Diverse properties of human t(8;14) neoplasms: [1] ATLS and absence of BCL-2 [2] modulation of RAG-1 expression with S-Ig ligation

An EBV(-) BL (Burkitt lymphoma) line (Black93), established from a patient exhibiting glucocorticoid-induced ATLS (acute tumor lysis syndrome), was highly sensitive to dexamethazone (DX) in vitro in the studies including 18 lymphoid cell lines (10 BL lines). In the BL lines, the highly sensitive ones always lacked Bcl-2(bcl-2 protein), while the DX resistant ones expressed Bcl-2. Black93 is the first BL cell-line derived from a ATLS patient, proving that cell lines can be established in vitro from ATLS patients. Since some pre-B ALL lines expressing Bcl-2 were DX-sensitive, the relationship between Bcl-2 and DX-sensitivity is not straight-forward. In the BL cells, however, the absence of Bcl-2 appears to be responsible for the DX-sensitivity. The DX-sensitivity and the absence of Bcl-2 is a major characteristic carried by t(8;14) neoplasms. In addition, there may be a stage of B-lineage differentiation without Bcl-2. While rare BL cases have been reported to express TdT (terminal desoxynucleotidyl transferase), Tree92 is the first such line, expressing S-Ig(mu, lambda), TdT and RAG (recombination activating gene)-1. When surface mu is ligated with antibody, RAG-1 was suppressed in expression, indicating that the signal through S-Ig can modulate the expression of RAG-1 in the Tree92 cells. Chromosome translocation is known to be associated with a specific stage of differentiation. Such specific stage for t(8;14), however, is broad enough to cover S-Ig(+), TdT(+) and RAG-1(+) stage, too. The phenotypic classification of leukemia/lymphoma and the delineation of differentiation scheme of normal hematopoietic cells, are dependent on each other. The documentation of the properties such as DX-sensitivity, the absence of Bcl-2, the expression of RAG-1 and its modulation by the signal through S-Ig is an example in which the diverse properties of human t(8;14) neoplasms can contribute for delineating the differentiation scheme of normal hematopoietic cells more precisely.

Impact of systemic depulsation on tissue perfusion and sympathetic nerve activity

BACKGROUND

We postulated that pathophysiologic processes under nonpulsatile circulation are related to the behavior of the sympathetic nerve activity that regulates tissue perfusion.

METHODS

Pulsatile and nonpulsatile pumps were installed in parallel in the left heart bypass circuit of anesthetized goats (n = 9) so that pulsatile circulation could be converted to nonpulsatile circulation instantly. At 5 minutes before and after systemic depulsation, we measured hemodynamic indices, renal nerve activity, and regional blood flow of the brain, heart, and renal cortex.

RESULTS

Renal nerve activity was significantly elevated after systemic depulsation (15.6 +/- 9.3 versus 19.4 +/- 9.8 microV), when mean aortic pressure remained almost constant. The renal cortical flow was significantly reduced after depulsation (3.61 +/- 1.23 versus 2.93 +/- 1.19 mL.min-1.g-1), whereas no significant difference was found in the regional blood flow of the brain or the heart.

CONCLUSIONS

The significant reduction of renal cortical blood flow after systemic depulsation is associated with a significant increase in renal nerve activity. Our results suggest that increased renal nerve activity plays an important role in the reduction of renal function after systemic depulsation.

[Epstein-Barr virus (EBV)-positive NK cell line YT, and ALL/LBL of NK-lineage]

