The actions of prostaglandins I2 and E2 on arrhythmias produced by coronary occlusion in the rat and dog

Prostaglandins E₂ and I₂ were compared with known antiarrhythmics for their actions against arrhythmias produced by occlusion of the left anterior descending coronary artery in the anaesthetised rat while PGI₂ was also examined in the dog. PGI₂ in the dog suppressed early arrhythmias produced during occlusion but did not influence those produced by occlusion-release or those occurring 24 hours after a permanent occlusion; none of the A,B,C or D series prostaglandins tested markedly reduced 24 hour arrhythmias. In the rat PGE₂ was antiarrhythmic against early occlusion arrhythmias (30 minutes occlusion) in a dose related manner (infusions of 1–4 μg/kg/min) whereas PGI₂ infusions potentiated the arrhythmogenic effect of occlusion. PGE₂ was as effective an antiarrhythmic as 10mg/kg Org. 6001 which was more effective in this test situation than d1-propranolol. No obvious mechanisms for the actions of PGE₂ or PGI₂ were apparent although both agents lowered blood pressure and reduced the size of the occluded zone produced by ligation.     

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion.Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible.We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training.Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.     

Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators

BackgroundNon-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or ‘rainout’ from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.ObjectiveTo assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.DesignSeven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH₂O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.ResultsSeveral ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H₂O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from ‘specific’ (tube occluded) to ‘ambiguous’ (Safety valve open). Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH₂O compared to the measured values of 13cmH₂O.ConclusionsThis study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.     

Ultrasound system to measure esophageal varix pressure: an in vitro validation study

We report our experience with an ultrasound system to measure esophageal varix pressure in an in vitro model. The ultrasound system consists of a 12.5 MHz frequency intraluminal ultrasound probe, a water infusion catheter, and a manometry catheter, all contained within a nondistensible latex bag. Esophagi and external jugular veins were harvested from five pigs. The vein and ultrasound system were placed inside the esophagus. One end of the vein was connected to a water reservoir to modulate its pressure; the other end was connected in two different ways to simulate hydrodynamic and hydrostatic flow conditions. The bag was inflated with water until vein occlusion was discernible on the ultrasound images. The influences of vein pressure, vein cross-sectional area and esophageal elasticity on the ultrasound measurement of vein pressure were assessed. A total of 108 trials were performed at nine different vein pressures. Complete vein occlusion occurred when the bag pressure was slightly greater (1.4 +/- 0.7 mmHg) than the vein pressure. For a vein pressure of 25 mmHg, the average occlusion and opening pressures were 27 +/- 0.2 and 25.7 +/- 0.3 mmHg, respectively (P < .05) suggesting that the vein opening pressure on the ultrasound images is more accurate than the vein closing pressure. In conclusion, the ultrasound technique can accurately measure intravariceal pressure in vitro. The bag pressure at the point of vein reopening is the best determinant of the vein pressure.     

Model for post-occlusive reactive hyperemia as measured noninvasively with pressure pulse waveform

Post-occlusive reactive hyperemia is a noninvasive maneuver to assess microvascular reactivity related to the bioavailability and/or bioactivity of endothelial-derived factors. The inability to respond to endogenous vasodilator substances is mostly described by a low peak flow after an event associated with a peak flow. The aim of this study is to propose a model to describe post-occlusive responses observed in the pressure waveforms after occlusion release. Model variables were investigated in search of those representatives of the endothelial response to the ischemic process. Radial pressure pulse waveforms were acquired in the anterior region of the wrist, superficial to the radial artery, using a piezoelectric transducer acquired by a 12 bits acquisition board model at a sampling rate of 1.0 kHz to increase the temporal resolution. The occlusion maneuver was performed using an arm-cuff placed over the brachial artery. A time series of pulse pressure (PP) values, calculated from successive values of beat-to-beat systolic and diastolic pressures, was found to be a useful variable representing blood pressure signal in the model. This data time series of the pulse pressure presents reduced initial values compared with the baseline measurement, and an increasing value until a steady state behavior was sustained after approximately 60 s. This behavior for the pulse pressure series was described by a hyperbolic tangent model with parameters K (rate of change of PP), PP₀ (first value of PP after cuff release), and ΔPP (change in PP). The model was applied to pulse pressure signals from normotensive and hypertensive subjects. The observed responses between groups suggest that PP₀ and ΔPP are related to an endothelial response to the ischemic process and could be used as a clinical tool to assess endothelial function in hypertension.     

