTEF!2!1!+-% feaafiart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaWaaeWaaeaada% WcaaqaaiGacofaciGGfbGaaiOlaiaacshacaGGUaGaaiymaiaaccda% caGGWaaabaGabiiEayaaraaaaaGaayjkaiaawMcaaaaa!3EB7!\[\left( {\frac{{\operatorname{S} \operatorname{E} .t.100}}{{\bar x}}} \right)\] Coulter Counter error for determinations of number, volume, and diameter of homogeneous particles was less than io%, and for natural populations of freshwater particles, less than 2o%. Millipore errors of number, area, and horizontal chord were roughly twice these values. Precision was least at low concentration of particles. In practical applications, pulp mill effluent analyses were characterized by close correlation between electronic methods of counting, but lake water particle determinations failed to relate. Microscope counts and sizes of freshwater particles were generally unrelated to electronic measurements. A definite electronic instrument specificity for homogeneous particles was apparent. Wide variations in determinations of characteristics by electronic and manual methods existed. The greatest problem in the. estimation of freshwater biomass is the determination of the unknown detrital fraction.     

Temporal changes of biodiversity in urban running waters – Results of a twelve-year monitoring study

Freshwater biodiversity underlies severe threats, mainly suffering from habitat degradation by anthropogenic land use, in particular by urbanisation. However, recent long-term studies indicate recovery of stream macroinvertebrate diversity due to improved water quality at least in North America and Europe. We monitored macroinverbrates at 56 urban stream sites over a 12-year period (2009–2020) in Braunschweig, a German urban district. We utilised these data to investigate spatio-temporal changes in taxon richness and assemblage structure as well as factors potentially affecting the resulting patterns. Overall taxon richness was increasing over the study period, comprising both all taxa and taxa being indicators for healthy stream conditions. 53.6% of the sites had significant positive trends becoming most eminent since 2014, despite decelerating since 2018, the beginning of an extra-ordinary dry period. Only 10.7% of the study sites had negative trends. Assemblage structure was shaped by environmental factors like stream width and water quality. Over-average taxon richness including positive trends and higher numbers of indicator taxa of healthy stream conditions was found in streams with higher flow velocity, good saprobic conditions and more natural streambed structure. In contrast, low taxon richness and predominance of tolerant taxa were found in streams with more degraded conditions. Most of the environmental conditions having positive effects on taxon richness were improved by various programs set up by the environmental authorities. We therefore conclude, if urban stressors like organic pollution and structural degradation can be mitigated by revitalisation and water quality improvement, urban streams can have good potential for increasing biodiversity and improving ecological functioning.     

Transferrin-receptor interaction and iron uptake by reticulocytes of vertebrate animals — a comparative study

Summary Transferrin-receptor interactions and iron uptake were studied in eleven different species of vertebrate animals (3 eutherian mammals, 3 marsupials, 2 reptiles and 1 bird, amphibian and bony fish). In the initial experiments it was shown that the uptake of transferrin-bound iron by immature erythroid cells from marsupial and reptilian species occurs by receptor-mediated endocytosis as in other vertebrate animals.Reticulocytes were incubated with¹²⁵I-⁵⁹Fe-labelled transferrins from heterologous species and the results for iron and transferrin uptake compared with those obtained with the homologous protein. Cells from eutherian mammals were able to take up transferrin and iron from other eutherians and from the bob-tailed lizard but not from marsupials and other submammalian species. With marsupials and reptiles a similar specificity was observed, and the marsupial cells could also utilize chicken transferrin but not vice versa.The results were extended by performing competition experiments in which the cells were incubated with radiolabelled homologous transferrin in the presence of increasing concentrations of non-radioactive heterologous transferrins. From the ability of the heterologous proteins to inhibit uptake of the homologous protein relative association constants (K _a ¹) for the transferrin-receptor interactions could be calculated. TheseK _a ¹ values reflected the patterns observed in the first series of experiments.These studies demonstrate that, although specificity exists in transferrin-receptor interactions throughout the range of vertebrate animals, in several instances reactivity between widely divergent species is also observed. Hence, structural similarities have been maintained throughout evolution. Nevertheless, no evidence of interaction between transferrin and its receptor from the two divisions of the Mammalia, the eutherians and the marsupials, was observed.Abbreviations BSS Hanks balanced salt solution - PBS phosphate-buffered saline - RRS Rana Ringer solution