Tele-affiliation in medical education: experience from the international program at Yale Office of Telemedicine.

OBJECTIVES: Telemedicine is developed in response to the needs of users that results in a more viable model. Yale has developed a process called tele-affiliation to combine services that are customized to the international client's needs. METHODS: Several defined steps compose the tele-affiliation process. The Yale-Greece telemedicine program is used as an illustration of this process. Some of the programs developed in response to Greek needs include breast cancer clinics, women's health clinics and tele-homecare monitoring for post-operative and chronically ill patients. RESULTS: Tele-affiliation creates on infrastructure that has the potential to change the method of health care delivery. By using the infrastructure created by the tele-affiliation process, templates for disease management, as well as health promotion and education can be delivered to a global audience. CONCLUSIONS: A tele-affiliation education environment has been developed and tested between Yale University School of Medicine and Greece resulting in an improved infrastructure for health education and management.

Time-related changes in hemodynamic parameters and pressure-derived indices of left ventricular function in a porcine model of prolonged pneumoperitoneum.

BACKGROUND: Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pressure causes a number of hemodynamic changes including a drop in cardiac output, but it is unclear whether there is a direct effect on cardiac contractility. In this experimental study, we sought to determine whether there is a direct impact of pneumoperitoneum on cardiac contractility. We also examined the time-related changes taking place during the insufflation period. METHODS: Six young pigs were anesthetized and mechanically ventilated. Pneumoperitoneum was established by insufflating carbon dioxide to a pressure of 15 mmHg and maintained for a period of 180 min. Hemodynamic parameters including left ventricular dP/dT were invasively recorded every 15 min. All hemodynamic changes were statistically evaluated, and parameters were correlated with time. RESULTS: Cardiac output decreased with insufflation from a baseline of 3.37 +/- 0.34 lt/min and reached the lowest value at 165 min of pneumoperitoneum (2.86 +/- 0.30 l/min; p = 0.023). Systemic vascular resistance (SVR) significantly increased from 2236 +/- 227 dyne/s/cm(5) to a maximum of 3774 +/- 324 dyne/s/cm(5) (p = 0.005). Left ventricular dP/dT maximum did not change significantly with insufflation. The decrease in cardiac output strongly correlated with the increase in SVR (r = -0.949). Time of insufflation correlated with cardiac output (r = -0.762) and dP/dT maximum (r = -0.727). CONCLUSIONS: Pneumoperitoneum at 15 mmHg negatively affects cardiac output without significantly affecting cardiac contractility. A significant increase in SVR appears to be the driving event for the decreased cardiac output. Prolonged pneumoperitoneum may have an additional negative effect on hemodynamic parameters.

Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension.

BACKGROUND: Right heart failure remains the leading early cause of mortality after heart transplantation, especially with antecedent pulmonary hypertension. Paradoxically, the discarded recipient right heart, acclimated to pulmonary hypertension, is often stronger than its nonconditioned donor replacement. Heterotopic ("piggyback") transplantation is plagued by problems related to the retained, dilated, hypocontractile left ventricle (lung compression, systemic emboli, arrhythmias). Were it possible to retain the recipient's right heart, excising only the left ventricle, this could have important advantages, especially in severe pulmonary hypertension. This report describes such a technique. METHODS AND RESULTS: In four transplantation experiments (dogs), right ventricular-sparing transplantation proved technically feasible and hemodynamically successful. Bleeding after excision of the left ventricle was easily controlled. Back-bleeding from the native aortic valve (now open into the pericardial space) was not problematic. All atrial, aortic, and pulmonary arterial connections proved feasible. The preserved recipient right heart of all animals remained in stable sinus rhythm. All recipients were easily weaned from cardiopulmonary bypass, maintaining mean arterial pressures 60 to 110 mm Hg. CONCLUSIONS: This investigation develops a technique for donor right ventricle sparing in cardiac transplantation, demonstrating technical and hemodynamic feasibility. This method holds promise for the unsolved clinical problem of right heart failure after orthotopic heart transplantation with antecedent pulmonary hypertension.

Reproducibility and accuracy of gated SPECT for determination of left ventricular volumes and ejection fraction: experimental validation using MRI.

