Role of oxygen holes in Li(x)CoO(2) revealed by soft X-ray spectroscopy

The fundamental electronic structure of the widely used battery material Li(x)CoO(2) still remains a mystery. Soft x-ray absorption spectroscopy of Li(x)CoO(2) reveals that holes with strong O 2p character play an essential role in the electronic conductivity of the Co(3+)/Co(4+) mixed valence CoO(2) layer. The oxygen holes are bound to the Co(4+) sites and the Li-ion vacancy, suggesting that the Li-ion flow can be stabilized by oxygen hole back flow. Such an oxygen hole state of Li(x)CoO(2) is unique among the various oxide-based battery materials and is one of the key ingredients to improving their electronic and Li-ion conductivities.

Formation of Crystalline delta-Endotoxin or Poly-beta-Hydroxybutyric Acid Granules by Asporogenous Mutants of Bacillus thuringiensis

Parental strains and asporogenous mutants of Bacillus thuringiensis subspp. kurstaki and aizawai produced high yields of delta-endotoxin on M medium, which contained 330 mug of potassium per ml, but not on ST and ST-a media, each of which contained only 11 mug of potassium per ml. On ST and ST-a media, refractile granules were formed instead. These granules had no insecticidal activity against silkworms and were isolated and identified as poly-beta-hydroxybutyric acid. Supplementation of the potassium-deficient ST-a medium with 0.1% KH(2)PO(4) (3.7 mM) led to the formation of crystalline delta-endotoxin. The replacement of KH(2)PO(4) with equimolar amounts of KCl, KNO(3), and potassium acetate or an equivalent amount of K(2)SO(4) had a similar effect, whereas the addition of an equimolar amount of NaH(2)PO(4) or NH(4)H(2)PO(4) did not cause the endotoxin to form. An asporogenous mutant, B. thuringiensis subsp. kurstaki strain 290-1, produced delta-endotoxin on ST-a medium supplemented with 3 mM or more potassium but formed only poly-beta-hydroxybutyric acid granules on the media containing </=1 mM potassium. These results clearly indicate that a certain concentration of potassium is essential for the fermentative production of delta-endotoxin by these isolates of B. thuringiensis. Manganese could not be substituted for potassium. Phosphate ions stimulated poly-beta-hydroxybutyric acid formation by strain 290-1. The sporulation of B. thuringiensis and several other Bacillus strains was suppressed on the potassium-deficient ST medium. This suggests that potassium plays an essential role not only in Bacillus cell growth and delta-endotoxin formation but also in sporulation.

Band structure of the heavily-electron-doped FeAs-based Ba(Fe,Co)2As2 superconductor suppresses antiferromagnetic correlations

In the heavily-electron-doped regime of the Ba(Fe,Co)2As2 superconductor, three hole bands at the zone center are observed and two of them reach the Fermi level. The larger hole pocket at the zone center is apparently nested with the smaller electron pocket around the zone corner. However, the (pi,0) Fermi surface reconstruction reported for the hole-doped case is absent in the heavily-electron-doped case. This observation shows that the apparent Fermi surface nesting alone is not enough to enhance the antiferromagnetic correlation as well as the superconducting transition temperature.

Excitonic insulator state in Ta2NiSe5 probed by photoemission spectroscopy

We report on a photoemission study of Ta2NiSe5 that has a quasi-one-dimensional structure and an insulating ground state. Ni 2p core-level spectra show that the Ni 3d subshell is partially occupied and the Ni 3d states are heavily hybridized with the Se 4p states. In angle-resolved photoemission spectra, the valence-band top is found to be extremely flat, indicating that the ground state can be viewed as an excitonic insulator state between the Ni 3d-Se 4p hole and the Ta 5d electron. We argue that the high atomic polarizability of Se plays an important role to stabilize the excitonic state.

Fatal familial insomnia with an unusual prion protein deposition pattern: an autopsy report with an experimental transmission study

We recently performed a post-mortem examination on a Japanese patient who had a prion protein gene mutation responsible for fatal familial insomnia (FFI). The patient initially developed cerebellar ataxia, but finally demonstrated insomnia, hyperkinetic delirium, autonomic signs and myoclonus in the late stage of the illness. Histological examination revealed marked neuronal loss in the thalamus and inferior olivary nucleus; however, prion protein (PrP) deposition was not proved in these lesions by immunohistochemistry. Instead, PrP deposition and spongiform change were both conspicuous within the cerebral cortex, whereas particular PrP deposition was also observed within the cerebellar cortex. The abnormal protease-resistant PrP (PrP(res)) molecules in the cerebral cortex of this case revealed PrP(res) type 2 pattern and were compatible with those of FFI cases, but the transmission study demonstrated that a pathogen in this case was different from that in a case with classical FFI. By inoculation with homogenate made from the cerebral cortex, the disease was transmitted to mice, and neuropathological features that were distinguishable from those previously reported were noted. These findings indicate the possibility that a discrete pathogen was involved in the disease in this case. We suggest that not only the genotype of the PrP gene and some other as yet unknown genetic factors, but also the variation in pathogen strains might be responsible for the varying clinical and pathological features of this disease.