The YT cells, already known as natural killer (NK) line, were tested for Epstein-Barr virus (EBV). The simply maintained YT cells (YT-O) and the two different subclones showed and identical length of junctional DNA of terminal repeats in Southern blot with LMP-1 probe, indicating that the 3 had already been positive for EBV before subcloning. YT-O expressed limited amount of EBNA2 or LMP-1 mRNA, whereas the 2 subclones expressed abundant EBNA2 or LMP-1 mRNA in the Northern blot analysis with EBNA2 or LMP-1 probe. Thus, the ex vivo cells were positive for EBV, since the BL (Burkitt lymphoma) type EBV gene expression in the YT-O does not generally occur in in vitro infection. The remaining clinical record indicated that the lymphoma was extranodal (angiocentric lymphoma), involving mediastinum and liver, but not nodal or lymphoblastic lymphoma (LBL). Acute lymphoblastic lymphoma (ALL)/LBL of the NK-lineage has not been defined, although such neoplasms should exist. Since T- and NK-lineages are so close in immature stages of differentiation that ALL/LBL of NK may have been sorted into T-lineage. The phenotypic records of the T-ALL/LBL in our laboratory indicated that CD7+CD5+CD2- is much higher in incidence than CD7+CD5-CD2+. This may reflect the size difference of physiological populations of T- and NK-lineage cells. Furthermore, the latter is of CD45RO type in contrast to the rest of the early-thymic (pro-thymic) T-ALL/LBL groups of CD45RA type. A CD56+ case of 4 CD7+CD5-CD2+ cases have been published as a case of LBL of NK-lineage. It is necessary to scrutinize CD7+CD5-CD2+ cells in order to clarify the phenotype of neoplastic and physiological NK cells in immature stages.

Sensitivity to dexamethasone and absence of bcl-2 protein in Burkitt's lymphoma cell line (Black93) derived from a patient with acute tumor lysis syndrome: comparative study with other BL and non-BL lines

An Epstein-Barr virus (EBV)-negative Burkitt's lymphoma (BL) cell line, designated Black93, was established in culture from a patient who developed acute tumor lysis syndrome (ATLS). Growth inhibition in vitro by dexamethasone (DXM) and the expression of bcl-2 protein (Bcl-2) were investigated in Black93 and 17 other cell lines derived from EBV-negative or -positive BL, pre-B acute lymphoblastic leukemia (ALL), follicular lymphoma (FL), and EBV-positive lymphoblastoid cell lines of normal B cell origin (B-LCL), assuming an inherent susceptibility of Black93 to cell death. The most marked growth inhibition by DXM was observed in Black93, two other BL, two pre-B-ALL and two FL lines. The other cell lines were less sensitive or were resistant. DNA extracted from the Black93 cells treated with DXM showed a ladder of oligo-nucleosomal DNA on electrophoresis. On testing of fixed smears by indirect immunofluorescence, bcl-2 protein (Bcl-2) was undetectable in Black93 and three BL lines but was detected in all the other cell lines at varying intensity. Western blot analysis showed mostly the same results. In the BL lines, the most DXM-sensitive cell lines lacked Bcl-2 expression, and the DXM-resistant cell lines always expressed Bcl-2. While none of the DXM-resistant cell lines lacked Bcl-2 expression, several pre-B or FL lines that expressed [correction of expessed] Bcl-2 were sensitive to DXM. Black93 is the first reported cell line established from a patient with ATLS. The positive sensitivity to DXM and the lack of Bcl-2 expression observed in Black93 are a major characteristic exhibited frequently by BL lines and, probably, by fresh BL cells. These properties may contribute to the precipitation of ATLS.

Development of a precise controller for an electrohydraulic total artificial heart. Improvement of the motor's dynamic response

In an electrohydraulic total artificial heart developed at the National Cardiovascular Center (Osaka, Japan), two blood pumps are pushed alternatively by means of the bidirectional motion of a brushless DC motor for pump systole and diastole. Improvement in the dynamic response of the motor is very important to obtain better pump performance; this was accomplished by using power electronic simulation. For the motor to have the desired dynamic response, it must be commutated properly and the damping ratio (zeta), which represents transient characteristics of the motor, must lie between 0.4 and 0.8. Consequently, all satisfactory specifications with respect to power consumption must be obtained. Based on the simulated results, the design criteria were determined and the precise controller designed to reduce torque ripple and motor vibration, and determine motor stop time at every direction change. In in vitro tests, evaluation of the controller and dynamic response of the motor was justified in terms of zeta, power consumption, and motor stop time. The results indicated that the power consumption of the controller and the input power of the motor were decreased by 1.2 and 2.5 W at zeta = 0.6, respectively, compared to the previous system. An acceptable dynamic response of the motor, necessary for the reduction of torque ripple and motor vibration, was obtained between zeta = 0.5 and zeta = 0.7, with an increase in system efficiency from 10% to 12%. The motor stop time required for stable motor reoperation was determined to be over 10 msec, for a savings in power consumption of approximately 1.5 W. Therefore, the improved dynamic response of the motor can contribute to the stability and reliability of the pump.