The recovery of terminal lymph flow following occlusion

The effects of external pressure on the relative terminal lymphatic flow rate following occlusion of the lymph system were studied. Sulfur colloid tagged with 99mTc was injected into the hind thigh of dogs prior to compressive loading. Initially, the lymphatic clearance of the tracer was measured for approximately forty minutes with no applied external pressure. The terminal lymph vessels were then occluded for thirty minutes with the application of an applied external pressure of 75 mm Hg. Finally, the lymphatic clearance following occlusion was measured with the application of a nonocclusive pressure. External pressures of 0, 30, and 45 mm Hg were tested to determine the effects of post-occlusive pressure application on terminal lymphatic clearance. Results indicated that terminal lymphatic clearance did not resume for an applied pressure of 45 mm Hg following occlusion. The relative lymphatic clearance rate at an external pressure of 30 mm Hg following occlusion was 54% of the clearance rate for a 0 mm Hg applied pressure prior to lymph occlusion. The results for a 0 mm Hg external pressure following occlusion indicated a 23 percent clearance rate compared to the pre-occlusive state. A two compartment model was utilized to determine the lymphatic clearance rate per unit tissue volume of subcutaneous tissue from the experimental data for each pressure phase.     

Coronary three-vessel disease with occlusion of the right coronary artery: What are the most important factors that determine the right territory perfusion?

With progressive occlusion of a coronary main artery, some anastomotic vessels are recruited in order to supply blood to the ischemic region. This collateral circulation is an important factor in the preservation of the myocardium until reperfusion of the area at risk. An accurate estimation of collateral flow is crucial in surgical bypass planning as it alters the blood flow distribution in the coronary network and can influence the outcome of a given treatment for a given patient. The evaluation of collateral flow is frequently achieved using an index based on pressure measurements. It is named collateral flow index (CFI) and defined as: (P_w − P_v)/(P_ao − P_v), where P_w is the pressure distal to the thrombosis, P_ao the aortic pressure and P_v the central venous pressure. In the present work, we study patients with severe coronary disease (stenoses on the left branches and total occlusion of the right coronary artery). Using a mathematical model that describes the coronary hemodynamics in that situation, we demonstrate that the dependence of the collateral circulation to the pressure values is not as simple as it is commonly believed: using pressures alone as an index of collateral flow is likely to result in misinterpretation of the collateral flow contribution, because collateral flow depends on many other factors related to the status of the native stenosed arteries and to the microvascular resistances (capillary and collateral resistances, and the proportion between them).     

Superoxide anion production during reperfusion is reduced by an antineutrophil antibody after prolonged cerebral ischemia

Neutrophils may be involved in the pathophysiology of reperfusion injury following cerebral ischemia. One potential mechanism of reperfusion injury by neutrophils is through production of the superoxide anion. We hypothesized that, due to progressive endothelial damage during ischemia, neutrophil activation would be more prominent after longer periods of ischemia prior to reperfusion. Thus, neutrophils would contribute more to pathological processes such as superoxide anion formation after longer than after shorter periods of ischemia. A reversible middle cerebral artery occlusion model in rats was employed and superoxide anion concentration was measured with a cytochrome c coated electrode placed on the cortical penumbral region. Occlusion times were varied from 60 min to 2 h, and neutrophils were inhibited with an antiCD18 antibody administered prior to occlusion. Neutrophil accumulation and reduction with antibody treatment was confirmed immunohistochemically. Superoxide anion (O₂^•−) concentration was detected during the hours following 60 min of occlusion, and increased further with 2 h of occlusion. Treatment with the antiCD18 antibody had no effect on O₂^•− concentration during reperfusion in the 60–90 min occlusion groups, but O₂^•− concentration was significantly lower in the antiCD18 antibody treated group than in the control group during reperfusion after 120 min of ischemia. The antibody also reduced cortical neutrophil accumulation in the 120 min ischemia group. These results indicate for the first time that superoxide production by neutrophils becomes more important with longer periods of ischemia, and other quantitatively less important sources of superoxide predominate with shorter periods of ischemia. This phenomenon may explain some of the variation seen between different models of ischemia with different durations of ischemia when targeting reactive oxygen species, and supports an approach to combination therapy to extend the therapeutic window and reduce the deleterious effects of reperfusion.     