Development of a flow estimation and control system of an implantable centrifugal blood pump for circulatory assist

A bypass flow rate estimation and control system (BECS) for an implantable centrifugal blood pump (ICBP) has been developed in our institute. The estimated flow rate (EF) of the ICBP was derived from the electric power consumption, the rotating speed of a motor, and the blood viscosity presumed by the hematocrit and body temperature. The error in the EF was 0.5 +/- 0.4 L/min in in vivo experiments for 40 days. The rotating speed of the motor was controlled automatically every 200 ms to bring the EF in accord with the desired flow rate (DF). The reactivity and accuracy of the BECS were investigated in in vitro and in vivo experiments. The ICBP was operated by the BECS in a mock circuit in parallel with a pulsatile ventricular assist device (PVAD) to simulate left heart bypass. The reactivity was evaluated by changing the DF from 7 L/min to 5 L/min at an afterload of 160/97 mm Hg. To evaluate the accuracy of the BECS, the ICBP was driven under the aortic pressure of 110/85 mm Hg in the abdominal wall of an adult goat (70 kg). The DF was set at 5 L/min for 4 min for the goat in an awake condition. It took 13 s to change the flow rate in the in vitro experiment. The measured flow rate (MF) was maintained at 5.0 +/- 0.2 L/min by the BECS in vivo. In conclusion, the BECS has moderate reactivity and accuracy.

Intrathoracic and intraabdominal wall implantation of a centrifugal blood pump for circulatory assist

An implantable centrifugal pump (ICP) 320 ml in volume and 830 g in weight has been developed for prolonged circulatory assist. The antithrombogenicity of the ICP is provided by a balancing hole in the center of the impeller. The watertightness and histocompatibility of the ICP are supported by its silicone ring seal and its casing of titanium and acrylic resin, respectively. The total efficiency of the ICP was 30% at a 5 L/min flow rate and a 100 mm Hg head. The heat generation, watertightness, and anatomical fitting of the ICP were assessed in an intrathoracic implantation in a goat (66 kg) and in an intraabdominal wall implantation in a goat (70 kg). Warfarin was given for anticoagulation in each experiment to keep the prothrombin time around 1.7 times that of the control. The temperatures of the pump surface, the pleura, and the room were measured every 3 h. Anatomical fitting was evaluated by pathological observation after the termination of the experiment. The ICP could run for 40 days in the chest cavity and for 11 days in the abdominal wall. The temperature of the motor remained about 1.8 degrees C higher than the reference in both experiments. The ICP was completely covered by a layer of smooth fibrous tissue. The moisture content of the seals remained normal. Although a small amount of atelectasis was found in the lingula, neither lung adhesion nor necrotic change of the chest wall was observed. The inflammation of the surrounding tissue including foreign body reaction and thermal burn was minimal. In conclusion, the ICP has satisfied in vivo testing of its watertightness, exothermicity, and anatomical fitting.

Development of design methods of a centrifugal blood pump with in vitro tests, flow visualization, and computational fluid dynamics: results in hemolysis tests

There are few established engineering guidelines aimed at reducing hemolysis for the design of centrifugal blood pumps. In this study, a fluid dynamic approach was applied to investigate hemolysis in centrifugal pumps. Three different strategies were integrated to examine the relationship between hemolysis and flow patterns. Hemolytic performances were evaluated in in vitro tests and compared with the flow patterns analyzed by flow visualization and computational fluid dynamic (CFD). Then our group tried to establish engineering guidelines to reduce hemolysis in the development of centrifugal blood pumps. The commercially available Nikkiso centrifugal blood pump (HPM-15) was used as a standard, and the dimensions of 2 types of gaps between the impeller and the casing, the axial and the radial gap, were varied. Four impellers with different vane outlet angles were also prepared and tested. Representative results of the hemolysis tests were as follows: The axial gaps of 0.5, 1.0, and 1.5 mm resulted in normalized index of hemolysis (NIH) values of 0.0028, 0.0013 and 0.0008 g/100 L, respectively. The radial gaps of 0.5 and 1.5 mm resulted in NIH values of 0.0012 and 0.0008 g/100 L, respectively. The backward type vane and the standard one resulted in NIH values of 0.0013 and 0.0002 g/100 L, respectively. These results revealed that small gaps led to more hemolysis and that the backward type vane caused more hemolysis. Therefore, the design parameters of centrifugal blood pumps could affect their hemolytic performances. In flow visualization tests, vortices around the impeller outer tip and tongue region were observed, and their patterns varied with the dimensions of the gaps. CFD analysis also predicted high shear stress consistent with the results of the hemolysis tests. Further investigation of the regional flow patterns is needed to discuss the cause of the hemolysis in centrifugal blood pumps.

Prolonged nonpulsatile left heart bypass with reduced systemic pulse pressure causes morphological changes in the aortic wall

We investigated the morphological changes in the aorta due to reduced systemic pulse pressure in prolonged nonpulsatile left heart bypass (LHB). Nineteen adult goats were divided into 3 groups, the nonpulsatile group in which nonpulsatile LHB was conducted, the pulsatile group in which pulsatile LHB was conducted, and the control group used as the normal control. The average aortic pulse pressures were 12, 47, and 37 mm Hg, respectively. The descending aorta was subjected to morphological examination. In the nonpulsatile group, the wall was significantly thinner, and the volume ratio of smooth muscle cells (SMCs) was much lower. In terms of the SMC type classification, the proportion of SMCs with low activity and low contractility was higher, and the cell density of the SMCs was increased compared to those in the other groups. These results indicate that prolonged nonpulsatile LHB causes morphological atrophic changes in the aorta.

