Phase shift between joint rotation and actuation reflects dominant forces and predicts muscle activation patterns.

During behavior, the work done by actuators on the body can be resisted by the body's inertia, elastic forces, gravity, or viscosity. The dominant forces that resist actuation have major consequences on the control of that behavior. In the literature, features and actuation of locomotion, for example, have been successfully predicted by nondimensional numbers (e.g. Froude number and Reynolds number) that generally express the ratio between two of these forces (gravitational, inertial, elastic, and viscous). However, animals of different sizes or motions at different speeds may not share the same dominant forces within a behavior, making ratios of just two of these forces less useful. Thus, for a broad comparison of behavior across many orders of magnitude of limb length and cycle period, a dimensionless number that includes gravitational, inertial, elastic, and viscous forces is needed. This study proposes a nondimensional number that relates these four forces: the phase shift (ϕ) between the displacement of the limb and the actuator force that moves it. Using allometric scaling laws, ϕ for terrestrial walking is expressed as a function of the limb length and the cycle period at which the limb steps. Scale-dependent values of ϕ are used to explain and predict the electromyographic (EMG) patterns employed by different animals as they walk.

Long-Term Outcomes of Bovine versus Porcine Mitral Valve Replacement: A Multicenter Analysis.

Introduction: Recent national guidelines recommending mitral valve replacement (MVR) for severe secondary mitral regurgitation have resulted in an increased utilization of mitral bioprosthesis. There is a paucity of data on how longitudinal clinical outcomes vary by prosthesis type. We examined long-term survival and risk of reoperation between patients having bovine vs. porcine MVR. Study Design. A retrospective analysis of MVR or MVR + coronary artery bypass graft (CABG) from 2001 to 2017 among seven hospitals reporting to a prospectively maintained clinical registry was conducted. The analytic cohort included 1,284 patients undergoing MVR (801 bovine and 483 porcine). Baseline comorbidities were balanced using 1 : 1 propensity score matching with 432 patients in each group. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. Results: In the overall cohort, patients receiving porcine valves were more likely to have diabetes (19% bovine vs. 29% porcine; p < 0.001), COPD (20% bovine vs. 27% porcine; p=0.008), dialysis or creatinine >2 mg/dL (4% bovine vs. 7% porcine; p=0.03), and coronary artery disease (65% bovine vs. 77% porcine; p < 0.001). There was no difference in stroke, acute kidney injury, mediastinitis, pneumonia, length of stay, in-hospital morbidity, or 30-day mortality. In the overall cohort, there was a difference in long-term survival (porcine HR 1.17 (95% CI: 1.00-1.37; p=050)). However, there was no difference in reoperation (porcine HR 0.56 (95% CI: 0.23-1.32; p=0.185)). In the propensity-matched cohort, patients were matched on all baseline characteristics. There was no difference in postoperative complications or in-hospital morbidity and 30-day mortality. After 1 : 1 propensity score matching, there was no difference in long-term survival (porcine HR 0.97 (95% CI: 0.81-1.17; p=0.756)) or risk of reoperation (porcine HR 0.54 (95% CI: 0.20-1.47; p=0.225)). Conclusions: In this multicenter analysis of patients undergoing bioprosthetic MVR, there was no difference in perioperative complications and risk of reoperation of long-term survival after matching.

Investigating the role of low level reinforcement reflex loops in insect locomotion.

