J Artif Organs DOI 10.1007/s10047-014-0759-z
REVIEW
Journal of Artificial Organs 2013: the year in review Journal of Artificial Organs Editorial Committee
Received: 28 January 2014 Ó The Japanese Society for Artificial Organs 2014
Members of the Editorial Committee of the Journal of Artificial Organs (JAO) are pleased to introduce to colleagues worldwide through the publication of JAO a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to practical development and clinical applications. The JAO, an international journal with articles published in English, is the official journal of the Japanese Society for Artificial Organs. We believe that JAO has a very high potential for promoting interest in the field of artificial organs not only in Japan but also in other parts of the world. We are also
convinced that the specialization, originality, and level of science of this journal are at the highest in the field. The impact factor announced in the Journal Citation Reports for 2012 was 1.414. We are proud of this impact factor, which will certainly enhance international interest in the journal. Actually, the number of papers submitted to JAO has been drastically increasing during the last several years after obtaining the impact factor. From the beginning with Volume 1 in 1998 to the last issue (Volume 16) in 2013, we have received submissions from 30 countries in the world, and we have accepted a total of 742 papers for publication through the peer review process. Since 2006, we have been continuing to review
Y. Sawa Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
G. Matsumiya Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
E. Tatsumi T. Tsukiya Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
A. Myoui Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
K. Matsuda Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan e-mail: [email protected]
M. Nishimura Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
Introduction
K. Fukunaga Faculty of Health Sciences, Kyorin University, Tokyo, Japan
T. Nishimura Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
A. Kishida Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
T. Nishinaka Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
T. Masuzawa Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
E. Okamoto Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
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and summarize the articles published in JAO in the past 1 year to provide an overview for our readers [1–8]. We also reviewed and summarized the selected articles in volume 16 this year. In volume 16, we published 70 articles, amounting to 510 pages in total, including 49 original papers, 3 review papers, 13 case reports, 2 brief communications, and 3 technical forums. These papers were related to the many aspects of basic research, development, and clinical application of artificial organs, covering a variety of subfields. The yearly acceptance rate was 68.8 % last year. During the past year, a total of 135 reviewers who were specialists in artificial organs and interdisciplinary fields helped our authors to improve their manuscripts through thoughtful reviews, critiques, and suggestions. We are very happy to present such excellent work in JAO. We would like to express our profound gratitude to all authors, reviewers, and members from all over the world, and express the hope that you will continue to support our journal. Artificial heart (basic) Kimura et al. [9] evaluated LVAD’s impact on blood coagulation activities with a single-use MagLev centrifugal blood pump. The platelet aggregability was measured with a turbidimetric assay method during the preoperative, operative, and postoperative periods. A decrease in platelet aggregation immediately after the pump started was observed in the cases of successful long-term pump operation, while the absence of such a decrease might have caused coagulation-related complications to terminate the experiments. Yamane et al. [10] examined the hemocompatibility for the implantable ventricular assist device EVAHEARTÒ through flow visualization with a 300 % scale-up model. The absence of flow separations around the centrifugal vanes indicated that the curvature of the open vanes was suitable. The flow in the S. Tokunaga The Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan T. Tomo Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan Y. Yagi Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan T. Yamaoka Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan Journal of Artificial Organs Editorial Committee (&) Osaka, Japan e-mail: [email protected]
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vane-shaft clearance was found to effectively produce sufficient shear stresses along the stationary shaft surface. Umeki et al. [11] of the National Cerebral and Cardiovascular Center developed a novel controlling system of continuous-flow LVAD, Native Heart Load Control System (NHLCS), in which the rotational speed of LVAD could be changed in synchronization with the cardiac beat. The authors examined the changes of myocardial oxygen consumption (MVO2) in acute ischemic heart failure model created by coronary embolization using 14 goats, in which a centrifugal LVAD was installed and driven in four different control modes: ‘‘circuit-clamp’’, ‘‘continuous support’’, ‘‘counter-pulse’’, and ‘‘co-pulse’’. Compared to the continuous mode, MVO2 was significantly reduced in the counter-pulse mode and increased in the co-pulse mode. The authors concluded that the native heart load can be actively changed by the NHLCS, and the NHLCS may expedite the native heart recovery, especially in the patients with ischemic heart diseases. Kishimoto et al. [12] of the National Cerebral and Cardiovascular Center developed a novel ‘‘delayed copulse mode’’ in continuous flow LVAD control to prevent aortic insufficiency (AI), a serious complication in patients on long-term LVAD support. This mode provided minimal support for early systole and maximal support shortly after aortic valve opening by changing the rotational speed in synchronization with heartbeat. The authors examined the difference between the constant rotational speed mode with 100 % bypass and the delayed co-pulse mode with 90 % bypass in an animal model. A centrifugal LVAD was installed in 7 goats with normal hearts and subsequent acute LV dysfunction created by micro-embolization of the coronary artery. As results the total flow did not change between the two modes, and the aortic valve opened when the delayed co-pulse mode was activated. The authors concluded that the delayed co-pulse mode allowed the aortic valve to open while maintaining a high total flow and may prevent the AI in long-term LVAD support. Sumikura et al. [13] reported endurance test system for long-term continuous evaluation of ventricular assist devices (VADs). The endurance test system consisted of a pulsatile pump with a small closed chamber, a closed chamber, a reservoir, and an electromagnetic proportional valve. The test system can quantitatively reproduce various circulatory conditions and continuous operation for 6 months was performed successfully to evaluate the durability and stability. Ferrari et al. [14] constructed the circulatory model that included the computational circulatory model and the rotary blood pump model. They evaluated the influence of pump characteristics and cardiovascular parameters on hemodynamics in atrio-aortic VAD assistance, and results of the computational simulation showed that their computational circulatory model contributes to education and
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training as it permits to easily create realistic patho-physiological conditions.
