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Sims MW, Winter J, Brennan S, Norman RI, André Ng G, Squire IB, Rainbow RD. PKC-mediated toxicity of elevated glucose concentration on cardiomyocyte function. Am J Physiol Heart Circ Physiol 2014; 307:H587-97. [DOI: 10.1152/ajpheart.00894.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
While it is well established that mortality risk after myocardial infarction (MI) increases in proportion to blood glucose concentration at the time of admission, it is unclear whether there is a direct, causal relationship. We investigated potential mechanisms by which increased blood glucose may exert cardiotoxicity. Using a Wistar rat or guinea-pig isolated cardiomyocyte model, we investigated the effects on cardiomyocyte function and electrical stability of alterations in extracellular glucose concentration. Contractile function studies using electric field stimulation (EFS), patch-clamp recording, and Ca2+ imaging were used to determine the effects of increased extracellular glucose concentration on cardiomyocyte function. Increasing glucose from 5 to 20 mM caused prolongation of the action potential and increased both basal Ca2+ and variability of the Ca2+ transient amplitude. Elevated extracellular glucose concentration also attenuated the protection afforded by ischemic preconditioning (IPC), as assessed using a simulated ischemia and reperfusion model. Inhibition of PKCα and β, using Gö6976 or specific inhibitor peptides, attenuated the detrimental effects of glucose and restored the cardioprotected phenotype to IPC cells. Increased glucose concentration did not attenuate the cardioprotective role of PKCε, but rather activation of PKCα and β masked its beneficial effect. Elevated extracellular glucose concentration exerts acute cardiotoxicity mediated via PKCα and β. Inhibition of these PKC isoenzymes abolishes the cardiotoxic effects and restores IPC-mediated cardioprotection. These data support a direct link between hyperglycemia and adverse outcome after MI. Cardiac-specific PKCα and β inhibition may be of clinical benefit in this setting.
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Winter J, Wong R, Chow T. Sci-Sat AM: Stereo - 09: Accuracy of Liver Cancer Treatment on Cyberknife® with Synchrony™ Optical Tracking Throughout the Respiratory Cycle. Med Phys 2014. [DOI: 10.1118/1.4894970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Eisenmann B, May N, Müller W, Schäfer H, Weiss A, Winter J, Ziegleder G. Neue Vertreter des ThCr2Si2-Typs und dessen Verwandtschaft zum Anti-PbFCl-Gitter. ZEITSCHRIFT FUR NATURFORSCHUNG SECTION B-A JOURNAL OF CHEMICAL SCIENCES 2014. [DOI: 10.1515/znb-1970-1207] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Der von SILLEN am BiOCl-Gitter beobachtete Übergang von der Stöchiometrie ABX zur AB2X2 wurde nunmehr auch bei intermetallischen Phasen gefunden. In diesem Zusammenhang gelang es, eine Reihe neuer Vertreter des ThCr2Si2-Typs darzustellen und strukturell zu charakterisieren
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Dommisch H, Winter J, Götz W, Miesen J, Klein A, Hierse L, Deschner J, Jäger A, Eberhard J, Jepsen S. Effect of growth factors on antimicrobial peptides and pro-inflammatory mediators during wound healing. Clin Oral Investig 2014; 19:209-20. [DOI: 10.1007/s00784-014-1239-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/25/2014] [Indexed: 12/26/2022]
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Winter J, Essmann S, Kidszun A, Aslanidis C, Griese M, Poplawska K, Bartsch M, Schmitz G, Mildenberger E. Neonatal respiratory insufficiency caused by an (homozygous) ABCA3-stop mutation: a systematic evaluation of therapeutic options. KLINISCHE PADIATRIE 2014; 226:53-8. [PMID: 24633979 DOI: 10.1055/s-0033-1363687] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Autosomal recessive ABCA3 (ATP-binding cassette protein A3) gene mutations have been associated with neonatal respiratory distress and pediatric interstitial lung disease. The clinical course of the disease depends on the underlying mutations. Therefore, knowledge of course, symptoms and treatment of the disease is important. PATIENT AND METHODS A term newborn suffered from progressive respiratory insufficiency, which led to death at the age of 4.8 months. The girl developed interstitial lung disease. Infections as well as structural and functional disorders of the lung were systematically excluded. A homozygous c.4681C > T (Arg 1561 Stop) mutation of the ABCA3 gene was identified. A literature review of the pathophysiology and treatment options of the disease was done. Therapeutic approaches with corticosteroids, macrolide, and hydroxychloroquine did not improve the clinical course. RESULTS Therapeutic strategies for chronic interstitial lung disease have been used successfully in cases of a mild clinical course in juvenile patients with ABCA3 gene mutation. In our patient with homozygous ABCA3 gene mutation,they were not effective. Lung transplantation remains as a therapeutic option, but because of donor organ shortage and associated morbidity and mortality it is rarely feasible. CONCLUSION More experience in the treatment of newborns with ABCA3 gene mutations is needed. Randomized, prospective evaluation of the different therapeutic approaches in a specific registry may improve prognosis and treatment of affected individuals.