Development of an integrated artificial heart-lung device for long-term cardiopulmonary support

An integrated artificial heart-lung device has been developed as a long-term cardiopulmonary support system. The device is composed of gas exchange and pumping units. The gas exchange unit consists of a special hollow fiber membrane that can prevent serum leakage. The entire blood contacting surface of the gas exchange unit is treated with covalent heparin bonding. The pumping unit consists of two pusher-plate artificial hearts joined to each end of the artificial lung unit. The core size and priming volume of the device are 11 x 14 x 17 cm and 400 ml, respectively. In in vitro evaluation, the device exhibited a maximum output of 7.0 L/ min, with a pressure gradient of 10 mmHg per 1 L/min flow rate. In acute in vivo evaluation with adult goats, the device satisfactorily replaced the animals' circulation and respiration for 6 hr. Pumping output ranged from 5.5 to 6.0 L/min, whereas PaO2 and PaCO2 were kept above 500 mmHg and below 30 mmHg, respectively. The device demonstrated prominent thrombus resistant properties in nonheparin animal use trials. These results indicate that the integrated artificial heart-lung device has a potential to be a long-term cardiopulmonary support system that can be used with minimal anticoagulant therapy.

A volume-controlled liquid ventilator with pressure-limit mode: imperative expiratory control

Liquid ventilation with perfluorocarbon (PFC) has been considered to offer advantages over gas ventilation to respiratory distress syndrome patients. We developed a volume-controlled liquid ventilator with pressure-limit mode; inspiration is performed mechanically with an actuator under the preset limit of the intratracheal pressure (Paw); expiration is performed by gravity assistance. Oxygenation and CO2 removal of PFC are done with a membrane oxygenator. An endotracheal tube with a Paw monitor line was placed in 5 rabbits weighing 2.7 +/- 0.6 kg, and liquid ventilation was conducted with the condition that the upper and lower limits of Paw were 20 and -20 mm Hg, respectively. The best arterial pH and gas tension were examined. The averaged arterial pH and gas tension were examined. The averaged arterial pH. Pao2, Paco2, and Sao2 were 7.45 mm Hg, 369 mm Hg, 46.2 mm Hg, and 100% at the best values, respectively. Ventilatory conditions at the best values were as follows: ventilation rates, tidal volume peak Paw, average Paw, and trough Paw were 5-15 (11 +/- 4) times/min, 13.3-17.3 (15.6 +/- 1.4) ml/kg, 5-18 (12 +/- 5) mm Hg, -7-4 (-1 +/- 4) mm Hg, and -20(-)-6 (-13 +/- 5) mm Hg, respectively. Pressure-limit control of the system worked well, but in the initial 3 animals, fluorothrax, that is the leakage of PFC into thoracic cavity, was recognized at the Paw from 20 to 25 mm Hg after the upper pressure limit was raised to 25 mm Hg to improve Paco2. The fluorothrax seemed to be caused by excess end-expiratory residual volume. An expiratory control mechanism appears to be imperative for further improvement of our liquid ventilator.

Influence of non pulsatile systemic circulation on tissue blood flow and oxygen metabolism

Influence of non pulsatile systemic circulation on oxygen metabolism was examined regarding tissue perfusion in 12 adult goats weighing from 46 to 55 kg. Under general anesthesia, a flow character, changeable total left heart bypass circuit consisting of pulsatile and non pulsatile pumps was installed through a left thoracotomy. Systemic flow was converted from pulsatile to non pulsatile in 7 of 12 animals, and in the reverse order in the other 5, by changing the driving pump. Esophageal mucosal blood flow was determined by a colored microsphere method that estimated tissue blood flow at the pre capillary level. Esophageal intramucosal pH was evaluated with a silicone balloon tonometer catheter surgically placed in the submucosal space. Hemodynamic and arterial blood gas parameters were unchanged at flow mode conversion. Although oxygen delivery was comparable between pulsatile and non pulsatile circulation, oxygen extraction ratio was lower and venous oxygen saturation was higher in non pulsatile than pulsatile circulation. Although statistically not significant, serum lactate level tended to be higher with non pulsatile circulation. No difference was observed in esophageal mucosal blood flow between pulsatile and non pulsatile circulation, whereas intramucosal pH, which strongly correlated with arterial pH regardless of the flow mode, was significantly lower under non pulsatile than pulsatile conditions. In conclusion, systemic oxygen uptake is less efficient in non pulsatile than pulsatile circulation in the setting of an acute experiment using animals, which may be accounted for by the disparity between the pre capillary blood flow and actual tissue oxygen metabolism.