Artificial heart (clinical) Fujita et al. [15] reported a successfully treated case with AI after continuous flow VAD implantation using aortic valve closure. They found fusion and shortening of the aortic leaflets during surgery. Direct aortic valve closure improved hemodynamics. They concluded that control of LVAD rotational speed is required to prevent AI. Imamura et al. [16] reported a case with persistent pulmonary hypertension (PH) after the implantation of a continuous-flow LVAD. They treated the case with the administration of an endothelin receptor antagonist, bosentan, and the pulmonary vascular resistance was significantly decreased. They concluded that the combination therapy with LVAD implantation and bosentan may be useful for patients with stage D heart failure complicated with severe PH. Saito et al. [17] reported a case in which thrombus formation around the pin-shaped bearing of the Jarvik 2000 biventricular assist device (BiVAD) caused massive hemolysis and pump failure. The BiVAD pumps were successfully converted to the new Jarvik 2000 BiVAD with conical bearings. Ushijima et al. [18] reported the conversion of an extracorporeal ventricular assist system (VAS), the NIPRO VAS, to an implantable LVAS, the EVAHEART LVAS in a patient diagnosed with secondary cardiomyopathy due to cardiac sarcoidosis. They emphasized that conversion to an implantable LVAS can be beneficial in carefully selected patients after ascertaining the operative indications and operation timing. Secondary PH often develops in patients with severe left heart dysfunction. Long-standing increases in post-capillary pressure may result in fixed PH due to histological changes in pulmonary vasculature. Sato et al. [19] described a case with very high pulmonary vascular resistance (15.9 Wood unit) that was initially considered contraindicated for heart transplantation. After aggressive medical treatment including dobutamine infusion, paracorporeal LVAS was implanted successfully. Right heart catheterization at 1 year after LVAS implantation demonstrated significant reduction of pulmonary vascular resistance down to 2.2 Wood unit. They suggested even extremely high pulmonary artery resistance over 15 Wood unit can decrease with proper medical management and LVAS implantation. Yoshioka et al. [20] reported the case of the successful removal of a DuraHeart LVAD. Before LVAD removal, they conducted a weaning test by decreasing pump speed and an additional normal saline infusion test. The patient’s
postoperative course was uneventful. They concluded that the continuous flow LVAD weaning test was found to be a substitute for the pulsatile LVAD off test. Prediction of reversibility of PH is important to determine eligibility for heart transplantation. Imamura et al. [21] reported a case with ‘‘out of proportion PH’’ who underwent step-wise acute pulmonary vasoreactivity test (APVT). Inhaled nitrogen monoxide (NO) alone did not decrease pulmonary artery pressure. Second test using combination of NO and inotrope infusion significantly decreased pulmonary artery pressure. No, however, worsened LV enlargement and dysfunction. Third test using combination of NO, inotropes, and phosphodiesterase-5 inhibitor, sildenafil, further decreased pulmonary vascular resistance and increased cardiac output. Dilatory effect of sildenafil on pulmonary vein and systemic vasculature may have resulted in the decrease of both pre- and after-load of left ventricle. They concluded that sildenafil is useful, safe, and effective for APVT and pretreatment before implantable LVAS treatment. Liver dysfunction often develops or worsens after LVAS implantation. Unremission of liver dysfunction results in early mortality. Nishi et al. [22] analyzed 101 patients who developed significant liver dysfunction (maximum total bilirubin level [5 mg dL) at early postoperative period. Twenty-eight percent of those patients did not recover from liver dysfunction. Multi-variate analyses demonstrated higher central venous pressure at early postoperative period as a significant risk factor. They suggested that appropriate management of postoperative liver congestion is a key to overcome postoperative liver dysfunction after LVAS implantation. Inoue et al. [23] reported a case of congenital heart disease, which had been on VAD for four years. The patient underwent Rastelli operation for congenital corrected transposition of great arteries and subsequently suffered right (systemic) ventricular failure. A paracorporeal VAD was successfully applied and the patient was awaiting heart transplantation for 4 years.
Cardiopulmonary bypass Hoashi et al. [24] investigated early clinical outcomes of a new extracorporeal life support system, Endumo 2000, in pediatric patients \1 year old. Their results showed the Endumo 2000 system provided safe and effective cardiopulmonary support without complications. Kondo et al. [25] developed a Kochi Medical School (KMS) type coronary perfusion cannula and compared it with two types of commercially available cannulae which have different distal tips.KMS had lower leakage, as well as lower perfusion pressure compared to the commercially available cannulae. They consider that KMS may be advantageous for safe infusion to the coronary ostium.
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Tokumine et al. [26] reports a highly reliable educational simulator for cardiopulmonary bypass. The preciseness of this simulator was proven through hybrid experiments using the actual software (ECCSIM) with the cardiopulmonary bypass system. This simulator is considered to be highly useful to educate potential users.
Artificial lung/ECMO Hayes et al. [27] reported a case of ambulatory V–V ECMO. The authors utilized a 23-Fr bicaval dual-lumen catheter as a blood access, which was placed via right jugular vein. With this method, the patient was able to sit upright for long periods of time and was mobile and ambulated for short distances, while on V–V ECMO.
Pacemaker Molfetta et al. [28] showed that the use of a newly developed methodology (Alg1) for AV and VV optimization improves cardiac resynchronization therapy clinical and echocardiographic (ECHO) outcomes. Tsukada et al. [29] reported the details of the nontraditional surgical procedure for the placement of a lead for an implantable cardioverter-defibrillator in a case without venous access into the heart; in a heterotaxy patient after the completion of total cavopulmonary connection.
Artificial valve Kouhi and Morsi [30] established a fine mathematical model of the stentless aortic heart valve to incorporate the sinus of valsalva, with validation results of the proposed model. The numerical model showed a rapid response of the leaflets to the transvalvular pressure where adequate values of stress are measured over the commissural lines. Tanoue et al. [31] demonstrated by measurement of LV contractility, afterload, and efficiency by use of transthoracic ECHO data in isolated AVR patient that improvements in LV contractility and efficiency after AVR can be expected for patients with low EF. However, contractility and efficiency did not improve after AVR for patients with AR and low EF. Low mortality and morbidity of AVR likely conceal a latent problem among patients with AR.