UNLABELLED: Quantitative gated SPECT (QGS) has been used for computation of left ventricular volumes and ejection fraction. This study evaluated, first, the effect of injected dose, time of imaging, and background activity on the reproducibility of QGS and, second, the accuracy of QGS, compared with cine MRI, for determining left ventricular volumes and ejection fractions in dogs with and without perfusion defects. METHODS: Sixteen dogs were subjected to either chronic occlusion of the circumflex artery (group I, no perfusion defect) or acute occlusion of the anterior descending coronary artery (group II, perfusion defect). Both groups underwent serial MRI and SPECT. RESULTS: ( QGS was very reproducible using the automated program (r = 0.99997). Correlation between left ventricular ejection fraction (LVEF) at 15 and 45 min was poor after the low-dose injection (r = 0.54; SE = 9%) and only fair after the high-dose injection (r = 0.77; SE = 5%). Correlation was poor in the presence of significant background activity (r = 0.36; SE = 12%). Correlation between QGS left ventricular volumes and MRI was good for group I (end-diastolic volume, r = 0.86; end-systolic volume, r = 0.81) and only fair for group II (end-diastolic volume, r = 0.66; end-systolic volume, r = 0.69). The overall LVEF correlation between QGS and MRI was poor (r = 0.51). QGS LVEF (mean +/- SD, 42% +/- 3%) overestimated MRI LVEF (29% +/- 2%). CONCLUSION: QGS provides a highly reproducible estimate of LVEF. However, QGS is affected by changes in background activity, time of imaging, and injected dose. In the presence of perfusion defects, QGS overestimated volume relative to MRI. The correlation between QGS- and MRI-derived LVEF was poor in this canine model.

Four different core materials measured for fracture strength in combination with five different designs of endodontic posts.

The purpose of this in vitro study was to determine the fractural load of four core materials supported by five post designs. This study was divided into 20 groups with 10 samples per group. Specimens were placed in a special jig at a 45-degree angle, and the fracture load values, in pounds, were obtained with the use of a universal testing machine. A 5 x 4 factorial design was used to assess and compare the fractural strength, and a two-way analysis of variance was used to determine whether the buccolingual, mesiodistal, and height dimensions differed across groupings. Mean fracture load values were obtained. Flexi-Post dowel/Ti-Core material at 277.1 pounds and ParaPost dowel/ Tytin silver amalgam at 277.3 pounds recorded the greatest mean values. These values were not statistically different. ParaPost dowel/Ketac-Silver material had the lowest mean value (49.6 pounds). For all posts Tytin silver amalgam and Ti-Core material were significantly stronger than Ketac-Silver and G-C Miracle Mix material. Ketac-Silver and G-C Miracle Mix materials did not differ from each other. Results indicated that Ti-Core composite material is at least as strong as Tytin silver amalgam.

Pilot study comparing the photoelastic stress distribution for four endodontic post systems.

This pilot study compared stress distribution using photoelastic blocks for both vertical loading and oblique loading (26 degrees angle) for four groups of post systems (Flexi-Post, Flexi-Flange, ParaPost and AccessPost dowels). For each group, three test blocks of photoelastic material were prepared with simulated endodontic canals, and the specimens were then photographed. Minimal stresses were observed for all the posts after cementation in the unloaded state. Stress distribution for the Flexi-Post, Flexi-Flange and AccessPost were favourable under vertical loading at 134 N and oblique loadings of 89 N and 134 N. Stress patterns were symmetric over the entire length of these posts. Stress distribution for the ParaPost under vertical loading at 134 N generated stress patterns that were asymmetric with concentration of stresses apically compared to coronally. Stress distribution for the ParaPost during oblique loadings of 89 N and 134 N were asymmetric with stress concentrated apically as compared to coronally. Stress distribution for the Flexi-Post, Flexi-Flange and AccessPost were all favourable under loading conditions studied.

Comparative study of two precision overdenture attachment designs.