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Winter J, Brack KE, Ng GA. Cardiac contractility modulation in the treatment of heart failure: initial results and unanswered questions. Eur J Heart Fail 2014; 13:700-10. [DOI: 10.1093/eurjhf/hfr042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Winter J, Kershaw O, Schmitz R, Gehlen H. [Equine leukaemic lymphoma--a rare form of equine lymphoma]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2014; 42:311-317. [PMID: 25327154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/09/2014] [Indexed: 06/04/2023]
Abstract
Equine leukaemic lymphoma is a rare disease of the haematopoetic tissue. It results from neoplastic degradation of B- and T-lymphocytes and their occurrence in the blood. Clinical signs are often unspecific and include chronic weight loss, ventral oedema at the thorax and abdomen and regional lymphadenopathy. Horses are often presented late in the course of the disease and therapy is rarely successful. This review summarizes the clinical pathologic findings of equine leukaemic lymphoma and the findings of laboratory testing and other diagnostic measures, and presents treatment options described in the literature.
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Lichtenberg D, Holst I, Winter J, Kleinschmidt S, Venner M. Clinic and immunohistochemical differentiation via cytokeratines of a renal adenocarcinoma in an eight-year-old Hanoverian gelding. PFERDEHEILKUNDE 2014. [DOI: 10.21836/pem20140305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ang R, Birnbaumer L, Gourine AV, Tinker A, Hamilton RM, Strandberg L, Cui X, Rath A, Liu J, Sirigam V, Ackerley C, Jaeggi E, Backx P, Silverman ED, Debney MT, Ng FS, Lyon AR, Peters NS, Opel A, Nobles M, Tinker A, Winter J, Chin SH, Brack KE, Ng GA, Finlay MC, Xu L, Nobles M, Lane J, Lowe M, Ben-Simon R, Bhar-Amato J, Hussain Q, Sebastian S, Taggart P, Tinker A, Lambiase PD, Almeida TP, Salinet J, Chu GS, Schlindwein FS, Ng GA, Williams SE, Linton NWF, Harrison J, Wright M, Plank G, O'Neill MD, Niederer S, Raine DT, Langley P, Shepherd E, Lord S, Murray S, Bourke JP, Chen Z, Hanson B, Sohal M, Child N, Sammut E, Jackson T, Shetty A, Bostock J, Gill J, Carr-White G, Rinaldi CA, Taggart P, Williams SE, Linton NW, Harrison J, Wright M, Rhode K, O'Neill MD, Barrows S, Jones K, Porter N. POSTER SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carls A, Springer W, Arnold R, Winter J, Gorenflo M, Haefeli WE. Substantial Increase of Sildenafil Bioavailability after Sublingual Administration in Two Children with Congenital Heart Defects. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Denysenko IB, Stefanović I, Sikimić B, Winter J, Azarenkov NA. Discharging of dust particles in the afterglow of plasma with large dust density. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2013; 88:023104. [PMID: 24032949 DOI: 10.1103/physreve.88.023104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Indexed: 06/02/2023]
Abstract
The discharging of dust particles in the afterglow of plasma with large dust density is studied. We used measured electron and metastable dependencies to calculate the rate describing collection of electrons by dust particles by solving the electron balance equation. This rate is compared with the rate calculated using the orbital motion limited (OML) theory. It is found that the OML theory may not be applied for description of dust charging at large afterglow times, and the energetic electrons generated in metastable-metastable collisions significantly affect charging of dust particles. The time dependence for dust charge is calculated by two different approaches: first, the "standard" approach is used, which assumes that ion and electron fluxes to the dust particles are different in the afterglow. Second, the dust charge is calculated by assuming that desorption of electrons from dust particles is very fast. Both approaches gave similar results for dust charging. In addition, the effects of secondary emission due to ion-dust and metastable-dust collisions on dust discharging are investigated. The main source of dust charging in the late afterglow of plasma with large dust density are the energetic electrons generated in Ar(m) metastable-metastable collisions.