Liquid-filled esophageal catheter for measuring pleural pressure in preterm neonates

The precise measurement of esophageal pressure (Pes) as a reflection of pleural pressure (Ppl) is crucial to the measurement of lung mechanics in the newborn. The fidelity of Pes as a measurement of Ppl is determined by the occlusion test in which, during respiratory efforts against an occlusion at the airway opening, changes in pressure (delta Pao) (Pao is assumed to be equal to alveolar pressure) are shown to be equal to changes in Pes (delta Pes). Eight intubated premature infants (640-3,700 g) with chest wall distortion were studied using a water-filled catheter system to measure Pes. During the occlusion test, all patients had a finite region of the esophagus where delta Pes equaled delta Pao, which corresponded to points in the esophagus above the cardia but below the carina. In conclusion, even in the presence of chest wall distortion, a liquid-filled catheter with the tip between the cardia and carina can provide an accurate measurement of Ppl, even in the very small premature infant with chest wall distortion.     

Measuring Blood Pressure in Mice using Volume Pressure Recording, a Tail-cuff Method

The CODA 8-Channel High Throughput Non-Invasive Blood Pressure system measures the blood pressure in up to 8 mice or rats simultaneously. The CODA tail-cuff system uses Volume Pressure Recording (VPR) to measure the blood pressure by determining the tail blood volume. A specially designed differential pressure transducer and an occlusion tail-cuff measure the total blood volume in the tail without the need to obtain the individual pulse signal. Special attention is afforded to the length of the occlusion cuff in order to derive the most accurate blood pressure readings. VPR can easily obtain readings on dark-skinned rodents, such as C57BL6 mice and is MRI compatible. The CODA system provides you with measurements of six (6) different blood pressure parameters; systolic and diastolic blood pressure, heart rate, mean blood pressure, tail blood flow, and tail blood volume. Measurements can be made on either awake or anesthetized mice or rats. The CODA system includes a controller, laptop computer, software, cuffs, animal holders, infrared warming pads, and an infrared thermometer. There are seven different holder sizes for mice as small as 8 grams to rats as large as 900 grams.Open in a separate windowClick here to view.^{(51M, flv)}     

Quaking and Gas Exchange in Leaves of Cottonwood (Populus deltoides, Marsh.)

Cottonwood (Populus deltoides, Marsh.) leaves are amphistomatous and have an adaptation in their petiole which allows them to oscillate in wind. A possible function of these oscillations in enhancing gas exchange was studied.

Cottonwood leaves were found to oscillate in the presence of wind velocities frequently encountered in nature. A pressure differential across the leaf was shown to result in bulk flow of air through that leaf. Oscillating a cottonwood leaf at frequencies found to occur in nature was found to increase the rate of O₂ flux through the leaf. The measured changes in boundary layer resistances during oscillations were found to be insufficient to account for the increased O₂ flux. Thus, the bulk flow of air through an oscillating cottonwood leaf results in a decreased total resistance which is typically 25% less than that of a still leaf.

     

Calf venous compliance measured with head-up tilt equals supine calf compliance

Elevated calf compliance may contribute to orthostatic intolerance following space flight and bed rest. Calf venous compliance is measured conventionally with venous occulusion plethysmography in supine subjects. With this well-established technique, subjects undergo inflation of a pressure cuff around the thigh just above the knee, which increases calf venous pressure. A plethysmograph simultaneously measures calf volume elevation. Compliance equals calf volume elevation per mm Hg thigh occlusion (calf venous) pressure in relaxed legs of the supine subjects. Compliance may also be measured during stepwise head-up tilt (HUT) as calf volume elevation per mm Hg gravitational venous pressure elevation produced by HUT. However, during HUT on a tilt table with a footplate, calf muscles activate to counteract gravity: this is an obvious and natural response to gravitational force. Such muscle activation conceivably could reduce calf compliance, yet relatively little calf muscle activation occurs during HUT and orthostasis (<10% of maximal voluntary levels). Also, this activation produces minimal calf volume change (<0.3%). Therefore, we hypothesized that calf compliance measured with HUT equals that measured with supine venous occlusion.     