In this study two precision overdenture attachment designs were tested for retention--a nylon overdenture cap system and a new cap and keeper system. The new cap and keeper system was designed to reduce the time involved in replacing a cap worn by the conditions of the oral environment. Six groups were tested at two different angles and retentive failure was examined at two different angles (26 and 0 degrees). Failure was measured in pounds with a force gauge over a 2000 pull cycle. The amount of force required to remove caps for two overdenture caps and a replaced cap for the metal keeper system was determined. Two dependent variables were absolute force and relative force. Repeated measures analysis of variance (RMANOVA) was used to compare the between-subjects effects of cap and angle, and the within-subjects effect of pull. The results indicated a significant difference between cap types (p < 0.0001) with respect to the relative force required to remove the cap. There was no effect of angle. For absolute force, RMANOVA revealed a highly significant interaction between pull and cap (p < 0.0001). Thus, the way that force changed over pulls depended on which cap was used (no effect of angle). For relative force, RMANOVA revealed no interaction between pull and cap, but there was a main effect of cap type (p < 0.0001) (no effect of angle). The nylon cap design required less force for removal but showed more consistency in the force required over the course of the 2000 pulls when compared with the keeper with cap insert. The results obtained in this study were consistent with similar studies in literature.

Comparison of the torsional forces at failure for seven endodontic post systems.

Resistance to torsional forces is critical in restoration of endodontically treated teeth. Seven post designs (Flexi-Post, Flexi-Flange, Para-Post, AccessPost, World Post, Vlock, and Dentatus posts) were cemented in roots of natural teeth with zinc phosphate and Flexi-Flow cements, which resulted in 11 different groupings that were subjected to torsional forces in a clockwise direction. In addition, clockwise and counterclockwise torque was applied to the Flexi-Post and Flexi-Flange systems cemented with zinc phosphate and Flexi-Flow cements. A total of 150 samples were prepared, and groups for this study were: group 1, Flexi-Post/zinc phosphate clockwise and counterclockwise; group 2, Flexi-Post/Flexi-Flow clockwise and counterclockwise; group 3, Flexi-Flange/zinc phosphate clockwise and counterclockwise; group 4, Flexi-Flange/Flexi-Flow clockwise and counterclockwise; group 5, Para-Post/zinc phosphate clockwise; group 6, AccessPost/zinc phosphate clockwise; group 7, AccessPost/Flexi-Flow with grooved dentin clockwise; group 8, World Post/zinc phosphate clockwise; group 9, World Post/Flexi-Flow with grooved dentin clockwise; group 10, Vlock Post/zinc phosphate clockwise; and group 11, Dentatus post/zinc phosphate clockwise. Torsional forces for the groups ranged from 17 ounce-inches (Dentatus/zinc phosphate) to 81 ounce-inches (Flexi-Post/zinc phosphate). Flexi-Post and Flexi-Flange threaded posts exhibited statistically greater resistance to torsional forces. Analyses were computed with one-way and three-way analysis of variance followed by Duncan's multiple range test. Duncan's multiple range test indicated that Flexi-Post/zinc phosphate/clockwise was similar to Flexi-Post/Flexi-Flow/clockwise and that both had significantly higher torque levels than the other treatment conditions in the clockwise direction (p 0.0001). Dentatus/zinc phosphate/clockwise had significantly lower torque levels than the other treatment conditions (p 0.031).

Comparison of the photoelastic stress properties for two combination prefabricated cast post systems.

The reason for a post and core preparation is to provide an anchoring system for a final restoration to the tooth root. This experiment was divided into two groups with the following systems; ExactaCast and Parapost. Casts for these systems were fabricated in photoelastic plastic and cemented with zinc phosphate cement. These photoelastic blocks were placed in a special jig on a universal testing machine. The experiment compared the photoelastic stresses generated for these two systems in two different stress modes; vertically at 30 pounds and obliquely (at a 26 degree angle) at 20 and 30 pounds. Specimens were then photographed after cementation in the unloaded and loaded states. Minimal stresses were observed for the ExactaCast in the unloaded state, while symmetric, even patterns of stresses concentrated coronally were present in the loaded vertical and oblique states. Minimal stresses were observed for the Parapost in the unloaded state, while asymmetric, uneven patterns of stresses concentrated apically were present in the loaded vertical and oblique states. The presence of the multiple tiered system for the Exacta-Cast clearly directs stresses in a symmetric pattern, while the single tiered Parapost system directs stresses in asymmetrical pattern. The symmetric even stresses for the ExactaCast are more favorable than the asymmetric, uneven stresses for the Parapost.

Post removal using a thick-walled hollow tube post design.