Altered oxygen metabolic conditions associated with increased norepinephrine levels in a nonpulsatile systemic circulation

Change in oxygen metabolic conditions accompanying the conversion of systemic flow from pulsatile to nonpulsatile (from P-mode to N-mode) was investigated in association with blood norepinephrine levels. Total left heart bypass was instituted through a left thoracotomy under general anesthesia in 10 adult goats. Pulsatile and nonpulsatile pumps were incorporated in the circuit in parallel, and the flow character was rapidly converted from the P-mode to the N-mode. Norepinephrine levels increased significantly after the conversion, from 222 +/- 54 pg/ml to 285 +/- 65 pg/ml. While oxygen delivery (DO2) was kept constant, the oxygen extraction ratio significantly decreased, from 21 +/- 3% to 16 +/- 3%, and venous oxygen saturation (SvO2) significantly increased, from 77 +/- 6% to 84 +/- 6% after depulsation. The serum lactate level was significantly higher in the N-mode than the P-mode (P-mode: 35 +/- 2 mg/dl, N-mode: 45 +/- 5 mg/dl). Strong positive and negative correlations of norepinephrine levels were observed with oxygen extraction ratio and SvO2, respectively, whereas norepinephrine levels did not correlated with DO2. Regression lines in these correlations unveiled higher oxygen uptake in the P-mode than the N-mode at the same norepinephrine level. These results indicate that, in the setting of an acute animal experiment, oxygen uptake is less efficient with the absence of pulsatility, and the higher norepinephrine concentration functioned to tune the oxygen metabolism in the initial stage of nonpulsatile systemic circulation.

Importance of metabolic function of the natural lung evaluated by prolonged exclusion of the pulmonary circulation

It is generally considered that the natural lung metabolizes various vasoactive substances through the pulmonary circulation. However, the influences of bypassing or eliminating the pulmonary circulation have not been fully elucidated, especially for prolonged periods. In this study, we performed total cardiopulmonary bypass and exclusion of the pulmonary circulation for up to 336 hr in awake goats to clarify the importance of the metabolic function of the lung. In seven adult goats, biventricular bypass with a pulsatile ventricular assist system was first established. After 2 weeks, the biventricular bypass was converted to total cardiopulmonary bypass without anesthesia. Adequate gas exchange and perfusion support were achieved in all animals. However, the institution of total cardiopulmonary bypass led to marked decreases in the mean aortic pressure and systemic vascular resistance, and they remained low thereafter. The arterial levels of prostaglandin E2 and norepinephrine, which are inactivated naturally through the pulmonary circulation, increased remarkably. These results indicate that the natural lung plays an important role in controlling systemic circulation by metabolizing various vasoactive substances. Understanding the non respiratory function of the natural lung is of prime importance for advancement of lung and heart-lung support.

Set-up, improvement, and evaluation of an electrohydraulic total artificial heart with a separately placed energy converter

The authors have been developing an electrohydraulic total artificial heart (TAH) system with a separately placed electrohydraulic energy converter to minimize anatomic constraints in the pericardial space. Improvements to the system and current status of the development are reported. The energy converter was miniaturized to improve implantability, and its thickness was reduced to 54 mm. System efficiency was increased by suppressing rush current at the time of motor reversal. Maximum cardiac output of the TAH system was 9 L/min, and maximum system efficiency increased to 10%. The blood pump system was implanted easily in the body of a 57 kg calf, and no significant temperature rise on the energy converter surface was observed. As the next step, main components were integrated into a total system. The transcutaneous energy transfer system could supply power to the TAH without a decline in pump performance, and the internal battery could support the system at 6.5 L/min of cardiac output for 1 hour without a decrease in cardiac output. The authors consider the TAH system with a separately placed energy converter the most promising approach to development of a TAH for smaller sized patients.