Biomaterials Takatori et al. [32] reported a prospective cohort study on the clinical safety of total hip replacement with poly(2-
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methacryloyloxyethyl phosphorylcholine)-grafted polyethylene liners. They recruited a prospective consecutive series of 80 patients in five participating hospitals. They proved that poly(MPC)-grafted particles are not recognized as foreign bodies by macrophages, and consequently, the wear particles produced from the poly(MPC)-grafted CLPE liners greatly reduced the risk of serious foreign body reaction. Furuzono et al. [33] reported carboxyl group-donated silver (CDT-Ag) nanoparticles as a coating material and its antibacterial activity. CDT-Ag nanoparticles were prepared using a two-phase reduction system. The antibacterial activity of CDT-Ag nanoparticles was evaluated in vitro using germ-negative bacteria, E. coli. Smaller size CDTAg nanoparticles of a mean diameter of 7 nm showed higher antibacterial activity. Fu et al. [34] compared the two types of sternal pins (Group A: Bioabsorbable poly-L-lactide PLLA, Group B; uncalcined hydroxyapatite and poly-L-lactide u-HA-PLLA) in terms of sternal stability and healing after median sternotomy. The u-HA-PLLA sternal pins exhibit certain osteoconductivity; however, both PLLA and u-HA-PLLA sternal pins provide comparable clinical outcomes regarding sternal stability and healing.
Tissue engineering/regenerative medicine Mizutani et al. [35] reported the new techniques for ligament regeneration. They used a highly oriented fiber scaffold made of elastin and collagen and a multiple-type dynamic culture system consisting of a combination of pressure and twist stimulation. Their results showed that the pressure stimulation and the elastin A addition upregulated the expression of alkaline phosphatase (ALP) and promoted the osteogenic differentiation of ligament cells. In addition, the twist stimulation upregulated the expression of type III collagen. Furthermore, the combination of pressure and twist stimulation promoted the expression of type III collagen and ALP protein depending on the portion of scaffold. Takewa et al. [36] of the National Cerebral and Cardiovascular Center developed autologous valved conduits (biovalves) with the sinus of Valsalva by in-body tissue engineering without any artificial support materials in an animal model. The biovalves were prepared by 2-month embedding of the molds composed of specially designed two different types of plastic rods in the subcutaneous spaces of goats. The feasibility of the biovalve was examined as an aortic valve in a goat model by implanting it in the specially designed apico-aortic bypass for 2 months (n = 3). Postoperative ECHO showed smooth movement of the leaflets with little regurgitation under
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systemic circulation (2.6 ± 1.1 L/min). Histological examination revealed preferable tissue regeneration in the biovalves. The authors concluded that the completely autologous biovalves with robust and elastic characteristics satisfied the higher requirements of the systemic circulation with the potential for valvular tissue regeneration. Hu¨lsmann et al. [37] reported a trial for preparing tissue engineered whole-heart. The cardiomyocyte seeding to acellular whole heart was pioneeingly reported by Ott et al. (Nature Medicine 2008). In the present paper, a novel customizable modular bioreactor system with medium perfusion, controlled 3D biomechanical stimulation, and a highly flexible operation platform based on LabVIEW was reported. Honda et al. [38] reported a combined therapy of concentrated growth factor (CGF) and bone marrow stromal cells. CGF is an autologous leukocyte-rich and platelet-rich fibrin biomaterials. They found that a CGF extract promoted the proliferation, osteogenic maturation, and mineralization of mesenchymal stem cells in vitro, and the combination therapy resulted in the excellent healing of critical-size bone defects in vivo.
Artificial kidney/dialysis Kanda et al. [39] reported that pentraxin 3 as a new biomarker of peritoneal injury. They get Serum, PE, and peritoneal specimens were obtained from 50 patients with end-stage kidney disease. They analyzed PTX3, high-sensitivity CRP, and MMP-2 and IL-6. Peritoneal effluent (PE) PTX3 level was significantly correlated with MMP-2 and IL-6 levels in PE, as well as the thickness of the submesothelial compact zone and the vasculopathy. They concluded that PTX3 may be a new biomarker of peritoneal inflammation and progressive fibrosis. Kitamura et al. [40] reported that vitamin E-bonded dialyzer decreases alpha (1) antitrypsin–LDL complex, an index of oxidative stress. 17 patients were enrolled in this study, were treated with conventional dialyzers during first 12 months, and then switched to vitamin E-bonded dialyzer. Alpha (1) antitrypsin–LDL complex had changed from 2.40 ± 0.50 to 1.48 ± 0.45 mg/mL, that of total cholesterol had changed from 188.2 ± 37.8 to 161.2 ± 30.2 mg/mL, and that of LDL cholesterol had changed from 103.0 ± 23.6 to 90.6 ± 18.6 mg/mL. They concluded that vitamin E-bonded dialyzer may be effective in reducing alpha (1) antitrypsin–LDL Complex as an oxidative stress marker. Sakurai et al. [41] compared pre dilution HDF and post dilution HDF with respect to their effects on blood cells. 5 patients were enrolled in this study. They evaluated interleukin (IL)-6, intercellular adhesion molecule (ICAM)-1,
and platelet-derived microparticles, and the phagocytotic and sterilizing functions of neutrophils before and after the sessions. The IL-6 and ICAM-1 concentrations decreased after predilution HDF, and increased after postdilution HDF. Lymphocyte blastoid transformation was more pronounced after predilution HDF than after postdilution HDF. They concluded that predilution HDF could be more favorable for dialysis patients than postdilution HDF in the effects on the neutrophils and lymphocytes.
Apheresis Kawaguchi et al. [42] investigated the efficacy of new adsorbents for removal of amyloid beta proteins, which are the main cause of Alzheimer’s disease. The device with C16-cellulose beads had high removal activity for amyloid beta proteins in humans. These adsorbents might be useful for Alzheimer’s disease therapy in future.
Artificial skin, muscle, bone/joint, neuron Giant congenital melanocytic nevi (GCMN) are difficult to remove completely because of the lack of available skin grafts for covering the resultant defects. Liem et al. [43] reported a method to produce reconstructed skin that was devoid of nevus cells by combining GCMN epidermal tissue with acellular dermal matrix (ADM) tissue derived from excised GCMN. They found that treating GCMN tissue with hypertonic saline (1 N NaCl) or 0.05 % trypsin was an appropriate decellularization method for producing ADM. Preparation can be done within 48 h; thus, this method may be applicable to cover the defect after removal of GCMN.
