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1.
Nature ; 610(7931): 283-289, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36224418

RESUMO

The current proliferation of mobile robots spans ecological monitoring, warehouse management and extreme environment exploration, to an individual consumer's home1-4. This expanding frontier of applications requires robots to transit multiple environments, a substantial challenge that traditional robot design strategies have not effectively addressed5,6. For example, biomimetic design-copying an animal's morphology, propulsion mechanism and gait-constitutes one approach, but it loses the benefits of engineered materials and mechanisms that can be exploited to surpass animal performance7,8. Other approaches add a unique propulsive mechanism for each environment to the same robot body, which can result in energy-inefficient designs9-11. Overall, predominant robot design strategies favour immutable structures and behaviours, resulting in systems incapable of specializing across environments12,13. Here, to achieve specialized multi-environment locomotion through terrestrial, aquatic and the in-between transition zones, we implemented 'adaptive morphogenesis', a design strategy in which adaptive robot morphology and behaviours are realized through unified structural and actuation systems. Taking inspiration from terrestrial and aquatic turtles, we built a robot that fuses traditional rigid components and soft materials to radically augment the shape of its limbs and shift its gaits for multi-environment locomotion. The interplay of gait, limb shape and the environmental medium revealed vital parameters that govern the robot's cost of transport. The results attest that adaptive morphogenesis is a powerful method to enhance the efficiency of mobile robots encountering unstructured, changing environments.


Assuntos
Biomimética , Meio Ambiente , Desenho de Equipamento , Robótica , Animais , Biomimética/instrumentação , Biomimética/métodos , Locomoção , Robótica/instrumentação , Robótica/métodos , Tartarugas/fisiologia
2.
J Exp Biol ; 227(5)2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38380513

RESUMO

Dolphins have become famous for their ability to perform a wide variety of athletic and acrobatic behaviors including high-speed swimming, maneuverability, porpoising and tail stands. Tail stands are a behavior where part of the body is held vertically above the water's surface, achieved through thrust produced by horizontal tail fluke oscillations. Strong, efficient propulsors are needed to generate the force required to support the dolphin's body weight, exhibiting chordwise and spanwise flexibility throughout the stroke cycle. To determine how thrust production, fluke flexibility and tail stroke kinematics vary with effort, six adult bottlenose dolphins (Tursiops truncatus) were tested at three different levels based on the position of the center of mass (COM) relative to the water's surface: low (COM below surface), medium (COM at surface) and high (COM above surface) effort. Additionally, fluke flexibility was measured as a flex index (FI=chord length/camber length) at four points in the stroke cycle: center stroke up (CU), extreme top of stroke (ET), center stroke down (CD) and extreme bottom of stroke (EB). Video recordings were analyzed to determine the weight supported above the water (thrust production), peak-to-peak amplitude, stroke frequency and FI. Force production increased with low, medium and high efforts, respectively. Stroke frequency also increased with increased effort. Amplitude remained constant with a mean 33.8% of body length. Significant differences were seen in the FI during the stroke cycle. Changes in FI and stroke frequency allowed for increased force production with effort, and the peak-to-peak amplitude was higher compared with that for horizontal swimming.


Assuntos
Golfinho Nariz-de-Garrafa , Trematódeos , Animais , Natação , Gravação em Vídeo , Água
3.
J Exp Biol ; 227(2)2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-38149677

