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Biomedical subjects

G Rau

Publications and source records attributed to G Rau.

At least 91 records · Page 5Linked to original sources

Concept and development of a measuring system for in vivo recording of orthodontically applied forces and torques in the multiband technique. Part I.

The cause of tooth movement with a multiband or multibracket appliance is the force system in the bracket, which is generated by an archwire and transmitted by a bracket to the respective tooth. Continuous arch wires are, from the biomechanical point of view, a statically multiply undetermined system. Quantitative determination of the forces and torques acting at the individual teeth, and thus observance of a non-critical level of applied forces, is therefore extremely problematic in practice, the force is applied by the orthodontist more or less "intuitively" on the basis of recommendations evolved in theory and in vitro. The measuring technique presented in this paper is designed to permit these force systems to be recorded in vivo for the first time, allowing account to be taken of the individual situation "tooth-periodontium-bone". Evolvement of an appropriate measuring principle was followed by development of the individual components of the measuring system. The results of the subsequent initial in vitro test series offer the prospect of successful clinical application.

Dental Stress Analysis↗

Gastroesophageal reflux in infants: evaluation of a new intraluminal impedance technique.

In this study, pH metry was simultaneously applied with a new technique, the intraluminal multiple electrical impedance (IMP) procedure, for measuring gastrointestinal motility for gastroesophageal reflux (GER) detection. Seventeen infants with clinical symptoms of GER disease such as recurrent apnea, aspiration pneumonia, wheezing, and failure to thrive were investigated during two feeding periods. A single catheter combining a pH electrode with seven electrodes for impedance measurements over a distance of 8.5 cm was used for the investigation. In all patients, 185 acid episodes were detected by pH metry. In 106 of these 185 acid episodes, a unique pattern in the IMP readings was noted, indicated by a retrograde esophageal volume flow. These episodes were regarded as acid GER episodes. Seventy-one of the 185 acid episodes occurred during the clearance process of a preceding acid GER characterized by typical IMP readings of an anterograde bolus transport. Eight of 185 acid episodes were missed in the IMP readings for technical reasons. The IMP pattern described as characteristic for a GER was observed in 490 other episodes not detected by pH metry. More than 75% of all GER detected by IMP reached the pharyngeal space; 73% of all GER occurred during feeding and the first 2 postprandial hours and 27% occurred during the remaining time until the next feeding. Even during the latter period, 34% of GER were detected by IMP only; they were missed by pH metry. Volume clearance indicated by IMP was always completed earlier than acidity clearance. The results show that IMP technique facilitates the detection of all GER, whereas pH metry is confined to the measurement of acid GER. Therefore, this technique might improve the evaluation of GER disease and detection of GER in conditions with gastric hypoacidity.

Electric Impedance↗

In vitro flow dynamics of a new mechanical cardiac valve prosthesis--"tricusp".

The hydrodynamic performance of a newly developed JCL-trileaflet mechanical heart valve prostheses (Tricusp) was measured and compared with some of the currently most used heart valve prostheses types. All experiments were performed in an electrohydraulic, computer-controlled pulse duplicator simulating the left side of the human circulatory system. Testing conditions were set according to a Food and Drugs Administration interlaboratory comparison protocol, with cardiac outputs 3.0, 4.5, 6.5 or 8.0 l/min and a constant heart rate of 70 beats/min. Mean systolic pressure differences, volume and energy losses, dimensionless pressure losses and energy loss coefficients were calculated from the recorded pressure, volume and flow tracings. The results with the Tricusp valve were found to be as good, or even better than those with the currently most used commercially available bileaflet valves.

Heart Valve Prosthesis↗

A desktop image processing system for computer-assisted orthopedic surgery (DISOS).

Within the framework of our research activities in orthopedic surgery a PC-based imageprocessing system for the processing of x-ray computer-tomographic data has been developed. The system is used as a work platform for the investigations concerning interaction modalities, strategies and techniques for an efficient planning and execution of surgical interventions in orthopedic surgery by means of individual templates. The method of individual templates has been presented in /1,2/ and will not be subject of this paper.

Computer Peripherals↗

The influence of LCD shutter glasses on spatial perception in stereoscopic visualization.

For a general establishment of stereoscopic visualisation systems in clinical routine a fundamental analysis of the influence of technical, optical and physiological parameters onto visual spatial perception seems to be necessary to achieve an optimisation of the existing devices. As one important component of these systems we perform studies on the influence of LCD Shutter glasses on the individual binocular perception. The developed shutter system, the initial experiments and their results are presented.