In vitro and in vivo heat dissipation of an electrohydraulic totally implantable artificial heart

The authors evaluated the heat transfer characteristics of an electrohydraulic totally implantable artificial heart (EH-TAH) developed at our institute. In three in vitro experiments, the heat dissipation of the EH-TAH was investigated. First, the EH-TAH was connected to a closed mock circuit filled with 1 L of saline, and driven at an input power of 20 W. The estimated heat conducted to the blood was approximately 10.3 W, which was almost half of the input power. Second, we simulated heat transfer with the circulation of a calf by using a heat exchanger. The amount of heat dissipating directly from the EH-TAH surface was calculated to be 10 W. Third, the temperature of the actuator examined with thermography was found to be almost uniform, and no prominent high temperature area was observed. In an in vivo study, the EH-TAH was implanted for 10 days in a calf weighing 62 kg. The input power was 18 +/- 2 W, the temperature of the actuator-tissue contacting surface was 39.4 +/- 0.8 degrees C, and that of the pump blood chamber was 39.8 +/- 0.4 degrees C. This slight temperature elevation was thought to be attributable to heat dissipation to the blood. On histologic study of the chest wall and the lung in contact with the actuator, vascularized connective tissue envelopes were observed, but unfavorable side effects, such as tissue necrosis, were not observed. These results suggest that the thermal effect of this system is acceptable at the input power used.

Morphologic changes of the aortic wall due to reduced systemic pulse pressure in prolonged non pulsatile left heart bypass

The morphologic changes of the aortic wall due to reduced systemic pulse pressure in prolonged non pulsatile left heart bypass (LHB) were investigated. Sixteen adult goats were divided into three groups: the non pulsatile group in which non pulsatile LHB was conducted for 137 days on average, the pulsatile group in which pulsatile LHB was conducted for 79 days on average, and the control group used as the normal control. The average aortic pulse pressures were 12, 48, and 37 mmHg, respectively. At the end of the experiments, the descending aorta was excised and subjected to morphologic examination. The wall thickness of the aorta in the non pulsatile group (1.4 mm) was significantly thinner than that in the pulsatile group (2.2 mm) and the control group (2.0 mm), and the volume ratio of smooth muscle cells (SMC) in the non pulsatile group (37%) was lower than that in the pulsatile group (48%) and the control group (49%). In SMC classification, the proportion of SMC with low activity and low contractility in the non pulsatile group (57%) was high as compared with that in the pulsatile (2%) and control (5%) groups. These results strongly indicate that prolonged non pulsatile LHB causes substantial morphologic changes in the aorta.

Development of an implantable centrifugal blood pump for circulatory assist

An implantable centrifugal pump (ICP) for prolonged circulatory assist has been developed, at 320 ml and 830 g. A central balancing hole was made in its impeller for better antithrombogenicity. Waterproofing and histocompatibility were supported by a silicone seal and a casing made of titanium and acrylic resin. Overall efficiency was 30% and normalized index of homolysis was 0.003 mg/dl, the same value as the BP-80, at a flow rate of 5 L/min and a head of 100 mmHg. Antithrombogenicity and hemolytic properties of the ICP were investigated in paracorporeal implantation in three goats (61-71 kg). Exothermicity, anatomic fit, and water tightness of the ICP were evaluated in intrathoracic implantation in an adult goat (66 kg). The ICP could run paracorporeally for 50, 200, and 381 days. There was no thrombus in the ICP after 381 days' pumping, and the ICP could run in the chest cavity for 40 days. The temperature of the motor rose 1.8 +/- 0.3 degrees C from that of the pleura. Moisture content of the seal remained normal. The ICP was completely covered with smooth fibrous tissue. Although a small area of atelectasis was found in the lingula, neither lung adhesion nor necrosis of the chest wall was observed. The ICP has satisfactory antithrombogenicity, hemolytic property, water tightness, anatomic fit, and exothermicity for use as an implantable circulatory assist device.

Establishment of flow estimation for an implantable centrifugal blood pump

A less invasive and non thrombogenic flow estimation of an implantable centrifugal blood pump (ICBP) has been developed, which was derived from electric power consumption, the rotating speed of a motor, and blood viscosity presumed by hematocrit and body temperature. The power consumption and the rotating speed of the motor were measured by a wattmeter every 0.2 sec. Accuracy and stability of the estimated flow (EF) were investigated during in vitro and in vivo experiments. The EF was compared with a measured flow rate (MF) monitored by an electromagnetic flowmeter. During in vitro experiments, the EF and MF were measured at 79 operating points. The ICBP was driven in a closed mock loop filled with goat blood with hematocrit values of 21.5, 28, 34, and 42%. During in vivo experiments, the ICBP was implanted in the chest cavity of a goat and driven for 40 days with continuous estimation of the bypass flow rate. Blood was taken to determine hematocrit value several times a week. The temperature of the pleura away from the ICBP was measured every 15 min. A linear correlation between the EF and MF was observed, and the correlation coefficient between the EF and MF was 0.99 during in vitro examinations. An averaged error of the EF was 0.5 L/min, with the MF ranging from 2.3 to 8.1 L/min during in vivo experiments. In conclusion, flow estimation was established with good stability and accuracy in both in vitro and in vivo experiments.