Role of the intrachain disulfide bond of ovalbumin during conversion into S-ovalbumin

Disulfide-reduced and carboxymethylated ovalbumin was treated at pH 9.9 and 55 degrees C for 24 h as a specific condition for preparation of S-ovalbumin. The stability and conformation of the product were investigated. Such alkaline treatment converted native protein to S-ovalbumin, but this modified ovalbumin was not stabilized, according to results of calorimetric analysis. Instead, it had lost its native like conformation; the magnitude of CD spectra decreased. The conformation after alkaline treatment was not clear, but the possibility of aggregation was excluded by electrophoretic analysis. These observations showed that the transformation of native ovalbumin into S-ovalbumin requires the presence of the disulfide bond.

Development of a membrane oxygenator for long-term respiratory support and its experimental evaluation in prolonged ECMO

The authors developed a new membrane oxygenator (MO) for long-term respiratory support and evaluated its performance in animal experiments for as long as 336 hr. The MO, with a membrane area of 1.2 m2 and priming volume of 140 ml, is compact and designed to be interposed in a ventricular assist system (VAS) conduit. It is made with a novel hollow fiber membrane, in which micropores are blind-ended so that serum leakage can be prevented during prolonged use. The blood contacting surface of the MO is heparinized with a newly developed covalent bonding technique that ensures good thrombus resistance. In vivo evaluation with five adult goats was performed by installing the MO into a venoarterial or venovenous bypass circuit. No systemic anticoagulant therapy was used, except for a heparin-added fluid infusion to keep the pressure monitoring lines open (2-3 U/kg/hr). Throughout the experiments, no plasma leakage was observed, and gas transfer rates were maintained in a satisfactory range. Platelet counts did not decrease to less than 60% of levels before bypass, and hemolysis was negligible. The levels of coagulation parameters including fibrinogen, fibrin degradation products (FDP), antithrombin III (AT III), antiplasmin, prothrombin time (PT) and activated partial thromboplastic time (APTT) remained within physiologic ranges and relatively constant. At the end of the evaluation, no thrombus formation was noted in three of five MOs. These results suggest that this MO is a promising device for long-term respiratory support.

Application of long-distance polymerase chain reaction to detection of junctional sequences created by chromosomal translocation in mature B-cell neoplasms

Junctional sequences created by chromosomal translocations in mature B-cell neoplasms, which involve immunoglobulin gene loci (IG) and putative proto-oncogenes on reciprocal partner chromosomes, are unique to neoplastic cells characterized by particular histological and immunological phenotypes. To establish a rapid and sensitive method to detect neoplastic cells carrying a specific chromosomal translocation, we have developed a novel strategy based on long-distance polymerase chain reaction (LD-PCR) amplification. Genomic DNA was extracted from tumor cells carrying t(14;19)(q32;q13), t(8;14)(q24;q32), t(3;22)(q27;q11), t(2;3)(p12;q27), or t(3;14)(q27;q32). Thirty-two to 35-mer oligonucleotide primer pairs were designed to be complementary to exons or flanking sequences of the BCL3, c-MYC and BCL6 oncogenes, and to IG constant region genes. LD-PCR with a newly available Taq polymerase for longer product synthesis successfully amplified fragments representing BCL3/C alpha junctional sequences for t(14;19); c-MYC/C mu, c-MYC/C gamma, and c-MYC/C alpha for t(8;14); BCL6/C lambda for t(3;22); BCL6/C kappa for t(2;3); 5'-BCL6/C mu, and 5'-BCL6/C gamma for t(3;14). In Burkitt's lymphoma/leukemia, all materials in which c-MYC rearrangements were detectable by conventional Southern blot hybridization showed positive LD-PCR amplification. The sizes of the amplified fragments varied from 1.8 kb to 12 kb, and these were specific to each material. Serial dilution of tumor cells or DNA in negative materials demonstrated a single band on agarose gel electrophoresis stained with ethidium bromide at a level of sensitivity of 10(-3), and hybridization with radioactive probe improved the level by one order of magnitude (1 cell in 10(4)), indicating that this LD-PCR approach is a sensitive technique capable of detecting minimal residual disease. Thus, the present study provided a useful tool for diagnosis and subsequent management of B-cell neoplasms characterized by specific chromosomal translocations.