PURPOSE: The retention of a post into the root is critical for the successful restoration of an endodontically treated tooth. A total of 80 Access Posts (Nos. 0, 1, 2, and 3) comprising eight groups were cemented in root canals with two different luting agents, Flexi-Flow cem with titanium and zinc phosphate cement. MATERIALS AND METHODS: Removal of these Access Posts was then performed with the corresponding retreatment drills. RESULTS: None of the samples for the No. 0 Access Posts were removed by extraction with the retreatment drills. None of the samples for the No. 1 Access Posts cemented with zinc phosphate were removed by extraction with the retreatment drills. All these posts were removed by hand with a hemostat, after breakage of the cement seal. 60% (group 3) and 40% (group 7) of the samples for the No. 2 Access Posts were removed by extraction with the corresponding retreatment drills. 80% (group 4) and 70% (group 8) of samples for the No. 3 Access Posts were removed by extraction with the corresponding retreatment drills. On an average removal of each Access Post Nos. 0 and 1 took between 1 and 2 minutes. On an average removal of each Access Post (Nos. 2 and 3) took between 2 and 3 minutes. CONCLUSION: No root fractures were observed for any sample with either technique. This was confirmed by visual and radiographic analysis.

5'-Nucleotidase inhibition enhances postischemic myocardial performance.

Adenosine methylene diphosphate (AMPCP), a 5'-nucleotidase inhibitor, was evaluated as an adjunct to cold crystalloid cardioplegic myocardial protection. Cardiopulmonary bypass (CPB) was instituted at 28 degrees C in two groups of mongrel dogs (each, n = 6). Myocardial ischemia was induced for 150 min by aortic cross clamping. Crystalloid cardioplegia (4 degrees C) was infused into the aortic root at 15 ml/kg/20 min in the control group (CP). The experimental group (CP + AMPCP) received identical doses of cardioplegia supplemented with 250 microM AMPCP. While on CPB, the mean arterial pressure was 70 mm Hg and the myocardial temperature ranged from 16 to 22 degrees C. Hemodynamic parameters were recorded prior to institution of CPB and at 15 and 45 min following the termination of CPB. Starling curves were constructed for cardiac index (CI), mean arterial pressure (MAP), mean left ventricular pressure (LVP), +dP/dt and -dP/dt at each time point for left atrial pressures between 5 and 12.5 mm Hg. The area under each curve was calculated and expressed as a percentage of prebypass values. Statistical analysis was performed with Student's two-tailed t test. The data demonstrate that although recovery of CI, MAP, heart rate, and LVP was similar in both groups, statistically significant improvement in recovery of myocardial compliance (-dP/dt) and systolic function (+dP/dt) was seen with AMPCP. The addition of the 5'-nucleotidase inhibitor, AMPCP, to cold crystalloid cardioplegia enhances postischemic myocardial performance in vivo and may be useful during prolonged periods of global myocardial ischemia.

Fracture strength of three different core materials in combination with three different endodontic posts.

The purpose of this study was to determine the fracture load for three different core materials supported by three different post systems. The study was divided into nine separate groups, and each group comprised 10 samples. Specimens were placed in a special jig on a 45-degree angle, and the fracture load values were obtained using a universal testing machine. A 3 x 3 factorial two-way analysis of variance (P < .0408) was used to test the effects of core material and post type on the fractural resistance. Fracture load values (as measured in pounds) were: Flexi-Post/Ti-Core, 204.9; Vlock/Ti-Core, 218.8; Parapost/Ti-Core, 164.8; Flexi-Post/Tytin, 156.0; Vlock/Tytin, 100.6; Parapost/Tytin, 134.6; Flexi-Post/Ketac-Silver, 69.4; Vlock/Ketac-Silver, 50.4; and Parapost/Ketac-Silver, 37.7. The titanium composite, Ti-Core, had the greatest fracture load values in all instances; the silver-filled glass-ionomer specimen, Ketac-Silver, had the least. The Flexi-Post and the microthread, Vlock, had the greatest fracture load values, and the Parapost had the least. Both the Flexi-Post and Vlock post have large bulky heads with many vertical and horizontal grooves, apparently facilitating the locking of the core material into the post.

Pulmonary artery balloon counterpulsation: safe after peripheral placement.