Others Sakata et al. [44] established a new bowel sound monitoring system with four sound sensors and a multichannel data logger. They investigated temporal changes in occurrence frequency of bowel sounds both in fasting state and after eating. The new bowel sound monitoring system might be useful for investigating the bowel activity in deciding the beginning of enteral nutrition in critically ill patients. Moriwaki et al. [45] observed variation in the local elastic distribution in aortic tissue walls by use of a scanning haptic microscope (SHM). SHM measurements were performed on canine thoracic aorta using a glass needle probe with a diameter of ca 5 lm. Under strain of 0–0.23, corresponding to internal pressure of 0–150 mmHg, wave-
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shaped elastin fibers stretched until they were almost straightened, and the average elastic modulus increased almost linearly. They found that the pressure resistance of the aorta under physiological strain was mainly afforded by elastin fibers; collagen fibrils contributed little except under much higher pressures. Zhong et al. [46] studied the possibility of testosterone secretion by proliferated Leydig cells embedded in Matrigel with the aim of developing a source of endogenous testosterone supplement for recipients while reducing the need for donor material. Leydig cells gradually formed aggregates when maintained in Matrigel and have a great steroidogenesis reserve. They contributed to continuous steroidogenesis, which implies that the pellet may provide the physiological demand for endogenous androgen once engrafted in vivo. This system may ultimately provide a novel alternative treatment for people who are in need of androgen replacement. Azuma and Iseki [47] reported on the current requirements for safety during medical device clinical trials in Japan. Based on their detailed analysis on the current status in Japan, and proposed introduction of Global Harmonization Task Force (GHTF) guidelines with some modifications to fit the current Japanese regulatory requirements. Kato et al. [48] studied Japanese major factors that impact device development using their trial simulation of VAD EVAHEART through interviews with the persons involved by creating a development model using system dynamics. They insisted that this study has a potential to clarify unclear relationships in the development of devices, which can help those who are considering developing medical devices as well as authorities that support the medical industry considering individual development policies, because the six stages of development shown in this manuscript can provide initial guidance on how to formulate their strategies. Sato et al. [49] conducted electrical stimulation of a sympathetic nerve fascicle to clarify the possibility of controlling peripheral glucose uptake. A sympathetic signal was microneurographically obtained in the unilateral sciatic nerve of rats and electrical stimulation was applied via the microelectrode. This report suggests that microstimulation in the peripheral sympathetic fascicle can enhance glucose uptake in peripheral tissues and shows an alternative possibility for controlling glucose uptake. Fukunaga et al. [50] developed a novel viscometer that can measure blood viscosity by applying the electromagnetically spinning method. They verified its performance by measurement of viscosity of non-Newtonian bovine blood, and they were able to measure decrease of viscosity with increasing shear rate. From results, the EMS viscometer would be a useful tool to measure blood viscosity in the clinical cite.
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Saito et al. [51] reported on the effect of hemoglobin vesicle on renal function in the animal models with moderate hemorrhagic shock. They focused on the possibility of adverse effect of hemoglobin transfusion. They carried out well-controlled animal experiments and demonstrated that resuscitation with hemoglobin vesicle transfusion showed equivalent performance on recovery of renal functions.
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patient after the completion of total cavopulmonary connection. J Artif Organs. 2013;16:495–7. Kouhi E, Morsi YS. A parametric study on mathematical formulation and geometrical construction of a stentless aortic heart valve. J Artif Organs. 2013;16:425–42. Tanoue Y, Oishi Y, Sonoda H, Nishida T, Nakashima A, Tominaga R. Left ventricular performance after aortic valve replacement in patients with low ejection fraction. J Artif Organs. 2013;16:443–50. Takatori Y, Moro T, Kamogawa M, Oda H, Morimoto S, Umeyama T, Minami M, Sugimoto H, Nakamura S, Karita T, Kim J, Koyama Y, Ito H, Kawaguchi H, Nakamura K. Poly(2methacryloyloxyethyl phosphorylcholine)-grafted highly crosslinked polyethylene liner in primary total hip replacement: oneyear results of a prospective cohort study. J Artif Organs. 2013;16:170–5. Furuzono T, Iwamoto T, Azuma Y, Okada M, Sawa Y. Preparation of carboxylated Ag nanoparticles as a coating material for medical devices and control of antibacterial activity. J Artif Organs. 2013;16:451–7. Fu X, Oshima H, Araki Y, Narita Y, Mutsuga M, Okada N, Tsunekawa T, Usui A. A comparative study of two types of sternal pins used for sternal closure: poly-L-lactide sternal pins versus uncalcined hydroxyapatite poly-L-lactide sternal pins. J Artif Organs. 2013;16:458–63. Mizutani N, Kawato H, Maeda Y, Takebayashi T, Miyamoto K, Horiuchi T. Multiple-type dynamic culture of highly oriented fiber scaffold for ligament regeneration. J Artif Organs. 2013;16:49–58. Takewa Y, Yamanami M, Kishimoto Y, Arakawa M, Kanda K, Matsui Y, Oie T, Ishibashi-Ueda H, Tajikawa T, Ohba K, Yaku H, Taenaka Y, Tatsumi E, Nakayama Y. In vivo evaluation of an in-body, tissue-engineered, completely autologous valved conduit (biovalve type VI) as an aortic valve in a goat model. J Artif Organs. 2013;16:176–84. Hu¨lsmann J, Aubin H, Kranz A, Godehardt E, Munakata H, Kamiya H, Barth M, Lichtenberg A, Akhyari P. A novel customizable modular bioreactor system for whole-heart cultivation under controlled 3D biomechanical stimulation. J Artif Organs. 2013;16:294–304. Honda H, Tamai N, Naka N, Yoshikawa H, Myoui A. Bone tissue engineering with bone marrow-derived stromal cells integrated with concentrated growth factor in Rattus norvegicus calvaria defect model. J Artif Organs. 2013;16:305–15. Kanda R, Hamada C, Kaneko K, Nakano T, Wakabayashi K, Io H, Horikoshi S, Tomino Y. Pentraxin 3 as a new biomarker of peritoneal injury in peritoneal dialysis patients. J Artif Organs. 2013;16:66–73. Kitamura Y, Kamimura K, Yoshioka N, Hosotani Y, Tsuchida K, Koremoto M, Minakuchi J. The effect of vitamin E-bonded polysulfone membrane dialyzer on a new oxidative lipid marker. J Artif Organs. 2013;16:206–10. Sakurai K, Saito T, Yamauchi F, Asahi D, Hosoya H. Comparison of the effects of predilution and postdilution hemodiafiltration on neutrophils, lymphocytes and platelets. J Artif Organs. 2013;16:316–21. Kawaguchi K, Takeuchi M, Yamagawa H, Murakami K, Nakai S, Hori H, Ohashi A, Hiki Y, Suzuki N, Sugiyama S, Yuzawa Y, Kitaguchi N. A potential therapeutic system for Alzheimer’s disease using adsorbents with alkyl ligands for removal of blood amyloid b. J Artif Organs. 2013;16:211–7. Liem PH, Morimoto N, Ito R, Kawai K, Suzuki S. Autologous skin reconstruction by combining epidermis and acellular dermal matrix tissue derived from the skin of giant congenital melanocytic nevi. J Artif Organs. 2013;16:332–42.