RESUMO

Cetaceans are capable of extraordinary locomotor behaviors in both water and air. Whales and dolphins can execute aerial leaps by swimming rapidly to the water surface to achieve an escape velocity. Previous research on spinner dolphins demonstrated the capability of leaping and completing multiple spins around their longitudinal axis with high angular velocities. This prior research suggested the slender body morphology of spinner dolphins together with the shapes and positions of their appendages allowed for rapid spins in the air. To test whether greater moments of inertia reduced spinning performance, videos and biologging data of cetaceans above and below the water surface were obtained. The principal factors affecting the number of aerial spins a cetacean can execute were moment of inertia and use of control surfaces for subsurface corkscrewing. For spinner dolphin, Pacific striped dolphin, bottlenose dolphin, minke whale and humpback whale, each with swim speeds of 6-7 m s-1, our model predicted that the number of aerial spins executable was 7, 2, 2, 0.76 and 1, respectively, which was consistent with observations. These data implied that the rate of subsurface corkscrewing was limited to 14.0, 6.8, 6.2, 2.2 and 0.75 rad s-1 for spinner dolphins, striped dolphins, bottlenose dolphins, minke whales and humpback whales, respectively. In our study, the moment of inertia of the cetaceans spanned a 21,000-fold range. The greater moments of inertia for the last four species produced large torques on control surfaces that limited subsurface corkscrewing motion and aerial maneuvers compared with spinner dolphins.


Assuntos
Golfinho Nariz-de-Garrafa , Jubarte , Stenella , Animais , Natação , Água
4.
J Exp Biol ; 226(4)2023 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-36728637

RESUMO

Tuna are known for exceptional swimming speeds, which are possible because of their thunniform lift-based propulsion, large muscle mass and rigid fusiform body. A rigid body should restrict maneuverability with regard to turn radius and turn rate. To test if turning maneuvers by the Pacific bluefin tuna (Thunnus orientalis) are constrained by rigidity, captive animals were videorecorded overhead as the animals routinely swam around a large circular tank or during feeding bouts. Turning performance was classified into three different types: (1) glide turns, where the tuna uses the caudal fin as a rudder; (2) powered turns, where the animal uses continuous near symmetrical strokes of the caudal fin through the turn; and (3) ratchet turns, where the overall global turn is completed by a series of small local turns by asymmetrical stokes of the caudal fin. Individual points of the rostrum, peduncle and tip of the caudal fin were tracked and analyzed. Frame-by-frame analysis showed that the ratchet turn had the fastest turn rate for all points with a maximum of 302 deg s-1. During the ratchet turn, the rostrum exhibited a minimum global 0.38 body length turn radius. The local turn radii were only 18.6% of the global ratchet turn. The minimum turn radii ranged from 0.4 to 1.7 body lengths. Compared with the performance of other swimmers, the increased flexion of the peduncle and tail and the mechanics of turning behaviors used by tuna overcomes any constraints to turning performance from the rigidity of the anterior body morphology.


Assuntos
Músculos , Atum , Animais , Atum/fisiologia , Natação/fisiologia
5.
Pediatr Cardiol ; 2023 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-37684488

RESUMO

Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.

6.
J Cardiovasc Electrophysiol ; 33(1): 128-133, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34716972

RESUMO

This series describes an innovative technique for pacing in patients with sinus node dysfunction after extracardiac Fontan surgery. This transpulmonary approach to the left atrial epi-myocardium has been successfully applied to three patients at two centers and resulted in excellent acute and midterm pacing characteristics without known complications. The principal advantage of this procedure in comparison to prior iterations is the absence of pacing material within the pulmonary venous atrium, so that future systemic thromboembolism risk is minimized. The transpulmonary approach for permanent atrial pacing offers a novel solution to the unique challenges for patients after extracardiac Fontan operation.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Marca-Passo Artificial , Estimulação Cardíaca Artificial/métodos , Estudos de Viabilidade , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Humanos , Síndrome do Nó Sinusal/terapia
7.
J Exp Biol ; 225(18)2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36039661