Pulmonary artery balloon counterpulsation is a promising experimental technique for treatment of right ventricular failure. However, clinical application has been limited in that the only device presently available (the large-volume intraaortic balloon) must be placed within a synthetic graft. Because a balloon with a smaller volume (which could be placed through a peripheral vein and be contained entirely within the pulmonary artery) would make the technique feasible on a wider scale, we tested an 8-mL pulmonary artery balloon placed through the femoral vein in 12 dogs. Two groups of animals were compared. One group had the pulmonary artery balloon in place but not counterpulsating; the other had the pulmonary artery balloon in place and counterpulsating. Each group was studied for 12 hours. A variety of hemodynamic parameters were measured. Effective diastolic augmentation and systolic unloading were noted in all 6 dogs that underwent counterpulsation (5.0 +/- 1.1 mm Hg of diastolic augmentation and 9.5 +/- 1.6 mm Hg of systolic unloading). Pulmonary function, as measured by arterial blood gas sampling and pulmonary vascular resistance, was not impaired. Examination of the heart and lungs showed no detrimental pathologic effects of pulmonary artery balloon counterpulsation. Placement of the balloon through a peripheral vein with a guidewire was easy and uncomplicated. We conclude that pulmonary artery balloon counterpulsation is safe over an extended period of 12 hours in the canine model and that diastolic augmentation and systolic unloading can be produced.

Retentive properties of a threaded split post with attachment sleeves cemented with various luting agents.

This study determined the retention, in pounds, of Nos. 1 through 3 stainless steel attachment sleeves for the threaded split post system cemented with various cements. Post heads and matching sleeves were also sandblasted and compared with attachments not sandblasted. Four luting agents were selected, zinc oxyphosphate cement (ZOP), and three brands of composite resin cement (CRC). The experiment was divided into two parts; in part 1, samples were not treated, and in part 2, samples were sandblasted. Retentive values were recorded with a universal testing machine. A 2 x 3 x 4 factorial three-way analysis of variance was used to compute the effects sandblasting, sleeve and post type, and the luting agent. No statistical differences were recorded for sleeves not sandblasted, Nos. 1 and 2, regardless of the luting agent. The nonsandblasted No. 3 sleeve cemented with Panavia CRC had significantly greater retention than All-Bond CRC or ZOP. There were no statistical differences in retention of sandblasted sleeves for the No. 1 sleeve despite the type of luting agent. For sandblasted sleeves Nos. 2 and 3, ZOP and Panavia CRC recorded significantly greater retention than All-Bond CRC. However, there was no difference between sandblasting and not sandblasting for the No. 1 sleeve. Mean loads for Nos. 2 and 3 sleeves were substantially greater for sandblasted compared with attachments not sandblasted.

Retention properties of a split-shaft threaded post: cut at different apical lengths.

The retention of the post to the root of an endodontically treated tooth is critical for a successful restoration. Modification of the post length to accommodate a specific clinical situation is common. This study compared the retention of No. 1 and No. 2 Flexi-Post restorations shortened apically from 1 to 5 mm with that reported for full-length control No. 1 and No. 2 Flexi-Post dowels. The experimental material was divided into 10 groups with 10 samples in each group. Retentive values were recorded in pounds with a universal testing machine. Analysis of variance with a Tukey-Student range, multiple-comparison test showed no statistical differences from apical reductions of 1, 2, 3, and 5 mm including the full-length control Flexi-Post No. 1 system. With 4 mm of apical shortening statistically greater retention was recorded. No statistical differences resulted with apical reductions of 1 to 4 mm or with the full-length control Flexi-Post No. 2 system, but 5 mm of apical shortening caused significantly less retention.

Comparison of the shear bond strength of a titanium composite resin material with dentinal bonding agents versus glass ionomer cements.

This study compared the in vitro shear bond strength of an autopolymerizing composite resin system (CR) (Ti-Core) with two third-generation dentinal bonding agents (DBA) (Tenure and Scotchbond 2) to glass ionomer cements (GIC) (Ketac-Silver, GC Miracle Mix, and Ketac-Cem). The experiment was divided in five groups. The shear bond strengths were evaluated on a universal testing apparatus at three different intervals; 15 minutes, 24 hours, and 7 days. Statistically, (two-way analysis of variance), the shear bond strengths from the greatest to least were: Ti-Core CR with Tenure DBA > Ti-Core CR with Scotchbond 2 DBA > Ketac-Silver GIC, GC Miracle Mix GIC > Ketac-Cem GIC. There were no differences in shear bond strengths according to time, and no interactions between groups and time. The shear bond strengths for Tenure DBA with Ti-Core CR were two and a half to three times greater than the silver-filled glass ionomers, Ketac-Silver GIC and GC Miracle Mix GIC. Tenure DBA with Ti-Core CR also had consistently greater shear bond strengths than Scotchbond 2 DBA with Ti-Core CR, and this trend is in agreement with similar research.