Hemodynamic and humoral conditions in stepwise reduction of pulmonary blood flow during venoarterial bypass in awake goats

The effects of reduced pulmonary arterial blood flow (PAF) during venoarterial bypass (VAB) on hemodynamic and humoral conditions were investigated in a series of experiments in a chronic animal model. A biventricular bypass system was installed in five adult goats weighing 49.8 +/- 1.1 kg. Two weeks later, the extracorporeal circuitry was changed to VAB without anesthesia. The PAF was reduced stepwise from 100% to 50, 25, 10, and 0% of total systemic flow. The mean aortic pressure and systemic vascular resistance decreased from 110 +/- 14 to 66 +/- 3 mmHg and from 1,288 +/- 77 to 740 +/- 73 dyne.sec/cm5, respectively, in proportion to the decrease in PAF from 100 to 0%. The prostaglandin E2 concentration increased from 1.5 +/- 0.6 to 8.8 +/- 0.6 pg/ml following the decrease in PAF from 100 to 0%. The renin-angiotensin system increased in proportion to the decrease in PAF. In contrast, the epinephrine and norepinephrine concentrations (60 +/- 10 and 227 +/- 80 pg/ml, respectively, at 100% PAF) did not change appreciably even at 10% PAF, but were markedly elevated to 335 +/- 117 and 2,088 +/- 1,503 pg/ml at 0% PAF. The antidiuretic hormone level similarly changed. In conclusion, decrease in PAF during VAB exerts significant effects on hemodynamics in a proportional manner and on vasoactive humoral factors in a diverse manner.

Early changes in circulating blood volume and volume regulating humoral factors after implantation of an electrohydraulic total artificial heart

The early changes in circulating blood volume (CBV) and volume regulating humoral factors after implantation of an electrohydraulic total artificial heart (EH-TAH) were investigated in a calf and compared with results in a sham operated control calf. CBV was measured by the dye dilution method using indocyanine green. CBV and humoral factors were periodically investigated. In the EH-TAH implanted calf, the cardiac output was estimated at 6-7 L/ min (94-109 ml/kg/min), and the aortic pressure and aerobic metabolic condition were favorable. Nevertheless, the CBV was increased to 132 and 168% of the pre-operative value (range in the control calf, 83-103%) on post operative days 4 and 8, respectively. The atrial natriuretic peptide level on days 2, 5, and 7 was 23, 170, and 240 (in the control calf, 19-61) pg/ml, respectively, and the antidiuretic hormone level was 7.3, 2.0, and 1.3 (0.5-1.3) pg/ ml, respectively. The plasma renin activity was 3.2, 3.7, and 3.1 (0.5-0.3) ng/ml/hr, respectively. The angiotensin-I and angiotensin-II levels were also increased in the EH-TAH implanted calf. It is concluded that significant water retention occurs even at sufficient cardiac output early after EH-TAH implantation. The changes in humoral factors are suggested to arise secondary to the increased CBV or other unknown factors.

Characteristics of mixed venous oxygen saturation and physical activity as parameters for artificial heart control

Mixed venous oxygen saturation (SvO2) and physical activity (PhyAc) are practical candidates as parameters of total artificial heart (TAH) control because SvO2 can be measured through a transparent blood pump housing with infrared rays and PhyAc can be calculated from signals of an accelerometer used for rate response pacemakers. Although the methods for measurement of the parameters have already been developed, characteristics of these parameters for TAH control, such as during exercise, are still unclear and were examined in this study. SvO2, cardiac output (CO), and PhyAc were measured as parameters. Multi-stage treadmill exercise tests were performed. Difference values (DVs) from the value at the start of exercise showed better correlation than did absolute values. Correlation coefficients between DV in CO and DV in SvO2 and between DV in CO and PhyAc were high at -0.82 and 0.72, while the time constants for the change of SvO2 and CO to the PhyAc change were 26 and 32 sec. Although the correlation coefficient between the CO and SvO2 was higher than that between CO and PhyAc, PhyAc responded more quickly to the speed change compared with the response of SvO2 and CO. It was concluded that SvO2 and PhyAc were useful parameters with different characteristics for TAH control during exercise.

Noninvasive pump flow estimation of a centrifugal blood pump

A flow rate estimating method was investigated for a centrifugal blood pump developed in our institute. The estimated flow rate was determined by the power consumption, the rotating speed of the motor, and the hematocrit value. The power consumption and the rotating speed of the motor were measured with a wattmeter. The examinations were performed in a closed mock loop filled with goat blood with hematocrit values of 21.5%, 28%, 34%, and 42%. Measured values of blood viscosity were 2.47, 3.09, 3.71, and 5.07 mPa.s at a share rate of 37.5/s, respectively. A linear correlation between the power consumption and the pump flow rate was observed in all hematocrit values. But variations in hematocrit caused a difference in the flow rate up to 1.1 L/min at the same power consumption and rotating speed. Effects of blood viscosity on the flow estimation were corrected by the hematocrit value. The value of the coefficient of determination, R2, between the estimated flow rate and the measured flow rate was 0.988. These results may indicate that the flow estimating method calculated by the power consumption of the motor, the rotating speed, and the hematocrit value is useful in the clinical situation.