RESUMO

Pinnipedia, an order of semi-aquatic marine mammals, adapted a body design that allows for efficient aquatic locomotion but limited terrestrial locomotion. Otariids, like the California sea lion (Zalophus californianus), have enlarged forelimbs and can bring their hindlimbs under the body to locomote quadrupedally on land, but phocids (true seals) have reduced forelimbs and are unable to bring their hindlimbs beneath them during terrestrial locomotion. Because of these differences, phocids are expected to have greater energetic costs when moving on land compared with otariids. The mechanical costs of transport (COT) and power outputs of terrestrial locomotion were first obtained from one male and two female adult California sea lions through video recording locomotion sequences across a level runway. The center of mass, along with six other anatomical points, were digitized to obtain variables such as velocity (V), amplitude of heave (A) and the frequency (f) of oscillations during the locomotion cycle. These variables represent the principal parameters of a biomechanical model that computes the power output of individuals. The three California sea lions in this study averaged a power output of 112.04 W and a COT of 0.63 J kg-1 m-1. This footage was compared against video footage previously recorded of three phocid species (harbor seal, gray seal and northern elephant seal). Power output and mechanical COT were compared for all four pinniped species by tracking the animals' center of mass. The quadrupedal gait of sea lions showed lower vertical displacements of the center of mass, and higher velocities compared with the terrestrial gait of phocids. Northern elephant seals, gray seals and harbor seals showed significantly higher COT and power outputs than the sea lions. California sea lions locomote with lower energetic costs, and thus higher efficiency compared with phocids, proving that they are a mechanically intermediate species on land between terrestrial mammals and phocids. This study provides novel information on the mechanical energy exerted by pinnipeds, particularly California sea lions, to then be used in future research to better understand the limitations of these aquatic mammals.


Assuntos
Caniformia , Phoca , Leões-Marinhos , Animais , Feminino , Locomoção , Masculino
8.
J Exp Biol ; 225(5)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35234874

RESUMO

Despite their enormous size, whales make their living as voracious predators. To catch their much smaller, more maneuverable prey, they have developed several unique locomotor strategies that require high energetic input, high mechanical power output and a surprising degree of agility. To better understand how body size affects maneuverability at the largest scale, we used bio-logging data, aerial photogrammetry and a high-throughput approach to quantify the maneuvering performance of seven species of free-swimming baleen whale. We found that as body size increases, absolute maneuvering performance decreases: larger whales use lower accelerations and perform slower pitch-changes, rolls and turns than smaller species. We also found that baleen whales exhibit positive allometry of maneuvering performance: relative to their body size, larger whales use higher accelerations, and perform faster pitch-changes, rolls and certain types of turns than smaller species. However, not all maneuvers were impacted by body size in the same way, and we found that larger whales behaviorally adjust for their decreased agility by using turns that they can perform more effectively. The positive allometry of maneuvering performance suggests that large whales have compensated for their increased body size by evolving more effective control surfaces and by preferentially selecting maneuvers that play to their strengths.


Assuntos
Motivação , Baleias , Animais , Tamanho Corporal , Natação
9.
Cardiol Young ; 32(11): 1820-1825, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34986912

RESUMO

BACKGROUND: Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery. METHODS: Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2-20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5-85, overweight 85-95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis. RESULTS: There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive-inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias. CONCLUSION: Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.


Assuntos
Cardiopatias Congênitas , Magreza , Criança , Humanos , Adulto Jovem , Magreza/complicações , Magreza/cirurgia , Sobrepeso/complicações , Fatores de Risco , Obesidade/complicações , Obesidade/epidemiologia , Índice de Massa Corporal , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/complicações , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Estudos Retrospectivos
10.
J Exp Biol ; 224(20)2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34542635