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J Artif Organs 44. Sakata O, Suzuki Y, Matsuda K, Satake T. Temporal changes in occurrence frequency of bowel sounds both in fasting state and after eating. J Artif Organs. 2013;16:83–90. 45. Moriwaki T, Oie T, Takamizawa K, Murayama Y, Fukuda T, Omata S, Nakayama Y. Observation of local elastic distribution in aortic tissues under static strain condition by use of a scanning haptic microscope. J Artif Organs. 2013;16:91–7. 46. Zhong L, Sun J, Liu G, Zhu Y, Zhu J. Research on the steroidogenesis of proliferated Leydig cells in vitro. J Artif Organs. 2013;16:229–33. 47. Azuma K, Iseki H. Analysis of safety reporting requirements during medical device clinical trials in Japan. J Artif Organs. 2013;16:234–41. 48. Kato T, Umezu M, Iwasaki K, Kasanuki H, Takahashi Y. Preliminary study on the development of a system dynamics model: the case of EVAHEART. J Artif Organs. 2013;16:242–7.
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49. Sato D, Shinzawa G, Kusunoki M, Matsui T, Sasaki H, Feng Z, Nishina A, Nakamura T. Effects of electrical microstimulation of peripheral sympathetic nervous fascicle on glucose uptake in rats. J Artif Organs. 2013;16:352–8. 50. Fukunaga K, Onuki M, Ohtsuka Y, Hirano T, Sakai K, Ohgoe Y, Katoh A, Yaguchi T, Funakubo A, Fukui Y. Blood viscometer applying electromagnetically spinning method. J Artif Organs. 2013;16:359–67. 51. Saito Y, Suzuki Y, Yamanashi Y, Terajima K, Sakamoto A, Kondo Y. The impact on renal function of fluid resuscitation with hemoglobin vesicle solution in moderate hemorrhagic shock. J Artif Organs. 2013;16:376–81.
REVIEW
Journal of Artificial Organs 2013: the year in review Journal of Artificial Organs Editorial Committee
Received: 28 January 2014 Ó The Japanese Society for Artificial Organs 2014
Members of the Editorial Committee of the Journal of Artificial Organs (JAO) are pleased to introduce to colleagues worldwide through the publication of JAO a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to practical development and clinical applications. The JAO, an international journal with articles published in English, is the official journal of the Japanese Society for Artificial Organs. We believe that JAO has a very high potential for promoting interest in the field of artificial organs not only in Japan but also in other parts of the world. We are also
convinced that the specialization, originality, and level of science of this journal are at the highest in the field. The impact factor announced in the Journal Citation Reports for 2012 was 1.414. We are proud of this impact factor, which will certainly enhance international interest in the journal. Actually, the number of papers submitted to JAO has been drastically increasing during the last several years after obtaining the impact factor. From the beginning with Volume 1 in 1998 to the last issue (Volume 16) in 2013, we have received submissions from 30 countries in the world, and we have accepted a total of 742 papers for publication through the peer review process. Since 2006, we have been continuing to review
Y. Sawa Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
G. Matsumiya Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
E. Tatsumi T. Tsukiya Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
A. Myoui Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
K. Matsuda Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan e-mail: [email protected]
M. Nishimura Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
Introduction
K. Fukunaga Faculty of Health Sciences, Kyorin University, Tokyo, Japan
T. Nishimura Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
A. Kishida Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
T. Nishinaka Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
T. Masuzawa Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
E. Okamoto Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
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and summarize the articles published in JAO in the past 1 year to provide an overview for our readers [1–8]. We also reviewed and summarized the selected articles in volume 16 this year. In volume 16, we published 70 articles, amounting to 510 pages in total, including 49 original papers, 3 review papers, 13 case reports, 2 brief communications, and 3 technical forums. These papers were related to the many aspects of basic research, development, and clinical application of artificial organs, covering a variety of subfields. The yearly acceptance rate was 68.8 % last year. During the past year, a total of 135 reviewers who were specialists in artificial organs and interdisciplinary fields helped our authors to improve their manuscripts through thoughtful reviews, critiques, and suggestions. We are very happy to present such excellent work in JAO. We would like to express our profound gratitude to all authors, reviewers, and members from all over the world, and express the hope that you will continue to support our journal. Artificial heart (basic) Kimura et al. [9] evaluated LVAD’s impact on blood coagulation activities with a single-use MagLev centrifugal blood pump. The platelet aggregability was measured with a turbidimetric assay method during the preoperative, operative, and postoperative periods. A decrease in platelet aggregation immediately after the pump started was observed in the cases of successful long-term pump operation, while the absence of such a decrease might have caused coagulation-related complications to terminate the experiments. Yamane et al. [10] examined the hemocompatibility for the implantable ventricular assist device EVAHEARTÒ through flow visualization with a 300 % scale-up model. The absence of flow separations around the centrifugal vanes indicated that the curvature of the open vanes was suitable. The flow in the S. Tokunaga The Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan T. Tomo Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan Y. Yagi Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan T. Yamaoka Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan Journal of Artificial Organs Editorial Committee (&) Osaka, Japan e-mail: [email protected]
