Journal of Artificial Organs 2007: the year in review

Analysis of responsive characteristics of ionic-strength-sensitive hydrogel with consideration of effect of equilibrium constant by a chemo-electro-mechanical model

A multiphysics model is presented in this paper for analysis of the influence of various equilibrium constants on the smart hydrogel responsive to the ionic strength of environmental solution, and termed the multieffect-coupling ionic-strength stimulus (MECis) model. The model is characterized by a set of partial differential governing equations by consideration of the mass and momentum conservations of the system and coupled chemical, electrical, and mechanical multienergy domains. The Nernst-Planck equations are derived by the mass conservation of the ionic species in both the interstitial fluid of the hydrogel and the surrounding solution. The binding reaction between the fixed charge groups of the hydrogel and the mobile ions in the solution is described by the fixed charge equation, which is based on the Langmuir monolayer theory. As an important effect for the binding reaction, the equilibrium constant is incorporated into the fixed charge equation. The kinetics of the hydrogel swelling/deswelling is illustrated by the mechanical equation, based on the law of momentum conservation for the solid polymeric networks matrix within the hydrogel. The MECis model is examined by comparison of the numerical simulations and experiments from open literature. The analysis of the influence of different equilibrium constants on the responsive characteristics of the ionic-strength-sensitive hydrogel is carried out with detailed discussion.

Cardiac rehabilitation and artificial heart devices

Recently, cardiac rehabilitation has gained popularity in Japan because beneficial effects on patients' prognosis have been reported. Another reason is that cardiac rehabilitation has been covered by health insurance since 1988 in Japan. Currently, cardiac rehabilitation is covered for the diseases of angina pectoris, acute myocardial infarction, chronic heart failure (CHF), peripheral arterial disease, and diseases of the aorta and after open-heart surgery. Left ventricular assist devices (LVADs) are sometimes used in patients with progressive CHF symptoms to provide circulatory support, because in most of these patients heart failure does not improve with application of medical therapy, intra-aortic balloon pumping, or a percutaneous cardiopulmonary system. Modern VAD control systems are compact, allowing patients to carry them around without difficulty. Since patient management at the outpatient clinic has become possible, patients are able to expand the scope of their activities. Early active rehabilitation in patients implanted with a LVAD improves their condition, favorably impacts the clinical course while they await heart transplantation, and also improves posttransplant recovery. Exercise therapy is one of the important components in comprehensive cardiac rehabilitation. Exercise therapy is important to improve the quality of life of patients with LVADs. Appropriate exercise therapy is effective for patients with various cardiac conditions who undergo diverse treatments and is practiced actively by many patients. In order to facilitate cardiac rehabilitation safely and effectively for patients with serious conditions, education for health care professionals is essential. In this review, we describe the concept of rehabilitation followed by cardiac rehabilitation for patients with heart failure, patients after open-heart surgery, and patients with implanted LVADs.