Insects are highly capable walkers, but many questions remain regarding how the insect nervous system controls locomotion. One particular question is how information is communicated between the 'lower level' ventral nerve cord (VNC) and the 'higher level' head ganglia to facilitate control. In this work, we seek to explore this question by investigating how systems traditionally described as 'positive feedback' may initiate and maintain stepping in the VNC with limited information exchanged between lower and higher level centers. We focus on the 'reflex reversal' of the stick insect femur-tibia joint between a resistance reflex (RR) and an active reaction in response to joint flexion, as well as the activation of populations of descending dorsal median unpaired (desDUM) neurons from limb strain as our primary reflex loops. We present the development of a neuromechanical model of the stick insect (Carausius morosus) femur-tibia (FTi) and coxa-trochanter joint control networks 'in-the-loop' with a physical robotic limb. The control network generates motor commands for the robotic limb, whose motion and forces generate sensory feedback for the network. We based our network architecture on the anatomy of the non-spiking interneuron joint control network that controls the FTi joint, extrapolated network connectivity based on known muscle responses, and previously developed mechanisms to produce 'sideways stepping'. Previous studies hypothesized that RR is enacted by selective inhibition of sensory afferents from the femoral chordotonal organ, but no study has tested this hypothesis with a model of an intact limb. We found that inhibiting the network's flexion position and velocity afferents generated a reflex reversal in the robot limb's FTi joint. We also explored the intact network's ability to sustain steady locomotion on our test limb. Our results suggested that the reflex reversal and limb strain reinforcement mechanisms are both necessary but individually insufficient to produce and maintain rhythmic stepping in the limb, which can be initiated or halted by brief, transient descending signals. Removing portions of this feedback loop or creating a large enough disruption can halt stepping independent of the higher-level centers. We conclude by discussing why the nervous system might control motor output in this manner, as well as how to apply these findings to generalized nervous system understanding and improved robotic control.

A dynamical model exploring sensory integration in the insect central complex substructures.

It is imperative that an animal has the ability to contextually integrate received sensory information to formulate appropriate behavioral responses. Determining a body heading based on a multitude of ego-motion cues and visual landmarks is an example of such a task that requires this context dependent integration. The work presented here simulates a sensory integrator in the insect brain called the central complex (CX). Based on the architecture of the CX, we assembled a dynamical neural simulation of two structures called the protocerebral bridge (PB) and the ellipsoid body (EB). Using non-spiking neuronal dynamics, our simulation was able to recreate in vivo neuronal behavior such as correlating body rotation direction and speed to activity bumps within the EB as well as updating the believed heading with quick secondary system updates. With this model, we performed sensitivity analysis of certain neuronal parameters as a possible means to control multi-system gains during sensory integration. We found that modulation of synapses in the memory network and EB inhibition are two possible mechanisms in which a sensory system could affect the memory stability and gain of another input, respectively. This model serves as an exploration in network design for integrating simultaneous idiothetic and allothetic cues in the task of body tracking and determining contextually dependent behavioral outputs.

Neurodynamic modeling of the fruit fly Drosophila melanogaster.

This manuscript describes neuromechanical modeling of the fruit fly Drosophila melanogaster in the form of a hexapod robot, Drosophibot, and an accompanying dynamic simulation. Drosophibot is a testbed for real-time dynamical neural controllers modeled after the anatomy and function of the insect nervous system. As such, Drosophibot has been designed to capture features of the animal's biomechanics in order to better test the neural controllers. These features include: dynamically scaling the robot to match the fruit fly by designing its joint elasticity and movement speed; a biomimetic actuator control scheme that converts neural activity into motion in the same way as observed in insects; biomimetic sensing, including proprioception from all leg joints and strain sensing from all leg segments; and passively compliant tarsi that mimic the animal's passive compliance to the walking substrate. We incorporated these features into a dynamical simulation of Drosophibot, and demonstrate that its actuators and sensors perform in an animal-like way. We used this simulation to test a neural walking controller based on anatomical and behavioral data from insects. Finally, we describe Drosophibot's hardware and show that the animal-like features of the simulation transfer to the physical robot.

Body stiffness in orthogonal directions oppositely affects worm-like robot turning and straight-line locomotion.

Earthworms locomote using traveling waves of segment contraction and expansion, which when symmetric result in straight-line locomotion and when biased result in turning. The mechanics of the soft body permit a large range of possible body shapes which both comply with the environment and contribute to directed locomotion. Inspired by earthworms, our new platform Compliant Modular Mesh Worm robot with Steering (CMMWorm-S) has been developed to study this type of locomotion. Compared with our previous robots, CMMWorm-S is capable of an entirely new movement (turning) using two actuated degrees of freedom per segment (a total of 12 motors). The modularity of the mesh, composed of 3D printed rigid pieces and flexible tubes, allows for the interchange of components to vary the stiffness of the robot. On this robotic platform, we show that locomotion efficiency is sensitive to body stiffness. In particular, greater bending stiffness improves turning locomotion, whereas greater circumferential stiffness speeds straight-line locomotion. The data presented demonstrate the contribution of each component towards the longitudinal, circumferential and bending stiffness of mesh-based robots. These analyses can help in the development of design criteria useful for future soft robotic peristaltic devices.

