Reliability of transcardiopulmonary thermodilution cardiac output measurement in experimental aortic valve insufficiency.

BACKGROUND: Monitoring cardiac output (CO) is important to optimize hemodynamic function in critically ill patients. The prevalence of aortic valve insufficiency (AI) is rising in the aging population. However, reliability of CO monitoring techniques in AI is unknown. The aim of this study was to investigate the impact of AI on accuracy, precision, and trending ability of transcardiopulmonary thermodilution-derived COTCPTD in comparison with pulmonary artery catheter thermodilution COPAC. METHODS: Sixteen anesthetized domestic pigs were subjected to serial simultaneous measurements of COPAC and COTCPTD. In a novel experimental model, AI was induced by retraction of an expanded Dormia basket in the aortic valve annulus. The Dormia basket was delivered via a Judkins catheter guided by substernal epicardial echocardiography. High (HPC), moderate (MPC) and low cardiac preload conditions (LPC) were induced by fluid unloading (20 ml kg-1 blood withdrawal) and loading (subsequent retransfusion of the shed blood and additional infusion of 20 ml kg-1 hydroxyethyl starch). Within each preload condition CO was measured before and after the onset of AI. For statistical analysis, we used a mixed model analysis of variance, Bland-Altman analysis, the percentage error and concordance analysis. RESULTS: Experimental AI had a mean regurgitant volume of 33.6 ± 12.0 ml and regurgitant fraction of 42.9 ± 12.6%. The percentage error between COTCPTD and COPAC during competent valve function and after induction of substantial AI was: HPC 17.7% vs. 20.0%, MPC 20.5% vs. 26.1%, LPC 26.5% vs. 28.1% (pooled data: 22.5% vs. 24.1%). The ability to trend CO-changes induced by fluid loading and unloading did not differ between baseline and AI (concordance rate 95.8% during both conditions). CONCLUSION: Despite substantial AI, transcardiopulmonary thermodilution reliably measured CO under various cardiac preload conditions with a good ability to trend CO changes in a porcine model. COTCPTD and COPAC were interchangeable in substantial AI.

Technical note: building a combined cyclotron and MRI facility: implications for interference.

PURPOSE: With the introduction of hybrid PET∕MRI systems, it has become more likely that the cyclotron and MRI systems will be located close to each other. This study considered the interference between a cyclotron and a superconducting MRI system. METHODS: Interactions between cyclotrons and MRIs are theoretically considered. The main interference is expected to be the perturbation of the magnetic field in the MRI due to switching on or off the magnetic field of the cyclotron. MR imaging is distorted by a dynamic spatial gradient of an external inplane magnetic field larger than 0.5-0.04 µT∕m, depending on the specific MR application. From the design of a cyclotron, it is expected that the magnetic fringe field at large distances behaves as a magnetic dipolar field. This allows estimation of the full dipolar field and its spatial gradients from a single measurement. Around an 18 MeV cyclotron (Cyclone, IBA), magnetic field measurements were performed on 5 locations and compared with calculations based upon a dipolar field model. RESULTS: At the measurement locations the estimated and measured values of the magnetic field component and its spatial gradients of the inplane component were compared, and found to agree within a factor 1.1 for the magnetic field and within a factor of 1.5 for the spatial gradients of the field. In the specific case of the 18 MeV cyclotron with a vertical magnetic field and a 3T superconducting whole body MR system, a minimum distance of 20 m has to be considered to prevent interference. CONCLUSIONS: This study showed that a dipole model is sufficiently accurate to predict the interference of a cyclotron on a MRI scanner, for site planning purposes. The cyclotron and a whole body MRI system considered in this study need to be placed more than 20 m apart, or magnetic shielding should be utilized.

Heart-lung interactions measured by electrical impedance tomography.

OBJECTIVE: The clinical value of stroke volume variations to assess intravascular fluid status in critically ill patients is well known. Electrical impedance tomography is a noninvasive monitoring technology that has been primarily used to assess ventilation. We investigated the potential of electrical impedance tomography to measure left ventricular stroke volume variation as an expression of heart-lung interactions. The objective of this study was thus to determine in a set of different hemodynamic conditions whether stroke volume variation measured by electrical impedance tomography correlates with those derived from an aortic ultrasonic flow probe and arterial pulse contour analysis. DESIGN: Prospective animal study. SETTING: University animal research laboratory. SUBJECTS: Domestic pigs, 29-50 kg. INTERVENTIONS: A wide range of hemodynamic conditions were induced by mechanical ventilation at different levels of positive end-expiratory pressure (0-15 cm H2O) and with tidal volumes of 8 and 16 mL/kg of body weight and by hypovolemia due to blood withdrawal with subsequent retransfusion followed by infusions of hydroxyethyl starch. MEASUREMENTS AND MAIN RESULTS: In eight pigs, aortic stroke volume variations measured by electrical impedance tomography were measured and compared to those derived from an aortic ultrasonic flow probe and from arterial pulse contour analysis. Data for four animals were used to develop and train a novel frequency-domain electrical impedance tomography analysis algorithm, while data for the remaining four were used to test the performance of the novel methodology. Correlation of stroke volume variation measured by electrical impedance tomography and that derived from an aortic ultrasonic flow probe was significant (r = 0.69; p < .001), as was the correlation between stroke volume variation measured by electrical impedance tomography and that derived from arterial pulse contour analysis (r = 0.73; p < .001). Correlation of stroke volume variation derived from an aortic ultrasonic flow probe and that derived from arterial pulse contour analysis was significant too (r = 0.82; p < .001). Bland-Altman analysis comparing stroke volume variation measured by electrical impedance tomography and that derived from an aortic ultrasonic flow probe revealed an overall bias of 1.87% and limits of agreement of ± 7.02%; when comparing stroke volume variation measured by electrical impedance tomography and that derived from arterial pulse contour analysis, the overall bias was 0.49% and the limits of agreement were ± 5.85%. CONCLUSION: Stroke volume variation measured by electrical impedance tomography correlated with both the gold standard of direct aortic blood flow measurements of stroke volume variation and pulse contour analysis, marking an important step toward a completely noninvasive monitoring of heart-lung interactions.

High-level functional expression of a fungal xylose isomerase: the key to efficient ethanolic fermentation of xylose by Saccharomyces cerevisiae?

Evidence is presented that xylose metabolism in the anaerobic cellulolytic fungus Piromyces sp. E2 proceeds via a xylose isomerase rather than via the xylose reductase/xylitol-dehydrogenase pathway found in xylose-metabolising yeasts. The XylA gene encoding the Piromyces xylose isomerase was functionally expressed in Saccharomyces cerevisiae. Heterologous isomerase activities in cell extracts, assayed at 30 degrees C, were 0.3-1.1 micromol min(-1) (mg protein)(-1), with a Km for xylose of 20 mM. The engineered S. cerevisiae strain grew very slowly on xylose. It co-consumed xylose in aerobic and anaerobic glucose-limited chemostat cultures at rates of 0.33 and 0.73 mmol (g biomass)(-1) h(-1), respectively.