Computer Simulation↗

Using human factor analysis and VR simulation techniques for the optimization of the surgical worksystem.

The introduction of minimal invasive operating techniques into the conventional surgical worksystem, requires a fundamental analysis of the resulting problems. Based on ergonomic investigations, concerning working postures, static holding work and task sequence analysis, bottlenecks of workplace design can be demonstrated. As a contribution to the optimization of workplace design, the development of a CAD-based VR simulation environment with an integrated anthropometric man-model, as a very useful tool for anthropometric system design is presented.

Computer Simulation↗

Three-dimensional versus two-dimensional video endoscopy. A clinical field study in laparoscopic application.

Stereoscopic visualisation systems are available for the medical application in clinical routine, especially in the field of endoscopic or minimal invasive surgery. As we have shown in laboratory studies in 1991 the use of stereoscopic visualisation systems leads to a significant improvement of endoscopic manipulation. A broader diffusion of these systems in clinical routine will be based on quantitative evaluation of the influence of stereoscopic visualisation systems on the intervention. As a first approach we performed a clinical field study to compare 2D and 3D video endoscopy in laparoscopic interventions in urological surgery.

Computer Simulation↗

In vitro testing of heart valve wear outside of the manufacturers laboratory--requirements and controversies.

BACKGROUND AND AIM OF THE STUDY: Currently, various national and international Standards regulate in vitro and in vivo testing as well as the clinical evaluation of heart valve prostheses. This study concentrates on a single aspect of these protocols: accelerated wear and fatigue testing. METHODS: The differences in the above Standards were appraised and an experimental study was designed to assess the validity of Standard testing conditions with respect to in vivo relevance. An instrumented BSCC tilting disc valve was tested in two different types of fatigue testers and in a separate study in a sheep model. RESULTS: By comparing the obtained results it could be clearly demonstrated that under the current Standard conditions (ISO, CEN, FDA) actual in vivo impact loading cannot be reproduced. Also, the two compared test devices, though operating under the same Standard conditions, generated totally different loading conditions on the test valve. CONCLUSIONS: Based on these findings it is suggested that the actual loading conditions of each valve type should be measured either in vivo in animal models or within a circulatory mock loop which provides physiologic loading conditions, and the test conditions for accelerated wear and fatigue testing should be modified accordingly. Cavitation effects which can be assumed to be associated with high frequency wear testing is another important issue which has to be addressed in future amendments to the Test Standards.

Animals↗

The heart-Hemopump interaction: a study of Hemopump flow as a function of cardiac activity.

The Hemopump is a useful left ventricular assist device. Because it is a rotary blood pump, the pump performance is not constant and is dependent on the cardiac cycle. We measured the static flow delivered by the pump at varying pressure heads (delta P) in a mock circulation. These data are compared to the pump performance in vivo. On the basis of these results, 5 sheep were instrumented for continuous Hemopump flow measurement as well as left ventricular and aortic pressure measurements. The Hemopump flow was relayed instantaneously to the pressure head. Low filling and ventricular failing (through intravenous administration of a beta-blocker) conditions were applied. The in vivo measured flows also are pressure head dependent, but the flow curve shows hysteresis resulting in a loop during each cardiac cycle. The in vivo peak flows (delta P = 0) are similar to the in vitro data. The in vivo means flows (delta = 50 mm Hg) are similar to the in vitro data for the lower pump speeds but are less than that at the higher pump speeds (3.74 +/- 0.55 L/min in vivo at Speed 7 versus 4.6 L/min in vitro). Low filling interrupts the delta P-flow loop and reduces flow. In the failing ventricle, delta P increases and flow is reduced. The cannula leaks and results in aortic insufficiency (0.36 +/- 0.05 L/min) when the pump is turned off. Several conclusions have been drawn from these tests: Cardiac activity is beneficial for the pump performance as well as when the aortic pressure curve is nonpulsatile; the longer the systolic phase, the higher the pump flow; the pump should never be turned off in clinical use, and filling is important for the pump's performance.

Animals↗

Hemodynamic system analysis of intraarterial microaxial pumps in vitro and in vivo.