RESUMO

California sea lions (Zalophus californianus) are a highly maneuverable species of marine mammal. During uninterrupted, rectilinear swimming, sea lions oscillate their foreflippers to propel themselves forward without aid from the collapsed hindflippers, which are passively trailed. During maneuvers such as turning and leaping (porpoising), the hindflippers are spread into a delta-wing configuration. There is little information defining the role of otarrid hindflippers as aquatic control surfaces. To examine Z. californianus hindflippers during maneuvering, trained sea lions were video recorded underwater through viewing windows performing porpoising behaviors and banking turns. Porpoising by a trained sea lion was compared with sea lions executing the maneuver in the wild. Anatomical points of reference (ankle and hindflipper tip) were digitized from videos to analyze various performance metrics and define the use of the hindflippers. During a porpoising bout, the hindflippers were considered to generate lift when surfacing with a mean angle of attack of 14.6±6.3 deg. However, while performing banked 180 deg turns, the mean angle of attack of the hindflippers was 28.3±7.3 deg, and greater by another 8-12 deg for the maximum 20% of cases. The delta-wing morphology of the hindflippers may be advantageous at high angles of attack to prevent stalling during high-performance maneuvers. Lift generated by the delta-shaped hindflippers, in concert with their position far from the center of gravity, would make these appendages effective aquatic control surfaces for executing rapid turning maneuvers.


Assuntos
Leões-Marinhos , Animais , Extremidades , Natação
11.
J Exp Biol ; 224(13)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34109418

RESUMO

High efficiency lunate-tail swimming with high-aspect-ratio lifting surfaces has evolved in many vertebrate lineages, from fish to cetaceans. Baleen whales (Mysticeti) are the largest swimming animals that exhibit this locomotor strategy, and present an ideal study system to examine how morphology and the kinematics of swimming scale to the largest body sizes. We used data from whale-borne inertial sensors coupled with morphometric measurements from aerial drones to calculate the hydrodynamic performance of oscillatory swimming in six baleen whale species ranging in body length from 5 to 25 m (fin whale, Balaenoptera physalus; Bryde's whale, Balaenoptera edeni; sei whale, Balaenoptera borealis; Antarctic minke whale, Balaenoptera bonaerensis; humpback whale, Megaptera novaeangliae; and blue whale, Balaenoptera musculus). We found that mass-specific thrust increased with both swimming speed and body size. Froude efficiency, defined as the ratio of useful power output to the rate of energy input ( Sloop, 1978), generally increased with swimming speed but decreased on average with increasing body size. This finding is contrary to previous results in smaller animals, where Froude efficiency increased with body size. Although our empirically parameterized estimates for swimming baleen whale drag were higher than those of a simple gliding model, oscillatory locomotion at this scale exhibits generally high Froude efficiency as in other adept swimmers. Our results quantify the fine-scale kinematics and estimate the hydrodynamics of routine and energetically expensive swimming modes at the largest scale.


Assuntos
Balaenoptera , Baleia Comum , Animais , Regiões Antárticas , Fenômenos Biomecânicos , Natação
12.
J Cardiovasc Magn Reson ; 23(1): 108, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34629101

RESUMO

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website ( https://www.scmr.org ) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.


Assuntos
Doenças Cardiovasculares , Imageamento por Ressonância Magnética , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/terapia , Humanos , Espectroscopia de Ressonância Magnética , Valor Preditivo dos Testes
13.
J Cardiovasc Electrophysiol ; 31(8): 2043-2048, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32542917

RESUMO

INTRODUCTION: Experience with catheter ablation of orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal reentrant tachycardia (AVNRT) in young children with hypoplastic left heart syndrome (HLHS) is limited. We report the feasibility, safety, and outcomes of catheter ablation of ORT and AVNRT in children with HLHS. METHODS AND RESULTS: This was a retrospective review of patients with HLHS who underwent catheter ablation for reentrant supraventricular tachycardias (excluding atrial tachycardias) between 2005 and 2017 at a single center. Descriptive data including demographics, clinical history, procedural data, and outcomes were recorded. Ten children with HLHS underwent eleven catheter ablation procedures. Median age and weight at ablation were 2.7 years (range: 0.1-10.5) and 11.4 kg (range: 3.6-30.4), respectively. Tachycardia mechanism was AVNRT in four, ORT in five (two with preexcitation), and both in one. Acute procedural success was 100% and there was no spontaneous recurrence of tachycardia orpreexcitationin median 92 months (range: 21-175 months) follow-up. Five patients underwent subsequent EP studies at catheterization (intracardiac) or after surgery (via epicardial wires): three were noninducible, one after AVNRT ablation had inducible atrial tachycardia, and one after initial ORT ablation had inducible ORT at fenestration closure and underwent successful repeat ablation. Thus, long-term freedom from clinical tachycardia was 100% and from inducible AVNRT or ORT was 80%. CONCLUSION: Transcatheter ablation for ORT and AVNRT in children with HLHS can be performed with excellent acute and long-term success without major complications.