Retentive properties of threaded split-shaft posts with titanium-reinforced composite cement.

The retention of posts in tooth roots is vital to the success of the restoration. This study compared the retention of posts of various sizes and diameters cemented with a titanium-reinforced composite cement with that of posts previously reported cemented with zinc phosphate cement. Four groups made up of 10 samples each were used and retention values were compared using a universal testing machine. Two-way analysis of variance and the Newman-Keuls multiple range comparison test were performed. Larger diameter posts cemented with titanium cement had better retention than similar posts cemented with zinc phosphate cement. The statistical increase in retention for the larger size posts is probably the result of the deeper channels (threads) in the dentin and the higher cohesive strength for the titanium-reinforced composite resin.

Comparison of the retentive properties of a sleeve cast crown/core system with crowns cemented to conventional cast cores.

The retention of the crown to the core substructure is of great importance for a successful restoration. The aim of this study was to compare the retentive values of the Flexi-Cast post and its sleeve crown/core complex with that of a crown cemented to a conventional cast post. Forty single-rooted teeth divided equally into four groups were used. Flexi-Cast crown and cores were cemented to Flexi-Cast posts in groups 1 through 3. Group 4, the control group, comprised crowns cemented to conventional cast cores. Groups 1 through 4 had retentive values of 126.2, 135.5, 185.0, and 79.3 lb, respectively. Statistically, the increase in retention for all sizes of the Flexi-Cast crown and cores when compared with the control cast post and crown was found to be significant (p less than or equal to 0.0001).

Compressive and diametral tensile strength of titanium-reinforced composites.

This article determines the compressive and diametral tensile strength of two titanium-reinforced composites (Bis-GMA-based), Ti-Core and Flexi-Flow cem with titanium and compares their strengths to dentin and commercially available core materials and cements. In addition scanning electron microscope (SEM) photographs were taken of Ti-Core and Flexi-Flow cem with titanium. Compressive and tensile loading was performed on a modified universal testing apparatus. Ti-Core and Flexi-Flow cem with titanium were measured to have compressive strengths of 41,132 and 41,876 psi and tensile strengths of 5219 and 4930 psi, respectively. Statistically (ANOVA, one-way analysis of variance), these titanium-reinforced composites are stronger in compressive and tensile strength than Ketac-Silver, Fleck's zinc cement, Durelon, Ketac-Cem, and GC Miracle Mix. Both titanium-reinforced composite materials approach the compressive and diametral tensile strengths of dentin (43,100 and 6000 psi). SEMs revealed that the titanium was uniformly and homogeneously interspersed within the resin matrix of the material.

Reperfusion with ATP-MgCl2 following prolonged ischemia improves myocardial performance.

This study was designed to test the hypothesis that infusion of ATP-MgCl2 during reperfusion following a prolonged period of hypothermic global ischemia would result in enhanced functional recovery of cardiac function. Two groups of dogs (n = 6 each) were placed on cardiopulmonary bypass (CP) with systemic hypothermia to 28 degrees C and subjected to 150 min of aortic cross-clamping. Crystalloid cardioplegia was infused every 20 min during ischemia. Reperfusion and rewarming were carried out for 20 min before discontinuation of CP bypass. During reperfusion, the experimental group received ATP-MgCl2(1.0 mg/kg/min ATP, 0.33 mg/kg/min magnesium). At 15 and 45 min following bypass, hemodynamic assessment was carried out for each animal by constructing Starling curves over a range of filling pressures at constant heart rate and comparing each animal to its own prebypass control level. The results indicated that ATP-treated animals exhibited complete functional recovery whereas control animals showed marked reduction in hemodynamic performance and myocardial compliance and had a higher myocardial water content (P less than 0.05). We conclude that infusion of ATP-MgCl2 during reperfusion following hypothermic ischemia may help ameliorate reperfusion injury.