MULTIDISCIPLINARY INVESTIGATION AT THE CENTER FOR BIOMEDICAL ENGINEERING OF UNICAMP ROSANA A. BASSANI Center for Biomedical Engineering (CEB) University of Campinas (UNICAMP) Campinas, SP, Brazil [email protected] Center for Biomedical Engineering (CEB/UNICAMP) HUMAN RESOURCE TRAINING Technicians Undegrad students Graduate students SUPPORT TO UNICAMP´S HEALTH AREA Medical Physics CEB UNICAMP Radioprotection Radiodiagnosis Radiotherapy Nuclear medicine Clinical Engineering RESEARCH AND DEVELOPMENT Basic investigation Methods Equipment (Medical Technology) Assessment Specification Maintenance Management INVESTIGATION IN CLINICAL ENGINEERING METHODS FOR MEDICAL TECHNOLOGY MANAGEMENT MEDICAL EQUIPMENT CLASSIFICATION Oshiyama, Bassani, D´Ottaviano & Bassani. Medical equipment classification: method and decision-making support based on paraconsistent annotated logic. Med Biol Eng Comput 2012; 50:395-402. (disbelief) false unknown inconsistent true (belief) INVESTIGATION IN CLINICAL ENGINEERING MANAGEMENT GETS (Health Technology Management System): a web-based system to interconnect Clinical Engineering nuclei in hospitals in Brazil and other countries for procedure standardization, information exchange and technical training. CAISM Information Central CIEC HD HC GETS GETS Intranet HEMOT Regional NEC MS/SUS Agencies P & D (IES) Companies NEC-CEB (Clinical Engineering Nucleus) Internet Privilege GETS GETS HD Intranet HD Regional Regional NEC HD (Health Division) HD NEC HD HD: Health division NEC: Clinical Engineering Nucleus CIEC: Information Central P&D: Research Institutions RESEARCH AND DEVELOPMENT Ultrasound-based Equipments for Diagnosis and Therapy Rehabilitation Engineering Cardiac Physiology (Bioengineering) Electrocardiogram (ECG) in the gecko (Hemidactylus mabouia) (Germer, Tomaz, Carvalho, Bassani & Bassani., J Comp Physiol, in press) RESEARCH AND DEVELOPMENT Microfluorimeters for measuring and imaging intracellular calcium concentration (Soriano, Bassani & Bassani, Braz J Biomed Engin, 2007) (Zoccoler & Oliveira, unpublished) RESEARCH AND DEVELOPMENT Methods for tachyarrhythmia induction and analysis of electrical propagation in isolated rat atria 20 M pinacidil sinus rhythm 40 -200 -100 100 -100 Potential difference (µV) 200 Potential difference (µV) Potential difference (µV) 100 -20 20 -40 Potential difference (µV) TRANSLATIONAL RELEVANCE APPLICATION: RESEARCH AND PHARMACEUTICAL INDUSTRY (Zafalon, Bassani & Bassani, J Mol Cell Cardiol 2004; Physiol Meas, 2009; Zafalon, Oshiyama, Bassani & Bassani, J Mol Cell Cardiol, 2013) RESEARCH AND DEVELOPMENT Calcium Transport in Cardiac Cells Membrane: ELECTRICAL EXCITATION Myofibrils: CONTRACTION EXCITATION WAVE CONTRACTION (Candasamy et al., J Biol Chem, 2014) RESEARCH AND DEVELOPMENT Basic Investigation Calcium Transport in Cardiac Cells during Postnatal Development SARCOPLASMIC RETICULUM (SR) is major source of Ca2+ for contraction in the adult electrical excitation (Bers, Nature, 2002) RESEARCH AND DEVELOPMENT Calcium Transport in Cardiac Cells during Postnatal Development NEONATAL RAT ADULT RAT Cardiac myocytes 20 m transients neonate 0.75 0.50 0.25 0.00 1.00 [Ca2+]i (M) Ca2+ [Ca2+]i (M) 1.00 500 ms adult 0.75 0.50 0.25 0.00 500 ms Ca2+ fluxes (Bassani & Bassani, Am J Physiol, 2002) RESEARCH AND DEVELOPMENT Calcium Transport in Cardiac Cells during Postnatal Development (Bassani & Bassani, Am J Physiol, 2002) Ca Ca Ca Ca SERCA SERCA DANGER! X Ca Ca T-Tubule Ca Ca NCX 3Na Ca Ca NCX 3Na RESEARCH AND DEVELOPMENT Calcium Transport in Cardiac Cells during Postnatal Development 1.25 neonate 1.25 (Bassani & Bassani, unpublished) basal 30 nM ISO 0.75 1.00 [Ca2+]i (M) -adrenoceptor stimulation (e.g., adrenaline) [Ca2+]i (M) 1.00 0.50 basal 30 nM ISO 0.75 0.50 0.25 0.25 0.00 0.00 adult 500 ms 500 ms Catecholamines can RECRUIT the SR function in neonatal myocardium Ca Ca Ca Ca SERCA SERCA Ca Ca Ca Ca Ca Ca NCX NCX 3Na 3Na RESEARCH AND DEVELOPMENT Cardiac Electrical Stimulation - + External electrical field (E) RESEARCH AND DEVELOPMENT Cardiac Electrical Stimulation: excitation and E orientation 6 20 Vmax (mV) ET (V/cm) 5 4 3 2 1 p< 0.001 15 10 (Bassani, Lima, Gomes & Bassani, Physiol Meas, 2006) 5 0 0 0 60 120 180 240 angle (degrees) 300 360 0 60 120 180 240 300 360 angle (degrees) The extent of membrane polarization depends on the direction of the electrical field Cardiac Electrical Stimulation: excitation with multidirectional E stimulation Excitatory cell recruitment (%) Greater efficiency! 100 *** 80 60 40 20 0 1 direction 3 directions (Fonseca, Bassani, Oliveira & Bassani, IEE Trans Biomed Engin, 2013) Cardiac Defibrillation Ventricular fibrillation (VF) Cardiac arrest: 17 per 100,000 inhabitants, only ~21% out-of-hospital survival (Nolan et al, Resuscitation, 2010) High-intensity electrical fields Electrical Defibrillation VF + Still, in out-of-hospital electrical defibrillation, the first shock may fail in 50% of the cases (Walker et al., Resuscitation, 2009) Halliday, Resnick & Walker, 1997 Cardiac Defibrillation DEFIBRILLATION: high E intensity may damage cell membrane (ELECTROPORATION) Sublethal E ~30 V/cm 0.9 [Ca2+]i ( M) 2+ [Ca ]i (M) 1.2 Lethal E 0.6 0.3 0.0 20x 1 10s 0 15 s (Oliveira, Bassani & Bassani., Biophys J , 2005) (Oliveira, Bassani & Bassani., EEE Trans Biomed Engin , 2008) Cardiac Defibrillation Cell damage depends on the electrical field orientation Lethality (%) 100 LONGIT TRANSV 75 50 25 12 5. 9 15 8. 5 19 9. 5 10 0 79 .4 63 .1 50 .1 39 .8 0 E (V/cm) (Oliveira, Bassani & Bassani., IEEE Trans Biomed Engin , 2008) Cardiac Defibrillation RAPIDLY-SWITCHING MULTIDIRECTIONAL DEFIBRILLATOR A R R P 60 ms Intl Patent: 1102055-5 (Viana, Bassani, Petrucci, Marques & Bassani, J Cardiovasc Thor Surg , in press) In vivo test in swine R P Cardiac Defibrillation 6 1.00 0.75 * 0.50 0.25 1 direction 3 directions 0.00 Shock energy (J) Probability of defibrillation RAPIDLY-SWITCHING MULTIDIRECTIONAL DEFIBRILLATOR 5 3 2 1 3 1 2 3 4 5 energy (J) 6 1 3 1 3 1 0 0.50 0 * * 4 * 0.75 0.90 probability of defibrillation 7 (Viana, Bassani, Petrucci, Marques & Bassani, J Cardiovasc Thor Surg , in press) MULTIDISCIPLINARY APPROACH: - cell physiology - mathematical modeling - product development - preclinical tests Support Thank you! Fernando de Noronha Brasil
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