Comparison of the effects of prostaglandins E1 and A1 on coronary occlusion induced arrhythmia

The present study compares the effects of PGE₁ and PGA₁ on ventricular arrhythmias following coronary artery occlusion. The left anterior descending coronary artery (LAD) was occluded abruptly in 55 cats anesthetized with α-chloralose. Lead II of the ECG along with arterial blood pressure were monitored for one hour after occlusion. Either vehicle or prostaglandin was infused into the left atrium (LA) or femoral vein (IV) 15 min prior to and for 1 hour after LAD occlusion at a rate of 0.15 ml/min. Prostaglandin was infused at either a high dose (1.0 μg/kg/min) or a low dose (0.1 μg/kg/min). Infusion of either PGE₁ or PGA₁ produced a marked fall in blood pressure and heart rate which returned toward control before occlusion. Abrupt occlusion of the LAD produced ventricular arrhythmia in all cats ranging from ventricular premature beats to ventricular fibrillation (VF). The control animals had a 38% incidence of VF. VF occurred in 75% of the animals in which PGE₁ was administered into the LA at either the high or low dose while the occurrence in those administered PGA₁ was 67% and 50%, respectively. Intravenous administration of the high dose of PGE₁ or PGA₁ resulted in VF in 13% and 67% of the animals after LAD occlusion, respectively. These data indicate that the IV administration of PGE₁ may protect the heart from VF while the infusion of PGE₁ or PGA₁ into the LA may enhance VF after LAD occlusion.     

A mass spectrometry membrane probe and practical problems associated with its application in fermentation processes

A sensor-type, multi-compound monitoring system was constructed to measure several substances dissolved in a culture medium by use of a membrane inlet system coupled with a low-cost quadrupole mass spectrometer. The membrane inlet system was shown to have higher sensitivity with an even faster response than a capillary inlet system. The system was able to monitor on-line gaseous (H₂, CO₂ and O₂) and volatile (ethanol, butanol, acetone, acetic acid and ethyl acetate) compounds at concentrations in a range suitable for fermentation process monitoring applications. The effects of temperature, agitation speed and pressure on measurements using the membrane inlet system were investigated. For volatile compound measurements, temperature and pressure had an effect on the response but the agitation speed did not. A high concentration of compounds caused measurement saturation due to the space charge effect, but this could be overcome by reducing the surface area of the membrane. The system was applied to the monitoring of ethanol in a yeast cultivation. Measurements were affected by CO₂ produced during the fermentation, but this could be compensated for by means of a linear empirical equation. The system demonstrated high potentiality for application to the on-line monitoring of multiple compounds in fermentation processes.     

Growth monitoring of a photosynthetic micro-organism (Spirulina platensis) by pressure measurement

An on-line measurement technique for estimating biomass production rate in a photosynthetic micro-organism culture was developed and tested experimentally. The technique is based on monitoring O₂ production from the increase in pressure inside a closed photobioreactor. The data obtained by this method correlated with the direct measurement of the biomass concentration. A material balance on the components in the system allows the validity domain of the method to be defined. The method was applied to batch cultures of the cyanobacterium, Spirulina platensis, in a cylindrical photobioreactor validating existing physiological and light energy models.     

Specificity of autonomic influences on cardiac responses during myocardial ischemia.

A possible role of the autonomic nervous system in the left ventricular response to acute regional myocardial ischemia was sought in conscious dogs instrumented for measurement of left ventricular pressure, internal diameter, and aortic flow. Ischemia produced by occluding the left circumflex coronary artery caused tachycardia and reduced contractility. Changes during control occlusions were compared with those during occlusion.s after beta-adrenergic blockade, parasympathetic blockade, and combined sympathetic and parasymphatetic blockade. Beta-blockade did reduce the tachycardia and slightly reduced left ventricular diameter changes in response to coronary occlusion. Results obtained in animals following surgical cardiac sympathectomy indicated reduced tachycardia and no effects on other parameters. The principal effect of parasympathetic blockade was to augment the increase in end diastolic diameter during occlusion Right atrial pacing indicated this change was due to higher initial heart rates. Combined parasympathetic and sympathetic blockade did not alter inotropic responses to coronary occlusion. Results indicated that inotropic support due to changes in activity in autonomic nerves is not increased during acute occlusion of the left circumflex coronary artery.     

Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice

Dobutamine is a β-adrenergic agonist with an affinity higher for receptor expressed in the heart (β₁) than for receptors expressed in the arteries (β₂). When systemically administered, it increases cardiac demand. Thus, dobutamine unmasks abnormal rhythm or ischemic areas potentially at risk of infarction. Monitoring of heart function during a cardiac stress test can be performed by either ecocardiography or cardiac catheterization. The latter is an invasive but more accurate and informative technique that the former.Cardiac stress test induced by dobutamine and monitored by cardiac catheterization accomplished as described here allows, in a single experiment, the measurement of the following hemodynamic parameters: heart rate (HR), systolic pressure, diastolic pressure, end-diastolic pressure, maximal positive pressure development (dP/dtmax) and maximal negative pressure development (dP/dt_min), at baseline conditions and under increasing doses of dobutamine.As expected, in normal mice we observed a dobutamine dose-related increase in HR, dP/dt_max and dP/dt_min. Moreover, at the highest dose tested (12 ng/g/min) the cardiac decompensation of high fat diet-induced obese mice was unmasked.     

Noninvasive pressure pulse waveform analysis of flow-mediated vasodilation evoked by post-occlusive reactive hyperemia maneuver

Post-occlusive reactive hyperemia (PORH) assesses flow-mediated vasodilation at microvascular level due to bioactivity of endothelial-derived factors. Ordinary augmentation index that quantifies endothelial response is based on an ensemble-averaged waveform that limits its short-time application. This study proposes a mathematical model and two corresponding indices to evaluate arterial pressure response after blood flow restoration. Radial pressure pulse waveforms were acquired by a 12 bits acquisition board at a sampling rate of 1.0 kHz using a piezoelectric transducer. Signals were stored during 30 s at baseline condition and 60 s after 5-min occlusion using an arm-cuff placed over the brachial artery. In both conditions, the pressure pulse waveform presents systolic and diastolic phases with progressive and regressive pulse waveforms, respectively. Changes in pulse wave morphology were also observed and comprised attenuation of the pulse pressure amplitude (markedly first and second systolic peaks). This characteristic of the pulse pressure was described by the time-domain summation of two pairs of Gaussian-like waveforms (representing independent progressive and regressive components) with parameters related to amplitude, time lag, and duration for each component. A steepest descent optimization routine was used to fit the model parameters to experimental data of normotensive and subjects with hypertension. The optimized parameters were used to calculate two indices, RIx_1,2 (second-to-first systolic peak ratio) and RIx_1,3 (first diastolic-to-first systolic ratio). The observed responses between groups suggest that RIx_1,2 is related to an endothelial response to the ischemic process and could be used as a clinical tool to assess endothelial function in hypertension.     

Separation of Forearm Hemodynamics Into Skin and Muscle Components by Means of I-Epinephrine Iontophoresis

By a combination of iontophoresis of I-epinephrine into the skin of one arm and simultaneous venous occlusion plethysmography in both treated (muscle only) and untreated forearms (muscle plus skin), we examined in 16 normal volunteers forearm blood flow, capillary filtration coefficient and venous capacity at cuff pressure of 40 mm of mercury (VC₄₀) at rest, during tonic finger exercise and after interrupted repetitive finger exercise. Blood pressure did not change during the testing procedure. Forearm muscle conductance was about 60% to 70% of total conductance and was positively correlated with total conductance during rest and exercise. With standard exercises muscle conductance rises to 1½ to 2½ times resting level, and skin conductance rises to 2½ to 4½ times resting level. The capillary filtration coefficient is almost entirely in the muscle. It doubles in value with tonic exercise but decreases to half its resting value after interrupted repetitive exercise despite greatly increased conductance. Therefore, repetitive exercise-induced dissociation between conductance and filtration surface occurs in striated muscle. The mechanism is yet unknown. VC₄₀ in muscle is about 84% of total forearm VC₄₀. During tonic exercise muscle VC₄₀ was reduced, and during interrupted repetitive exercise the values for muscle and skin returned to resting values. A high correlation between muscle only and muscle-plus-skin for forearm blood flow and the identify between arms for measuring capillary filtration coefficient makes iontophoresis unnecessary for determining these values in forearm striated muscle under these experimental conditions.