Because of the lack of a sophisticated pump management system, the performance of the Hemopump in patients cannot assessed successfully. To clarify the interrelationship between an intravascular nonpulsatile pump and a pulsating ventricle, an in vitro study was set up under controlled conditions. Before these in vitro experiments, a series of in vivo experiments were performed in sheep using Hp31 cannulae. As anticipated, the resulting pulsatile pump flow was a function of the momentary pressure difference across the pump. This varying pump flow showed a significant flow loop hysteresis, indicating that the pressure difference across the pump is not the only parameter governing momentary pump flow of a rotary pump operating at constant speed in a pulsatile environment. Furthermore, flow in the Hp31 was significantly influenced by the inflow situation, blood supply, size of the ventricular cavity, and shape and position of the inflow cannula within the ventricle. Pulsatile flow conditions with good as well as impaired inflow into the pump were accordingly simulated in vitro to verify the in vivo measurements, to characterize the various inflow conditions, and to discuss methods of improved pump management. As a result of the in vivo and in vitro experiments, one can rely on the measurement of nonpulsatile in vitro flow and pressure differences across the pump to characterize the momentary pump flow for good inflow conditions into the pump. For these situations, the flow hysteresis produced, caused by fluid inertia within the pump and cannula, can be neglected. In contrast, for an impaired inflow situation, the calculated pump flow based on pressure difference measurements can be misleading. Consequently, an improved pump management system is required to adjust the pump speed, the pump performance, to any kind of impaired inflow.

Animals↗

Quality control of bioprosthetic heart valves by means of holographic interferometry.

BACKGROUND AND AIMS OF THE STUDY: Limited durability of porcine bioprostheses is mainly caused by the progressive development of calcification. We tested the hypothesis that hidden tissue anomalies or unfavorable stress concentrations of commercially available bioprostheses may lead to later calcification and dysfunction. Application of holographic interferometry for non-destructive testing of biological heart valves enables a full-field analysis of heart valves and reveals deformation irregularities of valve tissue. MATERIAL AND METHODS: We developed an accelerated calcification protocol for bioprosthetic heart valves including an accelerated pulsatile valve tester for simultaneous testing of 10 heart valves under identical conditions and a rapid synthetic calcification fluid containing a final Ca x P of 130 (mg/dl)2 in barbital buffer solution. Ten porcine bioprostheses (St. Jude Medical, Bioimplant) were assessed by holographic interferometry and subjected to the pulsatile accelerated calcification process. Distribution and amount of calcification was evaluated by microradiography after 12 x 10(6) and 19 x 10(6) cycles, respectively. Areas of irregular fringe patterns detected by holography as well as areas of calcification were calculated and compared using a personal computer. RESULTS: All tested bioprostheses had localized or extended areas with holographic irregularities and the accelerated valve testing protocol resulted in even macroscopically visible calcifications at various sites. Comparative analysis of the obtained microradiographs revealed that 74.2% +/- 6.0% of calcified leaflet areas lay within the previously detected holographic anomalies. CONCLUSIONS: Our first results show a strong correlation between holographic anomalies and calcification of porcine bioprostheses. We conclude that suitable methods for evaluation and quality control of bioprosthetic heart valves are available and seem to be predictive with regard to valve calcification.

Aortic Valve↗

The effect of storage temperature on the stability of frozen erythrocytes.

A systematic study on the stability of frozen erythrocytes was performed. Washed and concentrated erythrocytes were mixed with an equal volume of cryoprotective solution containing 24% (w/w) hydroxyethyl starch (HES) and 60 mmol/liter NaCl according to an established protocol. Volumes of 250 microliters of this mixture were filled into polypropylene tubes and cooled to -196 degrees C with a rate of 293 degrees C/min by immersion in liquid nitrogen. The storage temperature was then varied from -10 to -75 degrees C and could be identified as the predominant factor influencing hemolysis kinetics. The effect of storage temperature on the frozen erythrocytes after thawing was evaluated by measuring the hemolysis in a dilute, isotonic NaCl solution (saline stability). A strong time dependence was found within the temperature range studied and could be described by an exponential kinetic law. A stability prediction was made for storage temperatures lower than those examined. Temperature ranges of qualitatively different hemolysis kinetics were identified and compared to devitrification behavior of intra-and extracellular solutions. The intracellular solution was simulated by a concentrated mixture of dried erythrocytes and water. The devitrification behavior was studied using DSC techniques. A rapidly frozen mixture was annealed at selected temperatures which fall into the range of storage temperatures for frozen erythrocytes. This paper tentatively interprets the devitrification data with respect to the means for cell damage during storage. The results are reviewed with respect to the design of a safe storage procedure.

Adult↗

Fuzzy logic and control: principal approach and potential applications in medicine.