Long-term evaluation of a nonpulsatile mechanical circulatory support system

Antithrombogenicity of a centrifugal pump (CP) developed in our institute is provided by a central balancing hole (BH) in the impeller. A current CP, the National Cardiovascular Center (NCVC)-2, was ameliorated to improve antithrombogenicity, whereby the BH diameter was widened to improve self washout flow velocity, and an edge of the thrust bearing was rounded off to minimize flow separation. Effects of these modifications were assessed in a long-term in vivo experiment. The antithrombogenicity, hemolytic property, and mechanical durability of the NCVC-2 were investigated in 3 goats. The NCVC-2 was installed paracorporeally between the left atrium and the aorta and driven as long as possible at rotating speeds of about 2,800 rpm. The NCVC-2 ran for 50, 200, and 367+ days. The mean bypass flow rates were 6.8, 5.0, and 5.3 L/min, respectively. Creatinine, blood urea nitrogen (BUN), glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic transaminase (GPT) did not increase until one week before termination. Plasma free hemoglobin was kept to a level less than 15 mg/dl, except for the last week of the second case. These results indicate that the NCVC-2 has excellent antithrombogenicity, an acceptable hemolytic property and the necessary durability for prolonged use.

Application of hydrogen absorbing alloys to medical and rehabilitation equipment

As power sources for rehabilitation equipment, electric, hydraulic, and pneumatic actuators have been used. However a more human-sized and higher powered actuator that can reduce the equipment size is desired. A new metal hydride (MH) actuator that uses the reversible reaction between the heat energy and mechanical energy of a hydrogen absorbing alloy has recently attracted much attention. The MH actuator is characterized by its small size, low weight, noiseless operation and a compliance similar to that of the human elbow joint. Therefore, the MH actuator has the characteristic of being light and easy to use and so is suitable for use in medical and rehabilitation applications. Some lifting devices using this actuator have already been developed and are being used for the care of the aged and disabled. The characteristics of the MH actuator are presented and then some applications are introduced in this paper. It is our opinion that in our aging society the MH actuator will play an important role in the development of medical and rehabilitation equipment.

Pore size of porous hydroxyapatite as the cell-substratum controls BMP-induced osteogenesis

To elucidate the biochemical mechanism of osteogenesis, the effect of matrix geometry upon the osteogenesis induced by bone morphogenetic protein (BMP) was studied. A series of five porous hydroxyapatites with different pore sizes, 106-212, 212-300, 300-400, 400-500, and 500-600 microns, was prepared. A block (approximately 5 x 5 x 1 mm, 40.0 mg) of each hydroxyapatite ceramics was combined with 4 micrograms of recombinant human BMP-2 and implanted subcutaneously into the back skin of rat. Osteoinductive ability of each implant was estimated by quantifying osteocalcin content and alkaline phosphatase activity in the implant up to 4 wk after implantation. In the ceramics of 106-212 microns, the highest alkaline phosphatase activity was found 2 wk after implantation, and the highest osteocalcin content 4 wk after implantation, consistent with the results observed with particulate porous hydroxyapatite [Kuboki, Y. et al. (1995) Connect. Tissue Res. 32: 219-226]. Comparison of the alkaline phosphatase activities at 2 wk and the osteocalcin contents at 4 wk after implantation revealed that the highest amount of bone was produced in the ceramics implants with pore size of 300-400 microns. In the ceramics with smaller or larger pore sizes, the amount of bone formation decreased as the pore size deviated from 300-400 microns. The results indicated that the optimal pore size for attachment, differentiation and growth of osteoblasts and vascularization is approximately 300-400 microns. This study using chemically identical but geometrically different cell substrata is the first demonstration that a matrix with a certain geometrical size is most favorable for cell differentiation.

Effects of self washout structure on the antithrombogenicity and the hemolytic properties of a centrifugal pump

Antithrombogenicity in an initial type (N1) of a centrifugal pump (CP) developed in our institute is provided by the central balancing hole of an impeller. A new CP (N2) was modified to obtain better antithrombogenicity, in which the balancing hole was widened to improve self washout flow velocity (Vsf), and an edge of the thrust bearing was rounded off to minimize flow separation. Effects of the modifications were assessed in vitro and in vivo studies. The Vsf of the N1 and the N2 evaluated by a Doppler velocimeter were 12.8 and 22.1 cm/s, respectively. Flow around the thrust bearing, which was visualized by a light cutting method, confirmed less flow stagnation in the N2. The hemolytic indices of the N1 and the N2 were 0.023 and 0.008 mg/dl, respectively. In vivo antithrombogenicity and the hemolytic properties of the N2 and the N1 were investigated without anticoagulation therapy in 3 goats. In each goat the N2 was driven for 1 week and exchanged for the N1, which was driven for the same period. Red thrombi at the thrust bearing were found in 2 N1s, and 2 small thrombi were on the impeller of another N1, whereas a thrombus of less than 1 mm3 at the TB was noted in 1 N2. Plasma free hemoglobin was not increased in either CP. These results indicate that the N2 has better antithrombogenicity and hemolytic properties than the N1.

