bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of Format and Design in Print Patient Information
Authors: Frost Marlene Hanson , Thompson Romayne , Thiemann Kay Boeding
Published: March 2003

PURPOSE: The purposes of this descriptive study were to: identify characteristics of print education materials that healthcare providers report as important to patients; compare whether Physician Data Query (PDQ) information that was provided in its original form, or was redesigned in color and black and white, influenced the distribution of this information; and explore whether providing PDQ information via patient information racks would increase patients' awareness of and use of PDQ information.

DESCRIPTION OF STUDY: Forty‐four oncology healthcare professionals were asked to complete a survey identifying characteristics that they believed important for effective print educational materials. PDQ statements were reformatted and placed in brochure racks for a 6‐month period. The number of statements distributed before and after this time period were compared. Subsequently, PDQ statements were placed sequentially for a 3‐week period in brochure racks in the following formats: original form as printed from the computer, redesigned with color print; and redesigned with black ink only.

RESULTS: The following characteristics were rated “very important” aspects of print educational materials by oncology healthcare professionals: appropriate reading level; clarity; credibility of the information; whether information is current/up‐to‐date; and patient acceptance of material. The characteristic receiving the fewest “very important” marks was attractiveness/eye appeal. The reported low marks on attractiveness/eye appeal contradict the concurrent findings that, after the redesign of PDQ statements (change in booklet size, use of color, increase in foot size for text and headings, and inclusion of a vertical bar to separate columns), there was a ninefold increase in the number PDQ statements distributed. Eighty‐nine percent of the statements distributed were the redesigned version. The use of color, however, did not appear to make a difference in the number of PDQ statements disseminated after the redesign.

CLINICAL IMPLICATIONS: In developing print education materials for cancer patients, the format, design, and placement of materials for patient access need to be considered. There are many valuable educational materials available on computer databases. Downloading the information and placing it in a brochure format may be an ideal approach for providing access to this information. Furthermore, because physicians and nurses have different priorities for printed patient education materials, it is important to involve both groups in the developments of the brochures.
Self‐Advocacy Training for Cancer Survivors
Authors: Walsh‐Burke Katherine , Marcusen Carol
Published: March 2003

objectives: With the advent of managed healthcare, self‐advocacy has been identified as an essential skill for cancer survivors. This article describes a self‐advocacy training program, the Cancer Survival Toolbox, developed through a unique collaborative effort by the National Coalition for Cancer Survivorship, the Association of Oncology Social Work, and the Oncology Nursing Society.

materials and methods: Self‐advocacy training is provided in audiotape format, as well as through the Internet and in interactive groups. The need for this training was established through surveys completed by 569 cancer survivors and 833 oncology professionals. Essential skills were identified through a literature review, and the content of the training was pilot tested with bicoastal groups of cancer survivors and with feedback from representatives of 15 national cancer organizations.

results: While the majority of the 569 respondents to the survivor survey were highly educated and between the ages of 31 and 60 years, fewer than half reported that when they first received a diagnosis of cancer they were able to communicate their needs effectively, had the skills necessary to make decisions, or were able to negotiate with healthcare providers, insurers, and employers. Results of the survey of professional oncology nurses and social workers also supported the need for self‐advocacy training. Fewer than one third of the 833 respondents to the professional survey reported that their patients who had received new diagnoses of cancer had essential self‐advocacy skills.

conclusions: This self‐advocacy training program is currently available on audiotape in English and Spanish. It is available in print in Chinese on the Internet. Data from the pilot groups indicate the program effectively addresses the self‐advocacy skills of communication, information seeking, problem solving, decision making, and negotiating. Data are currently being collected to assess the efficacy of the audiotape format and the impact of the training on survivors and professionals. Future plans include training oncology professionals to teach these skills and to work collaboratively with survivors in advocacy efforts. Additional programs designed to address the needs of the uninsured as well as older adult and pediatric survivor populations are in development.
Training Oncology Camp Volunteers
Authors: Beder Joan
Published: March 2003

Purpose: This article examines the training of oncology camp volunteers using a developmental and strengths perspective as a theoretical orientation. The literature on oncology camping, both empirical and anecdotal, is examined and relevant studies cited.

Overview: The selection of volunteers, the benefits of the oncology camp experience, and a training model are discussed. It is the contention of the author that camp volunteers need an orientation for working with the campers, one that incorporates both a developmental framework and a perspective that highlights capacity and strength. Both orientations are explored, and their applications are highlighted.