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vane-shaft clearance was found to effectively produce sufficient shear stresses along the stationary shaft surface. Umeki et al. [11] of the National Cerebral and Cardiovascular Center developed a novel controlling system of continuous-flow LVAD, Native Heart Load Control System (NHLCS), in which the rotational speed of LVAD could be changed in synchronization with the cardiac beat. The authors examined the changes of myocardial oxygen consumption (MVO2) in acute ischemic heart failure model created by coronary embolization using 14 goats, in which a centrifugal LVAD was installed and driven in four different control modes: ‘‘circuit-clamp’’, ‘‘continuous support’’, ‘‘counter-pulse’’, and ‘‘co-pulse’’. Compared to the continuous mode, MVO2 was significantly reduced in the counter-pulse mode and increased in the co-pulse mode. The authors concluded that the native heart load can be actively changed by the NHLCS, and the NHLCS may expedite the native heart recovery, especially in the patients with ischemic heart diseases. Kishimoto et al. [12] of the National Cerebral and Cardiovascular Center developed a novel ‘‘delayed copulse mode’’ in continuous flow LVAD control to prevent aortic insufficiency (AI), a serious complication in patients on long-term LVAD support. This mode provided minimal support for early systole and maximal support shortly after aortic valve opening by changing the rotational speed in synchronization with heartbeat. The authors examined the difference between the constant rotational speed mode with 100 % bypass and the delayed co-pulse mode with 90 % bypass in an animal model. A centrifugal LVAD was installed in 7 goats with normal hearts and subsequent acute LV dysfunction created by micro-embolization of the coronary artery. As results the total flow did not change between the two modes, and the aortic valve opened when the delayed co-pulse mode was activated. The authors concluded that the delayed co-pulse mode allowed the aortic valve to open while maintaining a high total flow and may prevent the AI in long-term LVAD support. Sumikura et al. [13] reported endurance test system for long-term continuous evaluation of ventricular assist devices (VADs). The endurance test system consisted of a pulsatile pump with a small closed chamber, a closed chamber, a reservoir, and an electromagnetic proportional valve. The test system can quantitatively reproduce various circulatory conditions and continuous operation for 6 months was performed successfully to evaluate the durability and stability. Ferrari et al. [14] constructed the circulatory model that included the computational circulatory model and the rotary blood pump model. They evaluated the influence of pump characteristics and cardiovascular parameters on hemodynamics in atrio-aortic VAD assistance, and results of the computational simulation showed that their computational circulatory model contributes to education and
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training as it permits to easily create realistic patho-physiological conditions.
Artificial heart (clinical) Fujita et al. [15] reported a successfully treated case with AI after continuous flow VAD implantation using aortic valve closure. They found fusion and shortening of the aortic leaflets during surgery. Direct aortic valve closure improved hemodynamics. They concluded that control of LVAD rotational speed is required to prevent AI. Imamura et al. [16] reported a case with persistent pulmonary hypertension (PH) after the implantation of a continuous-flow LVAD. They treated the case with the administration of an endothelin receptor antagonist, bosentan, and the pulmonary vascular resistance was significantly decreased. They concluded that the combination therapy with LVAD implantation and bosentan may be useful for patients with stage D heart failure complicated with severe PH. Saito et al. [17] reported a case in which thrombus formation around the pin-shaped bearing of the Jarvik 2000 biventricular assist device (BiVAD) caused massive hemolysis and pump failure. The BiVAD pumps were successfully converted to the new Jarvik 2000 BiVAD with conical bearings. Ushijima et al. [18] reported the conversion of an extracorporeal ventricular assist system (VAS), the NIPRO VAS, to an implantable LVAS, the EVAHEART LVAS in a patient diagnosed with secondary cardiomyopathy due to cardiac sarcoidosis. They emphasized that conversion to an implantable LVAS can be beneficial in carefully selected patients after ascertaining the operative indications and operation timing. Secondary PH often develops in patients with severe left heart dysfunction. Long-standing increases in post-capillary pressure may result in fixed PH due to histological changes in pulmonary vasculature. Sato et al. [19] described a case with very high pulmonary vascular resistance (15.9 Wood unit) that was initially considered contraindicated for heart transplantation. After aggressive medical treatment including dobutamine infusion, paracorporeal LVAS was implanted successfully. Right heart catheterization at 1 year after LVAS implantation demonstrated significant reduction of pulmonary vascular resistance down to 2.2 Wood unit. They suggested even extremely high pulmonary artery resistance over 15 Wood unit can decrease with proper medical management and LVAS implantation. Yoshioka et al. [20] reported the case of the successful removal of a DuraHeart LVAD. Before LVAD removal, they conducted a weaning test by decreasing pump speed and an additional normal saline infusion test. The patient’s
postoperative course was uneventful. They concluded that the continuous flow LVAD weaning test was found to be a substitute for the pulsatile LVAD off test. Prediction of reversibility of PH is important to determine eligibility for heart transplantation. Imamura et al. [21] reported a case with ‘‘out of proportion PH’’ who underwent step-wise acute pulmonary vasoreactivity test (APVT). Inhaled nitrogen monoxide (NO) alone did not decrease pulmonary artery pressure. Second test using combination of NO and inotrope infusion significantly decreased pulmonary artery pressure. No, however, worsened LV enlargement and dysfunction. Third test using combination of NO, inotropes, and phosphodiesterase-5 inhibitor, sildenafil, further decreased pulmonary vascular resistance and increased cardiac output. Dilatory effect of sildenafil on pulmonary vein and systemic vasculature may have resulted in the decrease of both pre- and after-load of left ventricle. They concluded that sildenafil is useful, safe, and effective for APVT and pretreatment before implantable LVAS treatment. Liver dysfunction often develops or worsens after LVAS implantation. Unremission of liver dysfunction results in early mortality. Nishi et al. [22] analyzed 101 patients who developed significant liver dysfunction (maximum total bilirubin level [5 mg dL) at early postoperative period. Twenty-eight percent of those patients did not recover from liver dysfunction. Multi-variate analyses demonstrated higher central venous pressure at early postoperative period as a significant risk factor. They suggested that appropriate management of postoperative liver congestion is a key to overcome postoperative liver dysfunction after LVAS implantation. Inoue et al. [23] reported a case of congenital heart disease, which had been on VAD for four years. The patient underwent Rastelli operation for congenital corrected transposition of great arteries and subsequently suffered right (systemic) ventricular failure. A paracorporeal VAD was successfully applied and the patient was awaiting heart transplantation for 4 years.