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.

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.

Relationship between pump speed design and hemolysis in an axial flow blood pump

In an attempt to reduce the hemolysis caused by axial flow blood pumps, we investigated whether the specific speed should be kept within the standard engineering range or whether pump speed should be minimized, thus making the specific speed beyond the standard range. Four pumps with 11.8 mm diameter impellers were designed to accommodate a flow of 5 L/min and a head of 100 mm Hg. The pumps were tested at 4 speeds: A, 14,000; B, 18,000; C, 22,000; and D, 26,000 rpm. Pump performance data were obtained, and the maximum point of total pump efficiency was found for each pump. The maximum efficiencies were A, 50%; B, 58%; C, 52%; and D, 53%. The specific speed of each pump recorded at the maximum efficiency point was calculated as A, 899; B, 954; C, 1,218; and D, 1,951 rpm. Hemolytic tests were performed with fresh goat blood in a closed, mock-loop circuit. Hemolytic indexes were A, 0.036; B, 0.22; C, 0.35; and D, 0.66. We have concluded that decreased hemolysis is correlated with a lower pump speed and that the specific speed for the lowest pump speed is less than the standard range. Having a specific speed outside the standard range was not correlated with reduced total pump efficiency.

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.

Development of an intravenous axial flow pump for temporary right heart assist

In clinical settings, quick application systems with easy access for circulatory support are desired. For left heart assist, an intraarterial axial flow pump (Hemopump) has been developed and applied to clinical cases. However, no simple way has been proposed for right heart assist. We have developed an intravenous axial flow pump for temporary right heart assist and have reported its hemodynamic effect. In this study, in vivo evaluation of this system was performed. The pump system consists of an outflow cannula, an impeller that was newly developed for intravenous use, and a driving system for the Hemopump. A prototype pump demonstrated 3.2 L/min of maximal flow at a pressure differential against 40 mmHg at a pump speed of 28,000 rpm in mock circulation. Application to goats is as follows. A 14 mm low porosity graft was anastomosed to the infrarenal inferior vena cava (IVC). The pump system was inserted into the IVC through the graft and advanced to the right heart using balloon catheter guidance under fluoroscopy, and the tip of the cannula of the pump was positioned at the main pulmonary artery. In acute experiments, this system provided effective right heart assist under induced pulmonary stenosis and induced biventricular failure with left ventricular assist. Chronic animal experiments were performed for as long as 4 hr using adult goats weighing 51-54 kg. There were no difficulties in pump insertion. In one goat, the drive shaft was broken because of kinking of the shaft inside the body, caused by failure in securing the pump. Levels of platelet counts and plasma hemoglobin were acceptable, and there was no prominent damage to heart tissues. In conclusion, an intravenous axial flow pump introduced through a peripheral vein is practicable for temporary right heart assist.

An approach to reducing hemolysis in an axial-flow blood pump

In an attempt to decrease hemolysis caused by an axial-flow blood pump, we studied whether specific speed (Ns) at a design point (determined by flow in m3/min, pump head in m, and pump speeds in rpm), should be kept within the existing engineering standard range (1000 < Ns < 2500) or whether pump speed should be reduced to a minimum (Ns < 1000). Four pumps (A: 14,000 rpm, B: 18,000 rpm, C: 22,000 rpm, and D: 26,000 rpm), each with an impeller 11.8 mm in diameter, were designed to accommodate a flow rate of 5 L/min and a pressure head of 100 mmHg. At this design point, the Ns of each pump was calculated as A:758, B:974, C:1191, and D:1407. Pump performance was observed, and the total efficiency of each pump was calculated. The hemolysis index (HI) was calculated after simultaneous testing in duplicate of all four pumps using fresh goat blood (anticoagulated with citrate-dextrose solution) in a closed mock-loop circuit. Total efficiency of each pump was calculated as A:49%, B:50%, C:45%, and D:22%. In the first hemolytic test, HIs were measured as A:0.066, B:0.18, and C:0.13; a water seal failed in pump D. In the second test, HIs were B:0.077, C:0.0499, and D:0.12; a bearing failed in pump A. It is concluded that a lower level of hemolysis is associated with a pump speed in the minimum range at the design point, even though Ns is outside the standard range.

Power of the fatigue resistant in situ latissimus dorsi muscle

To evaluate the in situ latissimus dorsi muscle as an actuator for circulatory assistance, 1) muscle power was analyzed in animal experiments, and 2) muscle weight was measured in human cadavers. Three adult goats underwent 12 week preconditioning. The insertion of the latissimus dorsi muscle was then connected to a spring and a tension transducer in series. The stroke length was measured with a photosensor without power loss. With contraction of muscles under various loads, tension-length relationships at end contraction and end relaxation were obtained and the maximum area of a square drawn within both lines was assumed to be maximum external power. Good fatigue resistance and the highest maximum external power of 3.16 Watts/kg at 120 min was derived from preconditioned latissimus dorsi muscle in burst frequency of 50 Hz. Muscle weight in 42 human cadavers was negatively correlated with age (r = 0.56) and was expected to be 221.6 g in patients aged 45 years. According to these data, the power of a human preconditioned latissimus dorsi muscle was estimated as 0.7 Watts. It was concluded the power of in situ preconditioned latissimus dorsi muscles was appropriate for right heart assistance or counterpulsation for left heart assist.