Coexpression of cell-surface immunoglobulin (sIg), terminal deoxynucleotidyl transferase (TdT) and recombination activating gene 1 (RAG-1): two cases and derived cell lines

While it is generally agreed that in the lymphoid differentiation of B lineage cells there is no stage in which cell-surface immunoglobulin (sIg) and terminal deoxynucleotidyl transferase (TdT) are expressed simultaneously, a few B cell acute lymphoblastic leukemia (B-ALL) cases with this phenotype have been reported. Two such cases and the derived cell lines are reported here, in which the expression of recombination activating gene-1 (RAG-1) was also detected. One case was a CD19+ CD22+ HLA-DR+ sIg+ (gamma, kappa) B-ALL. The cell line (Bay9I) also expressed CD10. Karyotypic analysis revealed t(14;18)(q32;q21) and additional aberrations. In the other case, the fresh leukemia cells expressed CD19, CD24 and HLA-DR antigen. The derived cell line (Tree92) also expressed CD22 and sIg (mu, lambda). The karyotype of the Tree92 cells was t(8;14)(q24;q32) with additional aberrations. Tree92 is the first established cell line having both t(8;14)(q24;q32) and TdT. TdT was detected by Northern blotting as well as indirect immunofluorescence analysis. In addition, both Bay9I and Tree92 expressed RAG-1, as detected by Northern blot analysis. Cross-linking of sIg on Tree92 cells with anti-mu antibody led to significant down-regulation of RAG-1 expression. It seems that there is a sIg+ TdT+ RAG-1+ B lineage differentiation stage, and that signaling through sIg can modulate RAG-1 expression.

Sympathetic nerve activities in pulsatile and nonpulsatile systemic circulation in anesthetized goats

To investigate the effects of pulsatile and nonpulsatile systemic circulation on the sympathetic nerve activity, using a left heart bypass technique, we converted systemic circulation between the pulsatile and the nonpulsatile mode in anesthetized goats and analyzed differences in periodicity and quantity of renal nerve activity (RNA). After pulsatile systemic circulation was converted to the nonpulsatile mode, the mean RNA was significantly increased from 10.7 +/- 3.6 to 13.1 +/- 3.4 microV and periodic discharges of RNA, which corresponded to pulse-related rhythm during pulsatile circulation, became obscure, whereas an 8-12 cycle/s rhythm, which was distinguished and accounted for 30 +/- 9% of total intervals during pulsatile circulation, became dominant (48 +/- 11%). These results clarified a significant increase in mean RNA after depulsation of the systemic circulation and indicated that the cardiac-related rhythm in RNA could be produced by periodic inputs from arterial baroceptors alone, whereas the 8-12 cycle/s rhythm that was present regardless of the type of circulation was the fundamental rhythm originating from the vasomotor center.

Development of a centrifugal pump with improved antithrombogenicity and hemolytic property for chronic circulatory support

A centrifugal pump with a unique structure has been developed for chronic support. The pump is driven by a magnetic coupling and has no rotating shaft, no seal around the rotating part, and a balancing hole at the center of the impeller and the thrust bearing. The pump was improved in stepwise fashion to realize good antithrombogenicity and low hemolysis. The first pump, the National Cardiovascular Center (NCVC)-0, had an impeller with 4 rectangular and curved vanes; 6 triangularly shaped curved vanes were employed in the second model, the NCVC-1, to reduce trauma to the blood. In the third design, the NCVC-2, the central hole was enlarged, and the thrust bearing shoulder was rounded so that blood washing was enhanced around the impeller; stream lines also were smoothed for improved antithrombogenicity. The hemolytic property of the device was evaluated in vitro with heparinized fresh goat blood; hemolysis indexes of the NCVC-0, -1, and -2 were 0.05, 0.01, and 0.006 g per 100 L, respectively. Antithrombogenicity of the pumps was examined in animal experiments as a left heart bypass device in goals weighing 52-75 kg. Six NCVC-0 pumps were driven for 14 to 33 (22.0 +/- 7.6) days in goats receiving the antiplatelet drug cilostazol orally. Four NCVC-1 pumps ran for 1 to 80 (28.5 +/- 30.6) days with the same drug regimen in 2 cases and with no anticoagulation therapy in 2 cases. After 3 preliminary 1-week tests of NCVC-2 pumps in animals, the pump was installed in 3 goats; 2 pumps were still running on the 182nd and 58th pumping day. Intracorporeal implantation also was attempted successfully. The results indicate that this pump has promising features for chronic support although longer term and additional evaluations are necessary.