Artificial Manduca sexta forewings for flapping-wing micro aerial vehicles: how wing structure affects performance.

A novel approach to fabricating and testing artificial insect wings has been developed. Utilizing these new techniques, locally harvested hawk moth (Manduca sexta) forewings are compared to engineered forewings with varying wing structures. A number of small, flexible engineered forewings were fabricated with identical planform size and shape but with variations in camber, ribbing, thickness and composition. A series of static and dynamic assessments compares the forewings in terms of structure and performance. Data from these experiments show that the fabrication method can produce artificial forewings with similar properties to that of M. sexta. Flexural stiffness (EI) data shows a maximum percent difference of 41% between the left and right natural M. sexta forewings, whereas engineered forewings have a maximum percent difference of 18%. When deflection is induced from the ventral side of the forewing, EI values are at least 9.1% higher than when it is induced from the dorsal side. According to simulations, approximately 57% of this difference can be attributed to the camber of the forewings. Fabricated forewings produced comparable amounts of lift to natural M. sexta forewings (1.00 gF and 0.96 gF at 25 Hz flapping frequency respectively).

Biorobotic approaches to the study of motor systems.

Biorobotics is a promising new area of research at the interface between biology and robotics. Robots can either be used as physical models of biological systems or be directly inspired by biological studies. A great deal of progress has recently been made in biorobotic studies of locomotion, orientation, and vertebrate arm control.

Orthotopic heart transplantation with preoperative unsuspected left superior vena cava and absence of right superior vena cava.

We report the case history of a 47-year-old man who underwent orthotopic heart transplantation for ischemic cardiomyopathy. At the time of cardiectomy, the patient was found to have a persistent left superior vena cava draining into the coronary sinus and complete absence of his right superior vena cava. The donor heart had been removed without knowledge of this venous anomaly; consequently, the donor's superior vena cava and innominate vein were not harvested. The persistent left superior vena cava was cannulated for cardiopulmonary bypass. The recipient's heart was excised along the atrial ventricular groove, preserving the persistent left superior vena cava and coronary sinus. The atrial cuffs of the recipient and donor were fashioned for atrial-to-atrial anastomoses. Successful endomyocardial biopsies have been performed through the femoral veins after transplantation.

Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group.

OBJECTIVE: To assess mortality and risk factors associated with reexploration for hemorrhage in patients undergoing coronary artery bypass grafting (CABG). DESIGN: Regional cohort study. Patient characteristics, treatment variables, and outcome measures were collected prospectively. SETTING: All 5 centers performing cardiac surgery in Maine, New Hampshire, and Vermont. PATIENTS: A consecutive cohort of 8586 patients undergoing isolated CABG between 1992 and 1995. MAIN OUTCOME MEASURES: Postoperative hemorrhage leading to reexploration, in-hospital mortality, and length of stay. RESULTS: A total of 305 patients (3.6%) underwent reexploration for bleeding. In these patients, in-hospital mortality was nearly 3 times higher (9.5% vs 3.3% for patients not requiring reoperation, P<.001) and average length of stay from surgery to discharge was significantly longer (14.5 days vs 8.6 days, P<.001). High rates of reexploration for hemorrhage were observed in patients with prolonged (> 150 minutes) cardiopulmonary bypass (39 [11.1%] of 351) and in those requiring an intra-aortic balloon pump intraoperatively (12 [8%] of 139). In multivariate analysis, older age, smaller body surface area, prolonged cardiopulmonary bypass, and number of distal anastomoses were associated with increased bleeding risks. The use of thrombolytic therapy within 48 hours of surgery was weakly but not significantly associated with the need for reexploration. Factors not significantly associated with reexploration included patient sex, preoperative ejection fraction, surgical priority, history of liver disease, myocardial infarction, prior CABG, renal failure, and diabetes mellitus. CONCLUSIONS: Hemorrhage requiring reexploration after CABG is associated with markedly increased mortality and length of stay. Patients predicted to have increased risks of bleeding may benefit from prophylactic use of aprotinin, aminocaproic acid, or other agents shown to reduce hemorrhage.