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Stanescu T, Tadic T, Marle J, Winter J, Petropoulos L, Sweitzer M, Jaffray D. WE-G-WAB-02: BEST IN PHYSICS (JOINT IMAGING-THERAPY)-MR and Linac Magnetic Field Mutual Decoupling for An MRI-Guided Radiation Therapy System. Med Phys 2013. [DOI: 10.1118/1.4815644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Winter J, Carlone M, Westmore M, Breen S, Stanescu T, Dahan M, Jaffray D. SU-C-103-06: Isocenter Calibration Concept and Feasibility for MR-Guided Radiation Therapy (MRgRT). Med Phys 2013. [DOI: 10.1118/1.4813973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tadic T, Jaffray D, Winter J, Petropoulos L, Marle J, Sweitzer M, Stanescu T. WE-G-WAB-07: Commissioning of a Novel Integrated Platform for Online MRIgRT. Med Phys 2013. [DOI: 10.1118/1.4815649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Winter J, Flanagan D, McNaughton SA, Nowson C. Nutrition screening of older people in a community general practice, using the MNA-SF. J Nutr Health Aging 2013; 17:322-5. [PMID: 23538653 DOI: 10.1007/s12603-013-0020-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND OBJECTIVE The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition. DESIGN Cross-sectional study of nutritional risk screen conducted over a six month period. PARTICIPANTS AND SETTING Patients attending a general practice clinic in Victoria, Australia, who attended for the "75 plus" health assessment check. MEASUREMENTS The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded. RESULTS Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category. CONCLUSION In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.
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Brack K, Winter J, Gupta A, Ng GA. The Effects of Sympathetic Nerve Stimulation on Ventricular Electrophysiology in Long QT Syndrome‐1. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.928.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Egginton S, Hauton D, Winter J, Evans RD. Individual microvascular units are critical to cardiac performance. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.898.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brack K, Winter J, Ng GA. The Antifibrillatory Effects of Vagus Nerve Stimulation in the Rabbit Ventricle involves cGMP‐Dependent Mechanisms. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.928.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dittrich M, Chesnyuk A, Gudimov A, McCulloch J, Quazi S, Young J, Winter J, Stainsby E, Arhonditsis G. Phosphorus retention in a mesotrophic lake under transient loading conditions: insights from a sediment phosphorus binding form study. WATER RESEARCH 2013; 47:1433-1447. [PMID: 23290913 DOI: 10.1016/j.watres.2012.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/30/2012] [Accepted: 12/06/2012] [Indexed: 06/01/2023]
Abstract
Phosphorus retention in sediments has been estimated for three basins in Lake Simcoe, a mesotrophic lake in Ontario, Canada. Total phosphorous (TP) fractionation was used to examine the concentration of phosphorus (P) binding forms in the sediments of Cook's Bay, Kempenfelt Bay, and the Main Basin. The extended sequential extractions allowed us to differentiate between organic-, inorganic-, carbonate-bounded and redox-sensitive phosphorus. Our results showed different mechanisms of P release in each of the three investigated basins, which may be linked to their distinct loading histories, present land-uses and morphology of the sampling sites. In the deep Main Basin, where moderate changes in P loading have been induced by deforestation, sediments are not an important long-term source of diagenetically mobile P, as almost 75% of P is released within a short time scale. P release is predominantly generated by a continuous epilimnetic P flux, rather than a large inventory of temporary P stored in the sediments. Diagenesis in the upper sediment layers is fast enough to prevent a large accumulation of temporary P. In the much deeper glacially formed Kempenfelt Bay with a highly urbanized catchment, P release from the sediments is dominated by the redox-sensitive P fraction, representing up to 40% and 57% of long- and short-term sediment P release, respectively. In the shallow and agriculturally-impacted Cook's Bay, the main P binding form that can be mobilized through diagenesis is carbonate-bound P. This fraction contributes 40.1% and 37.6% to the long- and short-term P sediment release, respectively. Although different mechanisms of P release have been revealed for the three basins in Lake Simcoe, the vertical profiles indicate that the sediments throughout the system are still able to bind deposited P.