Assuntos
Ablação por Cateter , Síndrome do Coração Esquerdo Hipoplásico , Taquicardia por Reentrada no Nó Atrioventricular , Taquicardia Reciprocante , Ablação por Cateter/efeitos adversos , Criança , Pré-Escolar , Eletrocardiografia , Humanos , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Reciprocante/diagnóstico , Taquicardia Reciprocante/cirurgia
14.
J Cardiovasc Electrophysiol ; 30(11): 2599-2602, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31432598

RESUMO

INTRODUCTION: Current resuscitation guidelines state that the safety of automated external defibrillators (AEDs) in infants less than 1 year of age is unknown. METHODS AND RESULTS: We report successful AED use in a 31-day-old previously healthy infant with out-of-hospital cardiac arrest. Chest compressions began immediately, pediatric AED pads were applied in less than 5 minutes and the initial rhythm was ventricular fibrillation. After two 50 J shocks, return of spontaneous circulation was achieved. She was diagnosed with a rare but previously described syndrome of infant ventricular fibrillation and was discharged to home in good condition after epicardial defibrillator placement. CONCLUSIONS: This case represents, to our knowledge, the youngest patient successfully defibrillated by an AED in a nonmedical setting. Although she received two shocks more than 11 J/kg each, she had no apparent myocardial damage at presentation.


Assuntos
Reanimação Cardiopulmonar/métodos , Desfibriladores , Parada Cardíaca Extra-Hospitalar/terapia , Fibrilação Ventricular/terapia , Reanimação Cardiopulmonar/instrumentação , Feminino , Humanos , Lactente , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
15.
J Exp Biol ; 222(Pt 20)2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31558588

RESUMO

The scale dependence of locomotor factors has long been studied in comparative biomechanics, but remains poorly understood for animals at the upper extremes of body size. Rorqual baleen whales include the largest animals, but we lack basic kinematic data about their movements and behavior below the ocean surface. Here, we combined morphometrics from aerial drone photogrammetry, whale-borne inertial sensing tag data and hydrodynamic modeling to study the locomotion of five rorqual species. We quantified changes in tail oscillatory frequency and cruising speed for individual whales spanning a threefold variation in body length, corresponding to an order of magnitude variation in estimated body mass. Our results showed that oscillatory frequency decreases with body length (∝length-0.53) while cruising speed remains roughly invariant (∝length0.08) at 2 m s-1 We compared these measured results for oscillatory frequency against simplified models of an oscillating cantilever beam (∝length-1) and an optimized oscillating Strouhal vortex generator (∝length-1). The difference between our length-scaling exponent and the simplified models suggests that animals are often swimming non-optimally in order to feed or perform other routine behaviors. Cruising speed aligned more closely with an estimate of the optimal speed required to minimize the energetic cost of swimming (∝length0.07). Our results are among the first to elucidate the relationships between both oscillatory frequency and cruising speed and body size for free-swimming animals at the largest scale.