Development of malignant hyperthermia during mitral valve replacement.

Malignant hyperthermia is a genetically predisposed, potentially fatal disorder triggered by anesthetic agents. The early diagnosis and treatment of malignant hyperthermia is essential, yet often difficult, because the signs and symptoms of this disorder are not unique to the disease. When the patient is also undergoing cardiopulmonary bypass this disorder may be very difficult to recognize. In this article, we report a case of malignant hyperthermia diagnosed during mitral valve replacement and discuss the preoperative and postoperative management possibilities. The unusualness of this case stems from the fact that the patient had centronuclear myopathy. Although reported with other types of myopathies, centronuclear myopathy has rarely been associated with malignant hyperthermia. This episode of malignant hyperthermia was diagnosed by intraoperative measurements showing increased oxygen consumption despite hypothermic cardiopulmonary bypass.

Trends in rates of reexploration for hemorrhage after coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: While mortality rates associated with coronary artery bypass grafting (CABG) have been declining, it is unknown whether similar improvements in the rates of morbidity have been occurring. This study examines trends in reexploration rates for hemorrhage, one of the serious complications of CABG surgery. It also explores changes in patient characteristics and several surgeon practice patterns potentially related to bleeding risks that may explain variations in these rates. METHODS: We performed a regional observational study of all of the 12,555 consecutive patients undergoing isolated CABG surgery in northern New England between 1992 and 1997. The rates of reexploration and patient characteristics were examined between two time intervals: period I (January 1, 1992 to June 1, 1994) and period II (June 1, 1995 to March 31, 1997). All of the region's 23 practicing surgeons responsible for these patients were surveyed to assess changes in practice patterns potentially related to bleeding risks. RESULTS: The adjusted rates of reexploration for bleeding declined 46% between periods I and II (3.6% versus 2.0%, p < 0.001). All of the five cardiac centers in northern New England showed similar trends with adjusted risk reductions ranging from 32% to 48% between the two time periods. This decline occurred despite the patients in period II having higher percentages of risk factors for reexploration for bleeding compared to patients in period I. From the surgeon survey, the number of surgeons using antifibrinolytics markedly increased from period I to period II. More surgeons were also using preoperative aspirin and heparin up until the time of surgery in period II. CONCLUSIONS: Similar to the rates of mortality, the rates of reexploration for bleeding following CABG surgery are substantially declining. This decrease in the reexploration rates occurred despite higher patient risks.

Improved in-hospital mortality in women undergoing coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.

BACKGROUND: Few studies have examined the changes in in-hospital mortality for women over time. We describe the changing case mix and mortality for women undergoing coronary artery bypass grafting (CABG) from 1987 to 1997 in northern New England. METHODS: Data were collected on 8,029 women and 21,139 men undergoing isolated CABG. The study consisted of three time periods (1987 to 1989, 1990 to 1992, and 1993 to 1997) to account for regional efforts to improve quality of care that occurred during 1990 to 1992. RESULTS: Compared with 1987 to 1989, women undergoing CABG in 1993 to 1997 were older, had poorer ventricular function, and more often required urgent or emergency operations. The crude and adjusted mortality rates for both women and men decreased significantly over time. The absolute magnitude of the change in adjusted rates was greater for women (3.1%) than for men (1.5%). Although women represented only 28% of the study population, the decrease in their mortality accounted for 44% of the total decrease in adjusted mortality during the study period. CONCLUSIONS: Over the last decade there has been a marked decrease in CABG mortality for women, despite a worsening case mix.