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Winter J. Drug Interactions in Infectious Diseases. Clin Infect Dis 2013. [DOI: 10.1093/cid/cis1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brack KE, Narang R, Winter J, Ng GA. The mechanical uncoupler blebbistatin is associated with significant electrophysiological effects in the isolated rabbit heart. Exp Physiol 2013; 98:1009-27. [PMID: 23291912 PMCID: PMC3734628 DOI: 10.1113/expphysiol.2012.069369] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blebbistatin (BS) is a recently discovered inhibitor of the myosin II isoform and has been adopted as the mechanical uncoupler of choice for optical mapping, because previous studies suggest that BS has no significant cardiac electrophysiological effects in a number of species. The aim of this study was to determine whether BS affects cardiac electrophysiology in isolated New Zealand White rabbit hearts. Langendorff-perfused hearts (n= 39) in constant-flow mode had left ventricular monophasic action potential duration (MAPD) measured at apical and basal regions during constant pacing (300 ms cycle length). Standard action potential duration restitution was obtained using the single extrastimulus method with measurement of the maximal restitution slope. Ventricular fibrillation threshold was measured as the minimal current inducing sustained ventricular fibrillation with burst pacing (30 stimuli, at 30 ms intervals). Optical action potentials were recorded using the voltage-sensitive dye di-4-ANEPPS. Measurements were taken at baseline and after 60 min perfusion with BS (5 μm). Blebbistatin significantly prolonged left ventricular apical (mean ± SEM; from 129.9 ± 2.9 to 170.7 ± 4.1 ms, P < 0.001, n= 8) and basal MAPD (from 135.0 ± 2.3 to 163.3 ± 5.6 ms, P < 0.001) and effective refractory period (from 141.3 ± 4.8 to 175.6 ± 3.7 ms, P < 0.001) whilst increasing the maximal slope of restitution (apex, from 0.79 ± 0.09 to 1.57 ± 0.16, P < 0.001; and base, from 0.71 ± 0.06 to 1.44 ± 0.24, P < 0.001) and ventricular fibrillation threshold (from 5.3 ± 1.1 to 17.0 ± 2.9 mA, P < 0.001). In other hearts, blebbistatin significantly prolonged optically recorded action potentials (from 136.5 ± 6.3 to 173.0 ± 7.9 ms, P < 0.05, n= 4). In control experiments, the increase of MAPD with blebbistatin was present whether the hearts were perfused in constant-pressure mode (n= 5) or in unloaded conditions (n= 5). These data show that blebbistatin significantly affects cardiac electrophysiology. Its use in optical mapping studies should be treated with caution.
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Winter J, Haist V, Eydner M, Venner M. Glycogen Branching Enzyme-Defizienz bei einem 11 Wochen alten deutschen Quarter Horse-Fohlen. PFERDEHEILKUNDE 2013. [DOI: 10.21836/pem20130202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hebb M, Winter J, Champagne K, McCurdy B, Zhu H, Petropoulos L. SU-E-J-55: Development of a Novel Cableless Radiolucent RF Coil for MR-Guided Radiation Therapy (MRgRT™). Med Phys 2012; 39:3665. [DOI: 10.1118/1.4734890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Winter J, Carlone M, Stanescu T, Breen S, Foxcroft S, Guyot B, Dahan M, Dahdal R, Jaffray D. SU-D-213CD-06: Workflow and Safety Systems of a Linac-MR Sim-Brachytherapy MRgRT™ Facility. Med Phys 2012; 39:3618-3619. [PMID: 28517391 DOI: 10.1118/1.4734691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop the operational workflow and safety systems of a magnetic resonance-guided radiotherapy system (MRgRT™), which comprises an MR scanner on rails that travels between a linac vault, MR simulation room and brachytherapy suite. METHODS To develop a safe and streamlined clinical workflow, we conducted a comprehensive process review based on a layered approach to overall MRgRT safety that included i) facility design, (ii) workflow iii) system design and interlocks and iv) policies and procedures. We applied existing guidelines for MR and radiation safety, and employed system-level failure modes and effects analyses to design the MRgRT facility and clinical procedures. RESULTS In the MRgRT system configuration, the MR and treatment systems are physically decoupled and used independently requiring novel administration of existing MR and radiation guidelines. A key element for the safe operation of the moving MR unit is the concept that all three rooms represent zone 4 areas (American College of Radiology guidelines). Using this concept, we applied MR guidelines to develop safe procedures for the overall suite, including screening of all persons entering the suite in zone 2 and control of ferromagnetic materials. We generated a clinical workflow that ensures expedient and safe transition between MR imaging and treatment delivery in both the linac and brachytherapy rooms. In addition, we designed emergency protocols for MRgRT, which helped drive requirements for the facility and system design, e.g., need for an accessible MR-safe stretcher. CONCLUSIONS We designed the first comprehensive description of the MRgRT workflow, interlocking systems and safety procedures. With this layered approach to safety, we addressed critical aspects regarding safe operation and workflow for the system and provided multiple redundancies for key processes. Coupled with customized staff training, the proposed design ensures the safe operation of the MRgRT facility. This work has received research personnel support from IMRIS.
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