Improvement in antithrombogenicity in a centrifugal pump with self wash-out structure for long-term use

Antithrombogenicity in the initial (NCVC-1) centrifugal pump (CP) developed at our institute is provided by a central balancing hole in an impeller that promotes self wash-out blood flow (Sf) around the impeller. The current CP (NCVC-2) was ameliorated to obtain better antithrombogenicity, where the balancing hole diameter was widened to improve Sf velocity (Vsf), and the edge of a thrust bearing (TB) was rounded to minimize flow separation. Effects of the modifications were assessed in in vitro and in vivo studies. The Vsf of the NCVC-1 and the NCVC-2 evaluated by Doppler velocimeter were 12.8 and 22.1 cm/sec, respectively. Flow around the TB visualized by a light cutting method confirmed less flow stagnation in the NCVC-2. In vivo antithrombogenicity of the CPs was investigated in three goats. A pulsatile VAD (P-VAD) was installed paracorporeally between the left atrium and the aorta. After 3 weeks, the P-VAD was exchanged for the NCVC-2 and the NCVC-1 in sequence. Each CP was driven for 1 week and disassembled. No anticoagulation was used, except for heparin injection at pump exchange. Thrombus at the TB was found in the two NCVC-1s, and two little thrombi were on the impeller of another NCVC-1, whereas a thrombus smaller than 1 mm3 at the TB was noted in one NCVC-2. These results indicate that the NCVC-2 has better antithrombogenicity and Sf around the impeller and the TB.

Acute phase responses of vasoactive hormones to non pulsatile systemic circulation

Acute phase responses of vasoactive hormones to the rapid conversion of a systemic flow pattern from pulsatile or non pulsatile mode to the reverse were assessed in 20 goats weighing 45-69 kg. A total left heart bypass was instituted under general anesthesia, with pulsatile and non pulsatile pumps interposed in the circuit in parallel, and the systemic flow mode was rapidly and bidirectionally converted from the pulsatile mode or non pulsatile mode to the reverse. Vasoactive hormone levels and hemodynamics were evaluated before and after 5 min of conversion. No significant difference was observed between the modes either in blood flow or systemic vascular resistance, while the mean aortic pressure was significantly higher in the non pulsatile mode than the pulsatile mode (106.7 +/- 2.4 versus 99.9 +/- 3.5 mmHg). Among various vasoactive hormone levels evaluated, only norepinephrine showed a significant difference between the modes, where concentration in the non pulsatile mode was significantly higher than the pulsatile mode (391.0 +/- 60.7 versus 309.4 +/- 42.5 pg/ml). No correlation was found between the absolute values of mean aortic pressure and norepinephrine level, whereas a significant reciprocal correlation was detected between the magnitude of inter-mode differences in these two parameters. In conclusion, a non pulsatile systemic circulation does not exert significant influence on vasoactive hormone levels, except for slight increase in norepinephrine with a reciprocally correlated increase in mean aortic pressure. It is deduced that activity of the sympathetic nervous system represented by norepinephrine level is higher in the non pulsatile mode than the pulsatile mode, and the baroreceptor reflex functions in an acute phase after flow mode conversion.

Heat generation and hemolysis at the shaft seal in centrifugal blood pumps

The heat and hemolysis around a shaft seal were investigated. Materials were original pumps (Nikkiso HMS-15:N-original, and 3M Delphin:D-original), vane-removed pumps (Nvane(-), Dvane(-)), and a small chamber with a shaft coiled by nichrome wire (mock pump). The original pumps were driven at 500 mmHg and 5 L/min, and vane-removed pumps were driven at the same rotation number. An electrical powers of 0, 0.5, 2, and 10 W was supplied to the mock pumps. In vitro hemolytic testing showed that hemolytic indices were 0.027 g/100 L in N-original, 0.013 in Nvane(-), 0.061 in D-original, and 0.012 in Dvane(-). Measurement of heat with a thermally insulated water chamber showed total heat within the pump of 8.62 and 10.85 W, and heat at the shaft seal of 0.87 and 0.62 W in the Nikkiso and Delphin pumps, respectively. Hemolysis and heat generation of mock pumps remained low. The results indicate that the heat generated around the shaft seal was minimal. Hemolysis at the shaft-seal was considerable but not major. Local heat did not affect hemolysis. It was concluded that the shaft-seal affected hemolysis, not by local heat but friction itself.

A flow visualization study of the NCVC centrifugal blood pump

A compact centrifugal pump, NCVC-1, has an open-type impeller with 6 curved vanes, and it is characterized by no shaft and no seal. A tunnel is placed in the center of the impeller-rotor assembly to irrigate the back space behind the rotor. To evaluate the flow, we performed 3 visualization methods: tracer, oil film, and injection streak line method. The flow, observed by the tracer method in NCVC-1, indicated little turbulence along vanes. A volute chamber proved effective to reduce vortex formation in the outlet. Oil film pattern revealed no flow separation on vanes at 5 L/min. Washout flow behind the rotor is essential to prevent thrombus formation and was shown as inward spiral flow without any stagnation. These data suggested that a combination of visualization techniques was useful to analyze various flow conditions, and the NCVC-1 has excellent flow characteristics with little turbulence and little flow stagnation, which must be beneficial to low hemolysis and high antithrombogenicity.