Cardiopulmonary bypass Hoashi et al. [24] investigated early clinical outcomes of a new extracorporeal life support system, Endumo 2000, in pediatric patients \1 year old. Their results showed the Endumo 2000 system provided safe and effective cardiopulmonary support without complications. Kondo et al. [25] developed a Kochi Medical School (KMS) type coronary perfusion cannula and compared it with two types of commercially available cannulae which have different distal tips.KMS had lower leakage, as well as lower perfusion pressure compared to the commercially available cannulae. They consider that KMS may be advantageous for safe infusion to the coronary ostium.
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Tokumine et al. [26] reports a highly reliable educational simulator for cardiopulmonary bypass. The preciseness of this simulator was proven through hybrid experiments using the actual software (ECCSIM) with the cardiopulmonary bypass system. This simulator is considered to be highly useful to educate potential users.
Artificial lung/ECMO Hayes et al. [27] reported a case of ambulatory V–V ECMO. The authors utilized a 23-Fr bicaval dual-lumen catheter as a blood access, which was placed via right jugular vein. With this method, the patient was able to sit upright for long periods of time and was mobile and ambulated for short distances, while on V–V ECMO.
Pacemaker Molfetta et al. [28] showed that the use of a newly developed methodology (Alg1) for AV and VV optimization improves cardiac resynchronization therapy clinical and echocardiographic (ECHO) outcomes. Tsukada et al. [29] reported the details of the nontraditional surgical procedure for the placement of a lead for an implantable cardioverter-defibrillator in a case without venous access into the heart; in a heterotaxy patient after the completion of total cavopulmonary connection.
Artificial valve Kouhi and Morsi [30] established a fine mathematical model of the stentless aortic heart valve to incorporate the sinus of valsalva, with validation results of the proposed model. The numerical model showed a rapid response of the leaflets to the transvalvular pressure where adequate values of stress are measured over the commissural lines. Tanoue et al. [31] demonstrated by measurement of LV contractility, afterload, and efficiency by use of transthoracic ECHO data in isolated AVR patient that improvements in LV contractility and efficiency after AVR can be expected for patients with low EF. However, contractility and efficiency did not improve after AVR for patients with AR and low EF. Low mortality and morbidity of AVR likely conceal a latent problem among patients with AR.
Biomaterials Takatori et al. [32] reported a prospective cohort study on the clinical safety of total hip replacement with poly(2-
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methacryloyloxyethyl phosphorylcholine)-grafted polyethylene liners. They recruited a prospective consecutive series of 80 patients in five participating hospitals. They proved that poly(MPC)-grafted particles are not recognized as foreign bodies by macrophages, and consequently, the wear particles produced from the poly(MPC)-grafted CLPE liners greatly reduced the risk of serious foreign body reaction. Furuzono et al. [33] reported carboxyl group-donated silver (CDT-Ag) nanoparticles as a coating material and its antibacterial activity. CDT-Ag nanoparticles were prepared using a two-phase reduction system. The antibacterial activity of CDT-Ag nanoparticles was evaluated in vitro using germ-negative bacteria, E. coli. Smaller size CDTAg nanoparticles of a mean diameter of 7 nm showed higher antibacterial activity. Fu et al. [34] compared the two types of sternal pins (Group A: Bioabsorbable poly-L-lactide PLLA, Group B; uncalcined hydroxyapatite and poly-L-lactide u-HA-PLLA) in terms of sternal stability and healing after median sternotomy. The u-HA-PLLA sternal pins exhibit certain osteoconductivity; however, both PLLA and u-HA-PLLA sternal pins provide comparable clinical outcomes regarding sternal stability and healing.
Tissue engineering/regenerative medicine Mizutani et al. [35] reported the new techniques for ligament regeneration. They used a highly oriented fiber scaffold made of elastin and collagen and a multiple-type dynamic culture system consisting of a combination of pressure and twist stimulation. Their results showed that the pressure stimulation and the elastin A addition upregulated the expression of alkaline phosphatase (ALP) and promoted the osteogenic differentiation of ligament cells. In addition, the twist stimulation upregulated the expression of type III collagen. Furthermore, the combination of pressure and twist stimulation promoted the expression of type III collagen and ALP protein depending on the portion of scaffold. Takewa et al. [36] of the National Cerebral and Cardiovascular Center developed autologous valved conduits (biovalves) with the sinus of Valsalva by in-body tissue engineering without any artificial support materials in an animal model. The biovalves were prepared by 2-month embedding of the molds composed of specially designed two different types of plastic rods in the subcutaneous spaces of goats. The feasibility of the biovalve was examined as an aortic valve in a goat model by implanting it in the specially designed apico-aortic bypass for 2 months (n = 3). Postoperative ECHO showed smooth movement of the leaflets with little regurgitation under
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systemic circulation (2.6 ± 1.1 L/min). Histological examination revealed preferable tissue regeneration in the biovalves. The authors concluded that the completely autologous biovalves with robust and elastic characteristics satisfied the higher requirements of the systemic circulation with the potential for valvular tissue regeneration. Hu¨lsmann et al. [37] reported a trial for preparing tissue engineered whole-heart. The cardiomyocyte seeding to acellular whole heart was pioneeingly reported by Ott et al. (Nature Medicine 2008). In the present paper, a novel customizable modular bioreactor system with medium perfusion, controlled 3D biomechanical stimulation, and a highly flexible operation platform based on LabVIEW was reported. Honda et al. [38] reported a combined therapy of concentrated growth factor (CGF) and bone marrow stromal cells. CGF is an autologous leukocyte-rich and platelet-rich fibrin biomaterials. They found that a CGF extract promoted the proliferation, osteogenic maturation, and mineralization of mesenchymal stem cells in vitro, and the combination therapy resulted in the excellent healing of critical-size bone defects in vivo.