Tandem operation of a turbo blood pump (BP-80--type centrifugal pump) to reduce hemolysis

When operating turbo blood pumps in tandem, the strength of shear stress is reduced, but the exposure duration of the stress is increased. The purpose of this experiment was to compare the degree of contribution of these two factors on hemolysis as well as to evaluate the effectiveness of the tandem operation of turbo blood pumps. Tandem operation of two Bio-pumps (BP-80; Medtronics Bio-medicus, Inc., Eden Prairie, Minnesota, U.S.A.) were compared with single operation of a BP-80 in in vitro hemolysis tests in three different driving conditions, that is, pumping heads of 200, 350, and 500 mm Hg under a pump flow rate of 5 L/min. The Allen's hemolytic indexes of the tandem operation at pumping heads of 200, 350, and 500 mm Hg were 0.014, 0.020, and 0.080 mg/dl, respectively. The hemolytic indexes of the single operation at pumping heads of 200, 35, and 500 mm Hg were 0.014, 0.056, and 0.12 mg/dl, respectively. These results indicate that tandem operation is a useful method of reducing hemolysis with the BP-80 under high pumping heads and that the effect on hemolysis of exposure to higher shear stresses may be more serious than that of longer durations of exposure to shear stress in turbo blood pumps.

Influence of ventricular fibrillation on sympathetic nerve activity under biventricular bypass circulation

Autonomic nerves play an important role in circulatory control. The characteristics of sympathetic nerve activity (SNA) during artificial circulation, however, are not well understood. In this study, we examined the influence of natural heart beating on the renal SNA (RSNA) using pulsatile 100% biventricular assistance and electrically induced ventricular fibrillation in anesthetized goats, whose heart rate and size are similar to the human heart's. Following induction of the ventricular fibrillation, the pulse-synchronous discharges in the RSNA did not change their periodicity and quantity significantly. It was concluded that the beating of the heart had little influence on the RSNA and was presumably not essential for maintaining nervous control of circulation as long as the circulation was maintained by an artificial heart.

Hemolysis and heat generation in six different types of centrifugal blood pumps

What the most causative factor affecting hemolysis is still controversial. To resolve this problem, we investigated the relationship between hemolysis and heat generation in six types of centrifugal blood pumps (Bio-Pump, Delphin, Capiox, Nikkiso, Isoflow, and Toyobo). The analyzed parameters were index of hemolysis in fresh goat blood, pumping performance, and heat generation in a thermally isolated mock circuit. These parameters were analyzed at a flow rate of 5 L/min by changing the pressure head (100 mm Hg and 500 mm Hg). At 500 mm Hg of pressure head, the Bio-Pump needed the highest rotation number and showed the highest hemolytic rate and heat generation. The index of hemolysis is well correlated to heat generation (r2 = 0.721). Heat may originate from the motor by conduction, hydraulic energy loss, and mechanical friction between the shaft and seal. We strongly suspect that hemolysis was caused by a factor such as mechanical friction which generates heat locally.

Development and in vivo evaluation of an implantable left ventricular assist system with an impedance based monitoring and control system

We have developed an implantable pneumatically driven diaphragm left ventricular assist system (LVAS) for small adults, and an electric impedance based monitoring and control system (Z system). In this Z system, measurement of electric impedance of the blood chamber is performed by charging an alternating current with a constant amplitude between two metal connectors without compromising anti-thrombogenicity. Automatic calibration was performed periodically by measuring trough values of impedance in the blood chamber for several beats while the blood pump was in a full-fill state under preset driving conditions. For precise control of the fill-to-empty (F/E) drive, an automatic trigger level adjustment method was developed. This method is an automatic searching algorithm that identifies the volume change of the last ejection or filling by the Z system and settles the next trigger level to maintain a definite stroke volume. In chronic in vivo evaluation, this LVAS was used in 13 adult goats. The pump was installed between the LV apex and the descending aorta and was placed in the abdominal wall. Pump output ranged from 2.5 to 5.8 L/min, and the Z system provided good monitoring. The F/E drive was achieved satisfactorily by this Z system. The physical condition of the goats was excellent for as long as 19 weeks. Hematologic, hepatic, and renal functions were within the normal range, and no prominent thromboembolic symptoms were observed. A new mobile control drive unit with this Z system is being developed. We conclude that this LVAS with the Z system is promising for long-term use in a clinical setting.