Development and evaluation of components for a totally implantable artificial heart system

The authors have been developing an electrohydraulic (EH) artificial heart system for total implantation. This system consists of intrathoracic ventricles, an abdominally placed EH actuator, flexible silicone oil conduits, externally coupled transcutaneous energy transfer (TET) system, transcutaneous optical telemetry (TOT) system, internal battery, and internal control drive unit. Fitting was evaluated in chronic animal experiments as a pneumatic system in 11 goats weighing 55.2 +/- 4.2 kg and 3 calves of 52.3 +/- 1.2 kg. The longest survival time in calves was 111 days, and that in goats was 51 days. The assembled EH pump was implanted in two goats of 49 and 50 kg as an acute experiment, and 4.2-6.7 L/min of cardiac output was maintained. For the TET system, an internal coil 3 cm in diameter was implanted to make an arch covered by skin. Electric energy was transmitted from the external to the internal coil, and energy of about 20 W was carried through wires to an external load. The DC-to-DC efficiency of the system was 76-83% for 40 days. The TOT system with internal light emitting diodes and external photodiodes also was evaluated in a goat. Disalignment of up to 12 mm was tolerated. Although more improvement is necessary, most of the components showed characteristics desirable for a totally implantable system.

In vitro and in vivo assessment of an intravenous axial flow pump for right heart assist

Right ventricular (RV) function is a limiting factor in maintaining systemic circulation with circulatory assist. There is, however, no easy way to institute RV assist, such as the intraarterial axial flow pump (Hemopump) used for left heart assist. In this study, the feasibility and hemodynamic effect of intravenous use of an axial flow pump was examined. A pump system was developed with an outflow cannula and an impeller that were newly designed for intravenous insertion with a Hemopump driving system. The pump system characteristics using goat blood at a hematocrit of 26% indicated that maximum flow at a pressure differential against 40 mmHg is 3.2 l/min at a pump speed of 28,000 rpm. The pump was tested in adult goats by intravenous insertion through a 14 mm, low porosity graft anastomosed to the infrarenal inferior vena cava. The pump was advanced until the tip of the cannula was positioned at the main pulmonary artery, using balloon catheter guidance under fluoroscopy. RV assistance was evaluated by pressure tracing, and aortic flow (AF) measured by electromagnetic flowmeter under 1) induced pulmonary stenosis (PS), and 2) electrically induced ventricular fibrillation (VF) in combination with left heart assist. Under PS, right atrial pressure decreased from 11 to 2 mmHg and AF increased from 1.0 to 4.1 l/min after initiation of the pump. Under VF, AF and aortic pressure were 2.6 l/min and 78 mmHg, respectively, with left ventricular assist. After initiation of the pump, they increased to 4.0 l/min and 98 mmHg, respectively. In chronic experiments using three adults goats for up to 48 hr, levels of plasma hemoglobin and platelet counts were maintained within an acceptable range. There was no prominent damage to the hearts. These data suggest that an axial flow pump introduced by an intravenous approach without thoracotomy is feasible and provides sufficient right heart assist.

A new porous hydroxyapatite ceramic prepared by cold isostatic pressing and sintering synthesized flaky powder

A new porous hydroxyapatite ceramic was prepared by cold isostatic pressing and sintering of the flaky powder, that was synthesized through two-stage hydrolysis of brushite; (1) a structural change into the apatite structure and (2) a compositional increase in Ca/P ratio, according to the method of Monma and Kamiya. The appearance of the synthesized powder resembled the flaky shape of the starting materials and its average particle size was about 15 microns. This powder consisted of fine needle crystals, which had a tendency to grow into the larger grains, but the powder was highly resistant to sintering under the usual heating conditions at 1200 degrees C. Porous hydroxyapatite blocks and granules were prepared by cold isostatic pressing and sintering a pellet consisting of the hydroxyapatite powder and spherical polymer beads. The product showed a 70% apparent porosity with spherical pores, ranging from 100-200 microns in size, and most pores were interconnected. These properties were ascribed to the effect of cold isostatic pressing on the hydroxyapatite powders with the flaky shape.

Postoperative chemoimmunotherapy for the treatment of liver cancer

A randomized study using spleen-derived lymphokine-activated killer (LAK) cells in hepatocellular carcinoma (HCC) is reported. We induced cytotoxic lymphocytes from resected spleen of HCC. The effect of recombinant interleukin-2 (rIL-2)-activated spleen cells for prevention of recurrence of HCC after hepatic resection was studied. Enough mononuclear cells could be harvested from the resected spleens. The induction of activated spleen cells was carried out by culture in fresh medium containing 1,500 JU/ml of IL-2. The cytotoxicity of the activated spleen cells maintained high levels during the culture period ranging from 3-30 days. These autologous activated spleen cells were administered to patients 2 days after the intra-arterial infusion of Adriamycin. A randomized study using these spleen LAK cells resulted in lower recurrence rates in the LAK IL-2-treated group. No severe side effects were observed. The lymphocytes derived from resected spleens were useful as the source of effector cells in clinical adoptive immunochemotherapy for HCC, because of their higher cytotoxicity and the simplicity of gaining a large amount of cells.