Artificial kidney/dialysis Kanda et al. [39] reported that pentraxin 3 as a new biomarker of peritoneal injury. They get Serum, PE, and peritoneal specimens were obtained from 50 patients with end-stage kidney disease. They analyzed PTX3, high-sensitivity CRP, and MMP-2 and IL-6. Peritoneal effluent (PE) PTX3 level was significantly correlated with MMP-2 and IL-6 levels in PE, as well as the thickness of the submesothelial compact zone and the vasculopathy. They concluded that PTX3 may be a new biomarker of peritoneal inflammation and progressive fibrosis. Kitamura et al. [40] reported that vitamin E-bonded dialyzer decreases alpha (1) antitrypsin–LDL complex, an index of oxidative stress. 17 patients were enrolled in this study, were treated with conventional dialyzers during first 12 months, and then switched to vitamin E-bonded dialyzer. Alpha (1) antitrypsin–LDL complex had changed from 2.40 ± 0.50 to 1.48 ± 0.45 mg/mL, that of total cholesterol had changed from 188.2 ± 37.8 to 161.2 ± 30.2 mg/mL, and that of LDL cholesterol had changed from 103.0 ± 23.6 to 90.6 ± 18.6 mg/mL. They concluded that vitamin E-bonded dialyzer may be effective in reducing alpha (1) antitrypsin–LDL Complex as an oxidative stress marker. Sakurai et al. [41] compared pre dilution HDF and post dilution HDF with respect to their effects on blood cells. 5 patients were enrolled in this study. They evaluated interleukin (IL)-6, intercellular adhesion molecule (ICAM)-1,
and platelet-derived microparticles, and the phagocytotic and sterilizing functions of neutrophils before and after the sessions. The IL-6 and ICAM-1 concentrations decreased after predilution HDF, and increased after postdilution HDF. Lymphocyte blastoid transformation was more pronounced after predilution HDF than after postdilution HDF. They concluded that predilution HDF could be more favorable for dialysis patients than postdilution HDF in the effects on the neutrophils and lymphocytes.
Apheresis Kawaguchi et al. [42] investigated the efficacy of new adsorbents for removal of amyloid beta proteins, which are the main cause of Alzheimer’s disease. The device with C16-cellulose beads had high removal activity for amyloid beta proteins in humans. These adsorbents might be useful for Alzheimer’s disease therapy in future.
Artificial skin, muscle, bone/joint, neuron Giant congenital melanocytic nevi (GCMN) are difficult to remove completely because of the lack of available skin grafts for covering the resultant defects. Liem et al. [43] reported a method to produce reconstructed skin that was devoid of nevus cells by combining GCMN epidermal tissue with acellular dermal matrix (ADM) tissue derived from excised GCMN. They found that treating GCMN tissue with hypertonic saline (1 N NaCl) or 0.05 % trypsin was an appropriate decellularization method for producing ADM. Preparation can be done within 48 h; thus, this method may be applicable to cover the defect after removal of GCMN.
Others Sakata et al. [44] established a new bowel sound monitoring system with four sound sensors and a multichannel data logger. They investigated temporal changes in occurrence frequency of bowel sounds both in fasting state and after eating. The new bowel sound monitoring system might be useful for investigating the bowel activity in deciding the beginning of enteral nutrition in critically ill patients. Moriwaki et al. [45] observed variation in the local elastic distribution in aortic tissue walls by use of a scanning haptic microscope (SHM). SHM measurements were performed on canine thoracic aorta using a glass needle probe with a diameter of ca 5 lm. Under strain of 0–0.23, corresponding to internal pressure of 0–150 mmHg, wave-
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shaped elastin fibers stretched until they were almost straightened, and the average elastic modulus increased almost linearly. They found that the pressure resistance of the aorta under physiological strain was mainly afforded by elastin fibers; collagen fibrils contributed little except under much higher pressures. Zhong et al. [46] studied the possibility of testosterone secretion by proliferated Leydig cells embedded in Matrigel with the aim of developing a source of endogenous testosterone supplement for recipients while reducing the need for donor material. Leydig cells gradually formed aggregates when maintained in Matrigel and have a great steroidogenesis reserve. They contributed to continuous steroidogenesis, which implies that the pellet may provide the physiological demand for endogenous androgen once engrafted in vivo. This system may ultimately provide a novel alternative treatment for people who are in need of androgen replacement. Azuma and Iseki [47] reported on the current requirements for safety during medical device clinical trials in Japan. Based on their detailed analysis on the current status in Japan, and proposed introduction of Global Harmonization Task Force (GHTF) guidelines with some modifications to fit the current Japanese regulatory requirements. Kato et al. [48] studied Japanese major factors that impact device development using their trial simulation of VAD EVAHEART through interviews with the persons involved by creating a development model using system dynamics. They insisted that this study has a potential to clarify unclear relationships in the development of devices, which can help those who are considering developing medical devices as well as authorities that support the medical industry considering individual development policies, because the six stages of development shown in this manuscript can provide initial guidance on how to formulate their strategies. Sato et al. [49] conducted electrical stimulation of a sympathetic nerve fascicle to clarify the possibility of controlling peripheral glucose uptake. A sympathetic signal was microneurographically obtained in the unilateral sciatic nerve of rats and electrical stimulation was applied via the microelectrode. This report suggests that microstimulation in the peripheral sympathetic fascicle can enhance glucose uptake in peripheral tissues and shows an alternative possibility for controlling glucose uptake. Fukunaga et al. [50] developed a novel viscometer that can measure blood viscosity by applying the electromagnetically spinning method. They verified its performance by measurement of viscosity of non-Newtonian bovine blood, and they were able to measure decrease of viscosity with increasing shear rate. From results, the EMS viscometer would be a useful tool to measure blood viscosity in the clinical cite.
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Saito et al. [51] reported on the effect of hemoglobin vesicle on renal function in the animal models with moderate hemorrhagic shock. They focused on the possibility of adverse effect of hemoglobin transfusion. They carried out well-controlled animal experiments and demonstrated that resuscitation with hemoglobin vesicle transfusion showed equivalent performance on recovery of renal functions.
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