Assuntos
Natação/fisiologia , Baleias/fisiologia , Animais , Análise de Regressão , Especificidade da Espécie , Baleias/anatomia & histologia
16.
Biol Lett ; 15(7): 20190103, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31311484

RESUMO

Dolphin skin has long been an inspiration for research on drag reduction mechanisms due to the presence of skin ridges that could reduce fluid resistance. We gathered in vivo three-dimensional surface data on the skin from five species of odontocetes to quantitatively examine skin texture, including the presence and size of ridges. We used these data to calculate k+ values, which relate surface geometry to changes in boundary layer flow. Our results showed that while ridge size differs among species, odontocete skin was surprisingly smooth compared to the skin of other swimmers (average roughness = 5.3 µm). In addition, the presence of ridges was variable among individuals of the same species. We predict that odontocete skin ridges do not alter boundary layer flows at cruising swimming speeds. By combining k+ values and morphological data, our work provides evidence that skin ridges are unlikely to be an adaptation for drag reduction and that odontocete skin is exceptionally smooth compared to other pelagic swimmers.


Assuntos
Golfinhos , Adaptação Fisiológica , Animais , Pele , Natação
17.
Pacing Clin Electrophysiol ; 42(3): 356-365, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30680764

RESUMO

INTRODUCTION: The Medtronic SelectSecure™ (Minneapolis, MN, USA) pacing lead (SS) has theoretical advantages compared to conventional (C) transvenous pacing leads (PLs). The study purpose was to determine whether differences in electrical function and lead survival exist between these PLs in a large data set of pediatric and congenital patients. METHODS: A multicenter historical longitudinal cohort study was performed comparing SS and CPL performance over a 72-month follow-up (FU). Ten centers provided data for both SS and CPL, matched for age, implanted pacing chamber, time period of implantation, and presence of heart disease. RESULTS: The cohort consisted of 141 subjects in each group. No statistical differences were observed in age, gender, presence of heart disease, or pacing indication. Atrial and ventricular capture thresholds were stable throughout FU and higher in the SS group (atrial: 0.75 ± 0.02 vs 0.5 ± 0.04 V, ventricular: 1.0 ± 0.04 vs 0.75 ± 0.04 V), P < 0.001. Group PL sensing thresholds did not differ. The SS group required greater energy to pace (atrial: 0.57 ± 0.05 vs 0.32 ± 0.02 mJ, ventricular: 0.83 ± 0.05 vs 0.56 ± 0.06 mJ), P = 0.001. Early lead dislodgement and phrenic nerve stimulation were greater in the SS group (P = 0.03). Long-term lead survival was high and similar between the two groups, P = 0.35. CONCLUSIONS: Long-term survival of both PL was high with a low fracture rate. The SS had excellent electrical function but did show higher capture thresholds and increased energy to pace; these differences are offset by other advantages of the SS PL.


Assuntos
Eletrodos Implantados , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Marca-Passo Artificial , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino
18.
Pacing Clin Electrophysiol ; 42(1): 46-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30334588

RESUMO

BACKGROUND: Axillary implant location is an alternative implant location in patients for cardiac implantable electronic devices (CIEDs) for the purposes of improved cosmetic outcome. The impact from the patient's perspective is unknown. The purpose of this study was to compare scar perception scores and quality of life (QOL) in pediatric patients with axillary CIED implant location versus the standard infraclavicular approach. METHODS: This is a multicenter prospective study conducted at eight pediatric centers and it includes patients aged from 8 to 18 years with a CIED. Patients with prior sternotomy were excluded. Scar perception and QOL outcomes were compared between the infraclavicular and axillary implant locations. RESULTS: A total of 141 patients (83 implantable cardioverter defibrillator [ICD]/58 pacemakers) were included, 55 with an axillary device and 86 with an infraclavicular device. Patients with an ICD in the axillary position had better perception of scar appearance and consciousness. Patients in the axillary group reported, on average, a total Pediatric QOL Inventory score that was 6 (1, 11) units higher than the infraclavicular group, after adjusting for sex and race (P = 0.02). CONCLUSIONS: QOL is significantly improved in axillary in comparison to the infraclavicular CIED position, regardless of device type. Scar perception is improved in patients with ICD in the axillary position.