During the last few years intelligent machines appeared in nearly all technical areas, such as consumer electronics, robotics, and industrial control systems. There are for example washing machines that work very effectively, need comparably less power than in the past, and have short execution times because they adjust their washing cycles to each set of clothes and change their washing strategies as the clothes become clean. These intelligent systems are based on fuzzy control strategies, i.e., common sense rules are used to describe a system's behavior instead of complex mathematical models. We have applied this new technology to control problems as well as to reasoning problems in biomedical engineering where appropriate mathematical models could not be built due to the complexity of the problem. After a short introduction to the concepts of fuzzy logic two approaches in the field are described: a fuzzy control strategy for the pump rate adjustment of a novel total artificial heart and an intelligent alarm system based on fuzzy inference which supports the anesthetist in monitoring and evaluating the hemodynamic state of a patient undergoing cardiac surgery. These examples indicate the inherent reliability and stability of this technique in the field of complex dynamic systems. Such properties are highly significant especially in medical applications.

Anesthesia↗

Fuzzy control concept for a total artificial heart.

The development of an electromechanically driven total artificial heart (Helmholtz-TAH) was initiated in 1990. Anatomical fitting, biocompatibility, and automatic physiologic adaptation of pump output are the basic requirements that characterize the overall TAH concept. For evaluation of these features, a TAH labtype was developed. It provides most features of the conceptual artificial heart and supports in vitro testing of energy conversion, pump behavior, structural parts, sensors, and control concepts. A fuzzy controller has been implemented for adaptation of the pump rate to body perfusion demand by left pump chamber filling detection. This controller will be an important element of a future extensive TAH control system. The implementation is supported by a professional fuzzy control development tool that allows on-line and real time optimization of control strategies for dynamic processes. The first experiments proved the feasibility and the advantages of this fuzzy control concept. The first in vitro test results are presented.

Fuzzy Logic↗

Concept, realization, and first in vitro testing of an intraarterial microaxial blood pump.

Intravascular operating microaxial pumps have been clinically introduced (Hemopump 21; Hemopump 14) and have proven to be useful tools for cardiac assist. Due to device-related complications that are associated with the drive concept of an extracorporeal motor and a flexible drive shaft cable, a new pump concept is presented and has been refined in the development process. The cable is replace by a proximally attached drive unit and an extracorporeal power supply. In addition to ongoing hydrodynamic studies of the flow inside the pump and improvements of the overall hydraulic performance, a microelectric motor was realized and integrated. In vitro tests revealed the feasibility of such a concept.

Aorta↗

Chyme transport patterns in human duodenum, determined by multiple intraluminal impedancometry.

To get information about the mechanisms involved in chyme transport during the fasting and postprandial states, the novel procedure of multiple intraluminal impedancometry was evaluated in 14 healthy subjects (6 during fasting, 8 after a test meal). All main features of the migrating motor complex (MMC) cycle were determined. During phase II of the MMC cycle and the postprandial period, different transport patterns of chyme, termed bolus transport events (BTEs), were determined. These were 1) simple long-distance propulsive transport (spreading distance > 16 cm), 2) short-distance propulsive transport, and 3) retrograde transport. A significantly lower number of BTEs was recorded during fasting than postprandially. Short-distance propulsive BTEs predominated during fasting (72%), and long-distance propulsive BTEs predominated after the test meal (76%). Retrograde BTEs were recorded during fasting (4%) and postprandially (8%). In the latter state, complex long-distance propulsive BTEs were also observed (5%), consisting of multiple components. A major proportion of gastric contents was found to be continuously transported to jejunum. In conclusion, impedancometry enables us to determine patterns and parameters of chyme transport during fasting and postprandial states.

Adult↗

Scanning tunneling microscopy study of poly-L-proline.

Differences in its peptide bonds allow the imino acid poly-L-proline to exist in two significantly different geometric structures. Form I with cis peptide bonds is supposed to be a right-handed helix and form II with trans peptide bonds a left-handed helix. Cis/trans isomerization about the proline imide is believed to cause the denaturation of a number of proteins and may be a key step in protein folding. Using scanning tunneling microscopy (STM), we present high-resolution images of air-dried poly-L-proline. It is found that the electric conductivity of one monolayer of poly-L-proline is sufficient to allow for STM imaging without significant tip-sample interaction. Only at locations where stacking of poly-L-proline chains occurs, a direct contact of the probing tip to the molecules becomes apparent and prevents us, at present, from resolving the atomic structure of the topmost layer. Our STM images of poly-L-proline show that form II is relatively rigid and forms aggregates in most cases. Form I, which is occasionally observed, is very flexible and exhibits sharp bends as well as 180 degrees backfolding. These observations confirm theoretical predictions on the existence of two peptide bond conformations of poly-L-proline.

Isomerism↗