A review of optical pacing with infrared light.

Optical pacing (OP) uses pulsed infrared light to initiate heartbeats in electrically excitable cardiac tissues without employing exogenous agents. OP is an alternative approach to electrical pacing that may overcome some its disadvantages for some applications. In this review, we discuss the initial demonstrations, mechanisms, safety, advantages and applications of OP.

Altering embryonic cardiac dynamics with optical pacing.

Several studies have shown that altering blood flow early in development leads to congenital heart defects. In these studies the perturbations to hemodynamics were very gross manipulations (vessel ligation, conotruncal banding, etc.) that would be inappropriate for probing the delicate mechanisms responsible for mechanically-transduced signaling. Also, these perturbations lacked feedback from a monitoring system to determine the exact degree of alteration and the location of its effect. Here, we employed optical pacing (OP) to alter the heart rate in quail embryos and optical coherence tomography (OCT) to measure the resultant shear forces on the endocardium. OP is a new technique utilizing pulsed 1.851 µm infrared laser light to noninvasively capture the heart rate to the pulse frequency of the laser without the use of exogenous agents. To measure shear stress on the endocardium, we extended our previous OCT algorithms to enable the production of 4-D shear maps. 4-D shear maps allowed observation of the spatial and temporal distribution of shear stress. Employing both OCT and OP, we were able to develop perturbation protocols that increase regurgitant flow and greatly modify the oscillatory shear index (OSI) in a region of the heart tube where future valves will develop. Regurgitant flow has been linked with valve development and precise perturbations may allow one to determine the role of hemodynamics in valvulogenesis.

Patterns and determinants of communal latrine usage in urban poverty pockets in Bhopal, India.

OBJECTIVES: To explore and explain patterns of use of communal latrine facilities in urban poverty pockets. METHODS: Six poverty pockets with communal latrine facilities representing two management models (Sulabh and municipal) were selected. Sampling was random and stratified by poverty pocket population size. A seventh, community-managed facility was also included. Data were collected by exit interviews with facility users and by interviews with residents from a randomly selected representative sample of poverty pocket households, on social, economic and demographic characteristics of households, latrine ownership, defecation practices, costs of using the facility and distance from the house to the facility. A tally of facility users was kept for 1 day at each facility. Data were analysed using logistic regression modelling to identify determinants of communal latrine usage. RESULTS: Communal latrines differed in their facilities, conditions, management and operating characteristics, and rates of usage. Reported usage rates among non-latrine-owning households ranged from 15% to 100%. There was significant variation in wealth, occupation and household structure across the poverty pockets as well as in household latrine ownership. Households in pockets with municipal communal latrine facilities appeared poorer. Households in pockets with Sulabh-managed communal facilities were significantly more likely to own a household latrine. Determinants of communal facility usage among households without a latrine were access and convenience (distance and opening hours), facility age, cleanliness/upkeep and cost. The ratio of male to female users was 2:1 across all facilities for both adults and children. CONCLUSIONS: Provision of communal facilities reduces but does not end the problem of open defecation in poverty pockets. Women appear to be relatively poorly served by communal facilities and, cost is a barrier to use by poorer households. Results suggest improving facility convenience and access and modifying fee structures could lead to increased rates of usage. Attention to possible barriers to usage at household level associated particularly with having school-age children and with pre-school childcare needs may also be warranted.

Intracoronary optical coherence tomography, basic theory and image acquisition techniques.

Optical coherence tomography (OCT) imaging is showing great potential as an alternative or complementary tool to intravascular ultrasound (IVUS) for aiding in stent procedures and future diagnosis/treatment of atherosclerosis. Here, we describe the basic theory behind OCT imaging and explain important parameters such as axial resolution, lateral resolution and sensitivity. Also, we describe several image acquisition techniques that have been adopted for OCT imaging.

Optical pacing of the embryonic heart.

Light has been used to noninvasively alter the excitability of both neural and cardiac tissue 1-10. Recently, pulsed laser light has been shown to be capable of eliciting action potentials in peripheral nerves and in cultured cardiomyocytes 7-10. Here, we demonstrate for the first time optical pacing (OP) of an intact heart in vivo. Pulsed 1.875 µm infrared laser light was employed to lock the heart rate to the pulse frequency of the laser. A laser Doppler velocimetry (LDV) signal was used to verify the pacing. At low radiant exposures, embryonic quail hearts were reliably paced in vivo without detectable damage to the tissue, indicating that OP has great potential as a tool to study embryonic cardiac dynamics and development. In particular, OP can be utilized to control the heart rate, and thereby alter stresses and mechanically transduced signaling.

Ultrahigh-speed optical coherence tomography imaging and visualization of the embryonic avian heart using a buffered Fourier Domain Mode Locked laser.

The embryonic avian heart is an important model for studying cardiac developmental biology. The mechanisms that govern the development of a four-chambered heart from a peristaltic heart tube are largely unknown due in part to a lack of adequate imaging technology. Due to the small size and rapid motion of the living embryonic avian heart, an imaging system with high spatial and temporal resolution is required to study these models. Here, an optical coherence tomography (OCT) system using a buffered Fourier Domain Mode Locked (FDML) laser is applied for ultrahigh-speed non-invasive imaging of embryonic quail hearts at 100,000 axial scans per second. The high scan rate enables the acquisition of high temporal resolution 2D datasets (195 frames per second or 5.12 ms between frames) and 3D datasets (10 volumes per second). Spatio-temporal details of cardiac motion not resolvable using previous OCT technology are analyzed. Visualization and measurement techniques are developed to non-invasively observe and quantify cardiac motion throughout the brief period of systole (less than 50 msec) and diastole. This marks the first time that the preseptated embryonic avian heart has been imaged in 4D without the aid of gating and the first time it has been viewed in cross section during looping with extremely high temporal resolution, enabling the observation of morphological dynamics of the beating heart during systole.

4D embryonic cardiography using gated optical coherence tomography.

Simultaneous imaging of very early embryonic heart structure and function has technical limitations of spatial and temporal resolution. We have developed a gated technique using optical coherence tomography (OCT) that can rapidly image beating embryonic hearts in four-dimensions (4D), at high spatial resolution (10-15 mum), and with a depth penetration of 1.5 - 2.0 mm that is suitable for the study of early embryonic hearts. We acquired data from paced, excised, embryonic chicken and mouse hearts using gated sampling and employed image processing techniques to visualize the hearts in 4D and measure physiologic parameters such as cardiac volume, ejection fraction, and wall thickness. This technique is being developed to longitudinally investigate the physiology of intact embryonic hearts and events that lead to congenital heart defects.

Hypnosis: practical applications and theoretical considerations in normal labour.

OBJECTIVE: To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women. DESIGN: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy. SUBJECTS: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included. SETTING: Aberdare District Maternity Unit, Mid Glamorgan, Wales. INTERVENTION: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy. OUTCOME MEASURES: Analgesic requirements, duration of first and second stages of labour. RESULTS: The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P < 0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P < 0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P < 0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P < 0.001) in both hypnotised groups compared with their controls. CONCLUSION: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.