Assuntos
Cicatriz/psicologia , Desfibriladores Implantáveis , Estética , Cardiopatias Congênitas/terapia , Marca-Passo Artificial , Qualidade de Vida , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários
19.
Pediatr Cardiol ; 40(6): 1253-1257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31263917

RESUMO

Obesity is associated with additional left ventricular hypertrophy (LVH) in adults with hypertrophic cardiomyopathy (HCM). It is not known whether obesity can lead to further LVH in children with HCM. Echocardiographic LV dimensions were determined in 504 children with HCM. Measurements of interventricular septal thickness (IVST) and posterior wall thickness (PWT), and patients' weight and height were recorded. Obesity was defined as a body mass index (BMI) ≥ 99th percentile for age and sex. IVST data was available for 498 and PWT data for 484 patients. Patient age ranged from 2 to 20 years (mean ± SD, 12.5 ± 3.9) and 340 (68%) were males. Overall, patient BMI ranged from 7 to 50 (22.7 ± 6.1). Obesity (BMI 18-50, mean 29.1) was present in 140 children aged 2-19.6 (11.3 ± 4.1). The overall mean IVST was 20.5 ± 9.6 mm and the overall mean PWT was 11.0 ± 8.4 mm. The mean IVST in the obese patients was 21.6 ± 10.0 mm and mean PWT was 13.3 ± 14.7 mm. The mean IVST in the non-obese patients was 20.1 ± 9.5 mm and mean PWT was 10.4 ± 4.3 mm. Obesity was not significantly associated with IVST (p = 0.12), but was associated with increased PWT (0.0011). Obesity is associated with increased PWT but not IVST in children with HCM. Whether obesity and its impact on LVH influences clinical outcomes in children with HCM needs to be studied.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Ventrículos do Coração/patologia , Obesidade/complicações , Septo Interventricular/patologia , Adolescente , Índice de Massa Corporal , Cardiomiopatia Hipertrófica/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Masculino , Adulto Jovem
20.
J Exp Biol ; 221(Pt 18)2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30127084

RESUMO

The aquatic specializations of phocid seals have restricted their ability to locomote on land. The amphibious northern elephant seal, Mirounga angustirostris, is the second largest phocid seal in the world, with males reaching 2700 kg. Although elephant seals are proficient swimmers and deep divers, their extreme size and aquatic specializations limit terrestrial movement. The kinematics of terrestrial locomotion in northern elephant seals were analyzed from video recordings of animals observed on the beach of Año Nuevo State Reserve, CA, USA. The seals moved using a series of rhythmic undulations produced by dorsoventral spinal flexion. The traveling spinal wave moved anteriorly along the dorsal margin of the body with the chest, pelvic region and foreflippers serving as the main points of contact with the ground. The hindflippers were not used. The spinal wave and foreflippers were used to lift the chest off the ground as the body was pushed forward from the pelvis as the foreflippers were retracted to pull the body forward. Seals moved over land at 0.41-2.56 m s-1 (0.12-0.71 body lengths s-1). The frequency and amplitude of spinal flexions both displayed a direct increase with increasing speed. The duty factor for the pelvic region decreased with increasing velocity while the duty factor of the foreflipper remained constant. Kinematic data for elephant seals and other phocids were used in a biomechanical model to calculate the mechanical energy expended during terrestrial locomotion. The elephant seals were found to expend more energy when traveling over land for their size than smaller phocids. The unique method of terrestrial movement also exhibited greater energy expenditure on land than values for large quadrupeds. The trade-off for the northern elephant seal is that its massive size and morphology have well adapted it to an aquatic existence but limited its locomotor performance (i.e. speed, endurance) on land.


Assuntos
Tamanho Corporal , Locomoção/fisiologia , Focas Verdadeiras/fisiologia , Animais , Fenômenos Biomecânicos , California , Metabolismo Energético , Meio Ambiente , Masculino , Modelos Biológicos , Movimento
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