How does the sympathetic nervous system behave during non pulsatile circulation?

Non pulsatile circulation is commonly applied to clinical cardiopulmonary bypass or circulatory assist. However, influences of non pulsatile circulation on sympathetic nerve activity, which plays an important role in circulatory control, have not been elucidated. In this study the renal sympathetic nerve activity (RSNA) was recorded for the first time in goats, whose heart rate and size are similar to humans', and the difference during pulsatile and non pulsatile circulation was evaluated. Total left heart bypass was instituted in eight adult goats under general anesthesia. A pneumatic pulsatile pump and a centrifugal non pulsatile pump were incorporated in parallel so that pulsatile circulation and non pulsatile circulation could be instantly converted to the other. The pumping rate was set at 90/min regardless of the native heart rate during pulsatile circulation and the mean aortic pressure was maintained constant at the conversion of circulatory mode. The original signals of RSNA were integrated and defined as the mean RSNA. The mean RSNA and the mean aortic pressure were averaged every 30 sec and quantified during pulsatile circulation and non pulsatile circulation. The pulse synchronized burst of RSNA during pulsatile circulation immediately disappeared and the mean RSNA significantly increased up to 120% of pre depulsation level after changing the circulatory mode to non pulsatile circulation. Reverse conversion of circulatory mode from non pulsatile circulation to pulsatile circulation decreased the mean RSNA to 79%. The results suggest that vasotonus may be affected in its periodicity as well as its quantity by the loss of pulsation during the initial phase after depulsation.

Long-term cardiopulmonary support with a composite artificial heart-lung system

A novel cardiopulmonary support (CPS) system as a long-term total substitute for the natural heart and lung was designed and evaluated. The CPS system is composed of a ventricular assist device (VAD) and a newly developed compact artificial lung (AL). The pneumatic VAD was originally developed in the authors' institute and has proven durable and antithrombogenic in over 120 clinical uses. The AL, with 1.2 m2 membrane surface area and 140 ml priming volume, consists of a special gas exchange membrane where not only are micropores blind-ended to prevent serum leakage, but the blood contacting surface is treated with heparin binding to ease systemic anticoagulation. Chronic animal experiments of total CPS were carried out in three goats weighing from 28 to 36 kg. Venoarterial bypass was instituted with the CPS system in which all venous blood was drawn from both the right atrium and ventricle and returned to the aorta. No systemic anticoagulation was conducted except for heparin added fluid infusion from pressure lines. One animal survived for 2 weeks without any device related problems until electively euthanized. Blood flow rate ranged between 3.2 to 4.5 L/min, O2 transfer between 120 to 220 ml/min, and CO2 removal between 60 to 210 ml/min. No substantial changes were found in platelet count or other coagulation factors. These results indicate that the system has the ability to be used for long-term CPS, such as a bridge to lung or heart-lung transplantation.

A two stage axial flow pump. New approach to reduction of hemolysis

From an engineering point of view, the suitable revolution number for high efficiency operation of an axial flow pump is known. A multistage axial flow pump is a useful tool for reducing revolution number with a high efficiency axial flow pump. A two stage (25) axial flow pump designed at a 5 L/min flow rate and a 100 mmHg pressure head was evaluated in three kinds of in vitro hemolysis tests. Each stage design point of the 2s pump was tested at a 5 L/min flow rate and a 50 mmHg pressure head. Specific speed and revolution number of the 2S pump were 1400 rpm, m3/min, m, and 15500 rpm, respectively. In the first test the 2S pump was compared with two single stage axial flow pumps (1S-A and 1S-B100) designed by the same method. The specific speed of the 1A was the same as that of the 2S pump, which was driven at 26000 rpm. The impeller of the 1S-B100 was the same as that of the 2S pump, which was driven at a 22000 rpm RN and a 1100 specific speed. The 2S pump was separated into two single stage axial flow pumps and the effect of series operation on hemolysis was evaluated in the second test. In the third test the 2S pump was compared with the 1S-B100 by using diluted goat blood samples with three different hematocrit values. The results showed that the hemolysis index of the 2S pump, regarded as a total hemolysis index of both stage axial flow pumps, was less than those of the single stage axial flow pumps at all hematocrit values.