Clinical implications: The training of volunteers is a critical aspect of the oncology camp. In almost all oncology camps, volunteers form the staff complement. As such, their training and orientation to the campers is central to the summer experience for campers, volunteers, and staff. Administrators and camp directors are urged to incorporate some of the suggestions offered in this report to help ensure a positive summer experience.
Abnormal Mammogram Follow‐up
Authors: Ell Kathleen , Padgett Deborah , Vourlekis Betsy , Nissly Jan , Pineda Diana , Sarabia Olga , Walther Virginia , Blumenfield Susan , Lee Pey‐Jiuan
Published: March 2003

purpose: The purpose of this study was to test an intervention (the Screening Adherence Follow‐up Program [SAFe]) that was designed to reduce the number of known barriers to diagnostic follow‐up adherence and initiation of treatment among women with low incomes who had abnormal mammogram findings.

description of program: The investigators developed and implemented a highly structured, theory‐ and evidence‐based intervention that combined health education, counseling, and systems navigation, which was delivered by a team consisting of a peer counselor and a social worker who held a masters degree. A scripted baseline telephone interview identified potential barriers to follow‐up adherence and provided counseling interventions for each patient. Patients were assigned to different service intensities based on the level of risk for nonadherence. Patients with significant mental health symptoms, psychosocial stressors, or who had received a diagnosis of cancer were referred to the team social worker for further assessment and intervention. Patients also received reinforcing telephone follow‐up calls at 6 and 12 months.

results: An observational pilot study of SAFe (N = 605) in two large urban diagnostic centers showed that 71% of women receiving SAFe were Hispanic, 18% were Black, and 11% were from other ethnic backgrounds. Adherence rates through diagnostic resolution and the initiation of treatment for women who had received a diagnosis of cancer were 93% and 90%, respectively, at the two study sites. Rates of adherence among women who could not be located or who refused study consent were significantly lower (72% and 69%, respectively). The rate of timely adherence was also higher among the women served. Patient satisfaction with SAFe was generally high.

clinical implications: Study results support the combining of interventions and the practical utility of a clinical decision‐making algorithm to determine individualized nonadherence risk and to assign service intensity based on individual need. Problems in locating women for enrollment were experienced.
Characterization of MADS genes in the gymnosperm Gnetum parvifolium and its implication on the evolution of reproductive organs in seed plants
Authors: Shindo Satomi , Ito Motomi , Ueda Kunihiko , Kato Masahiro , Hasebe Mitsuyasu
Published: March 2003

SUMMARY Gnetales, one of the extant gymnosperm orders, has traditionally been recognized to be most closely related to flowering plants, because the reproductive organ of Gnetales has some morphological characteristics similar to flowering plants. Most recent molecular phylogenetic studies do not support the sister relationship of the Gnetales and flowering plants, but instead support a close relationship between Gnetales and other extant gymnosperms. The MADS genes are transcription factors, some of which are involved in reproductive organ development in flowering plants. To resolve the discrepancy in phylogenetic inferences, and to provide insights into the evolution of reproductive organs in seed plants, four MADS genes (GpMADS1–4) were cloned from Gnetum parvifolium. GpMADS2 is likely to be a pseudogene and the other three genes were characterized. A MADS gene tree based on partial amino acid sequences showed that GpMADS3 is included in the AGL6 group, but the other two genes do not cluster with any previously reported MADS gene. The three GpMADS genes were expressed during the early stage of ovule development in the differentiating nucellus and three envelopes. A comparison of MADS gene expression among conifers, Gnetum, and flowering plants suggests that the comparable reproductive organs in Gnetum and flowering plants evolved in parallel, and is likely to support the homology between the ovule‐ovuliferous scale complex of conifers and the Gnetum ovules, including the three envelopes.
Evolution of animal body plans: the role of metazoan phylogeny at the interface between pattern and process
Authors: Jenner Ronald A.
Published: March 2003

SUMMARY Comprehensive integrative studies are the hallmark of evolutionary developmental biology. A properly defined phylogenetic framework takes a central place in such analyses as the meeting ground for observation and inference. Molecular phylogenies take this place in many current studies on animal body plan evolution. In particular, 18S rRNA/DNA sequence analyses have yielded a new view of animal evolution that is often contrasted with a presumed traditional or classical view. First, I expose this traditional view to be a simplified historical abstraction that became textbook dogma. Second, I discuss how two recent important studies of animal body plan evolution, examining the evolution of the platyhelminth body plan and the evolutionary significance of indirect development and set‐aside cells, have actively incorporated two problematic aspects of the newly emerging molecular view of animal evolution: incomplete and unresolved phylogenies.
Turning Hox “signatures” into synapomorphies
Authors: Telford Maximilian J.
Published: March 2003

SUMMARY It has recently been shown that the three metazoan superphyla that are recognized on the basis of 18S rDNA phylogenies—ecdysozoans, lophotrochozoans, and deuterostomes—each have characteristic Hox genes. This observation has been taken further, and these “signature” Hox genes have been looked for in taxa of uncertain affinity such as the mesozoa, in order to link them to one of the three superphyla. Here I point out that, in the absence of an out‐group, these so‐called signature Hox genes are unpolarized characters and, as such, should not be used in this cladistic sense to determine phylogeny. Taking the example of the mesozoans, which have the Lox5 gene in common with the lophotrochozoans, I show that it is possible to polarize this character using paralogous Hox genes as proxy out‐groups; however, due to the impossibility of reliable alignment outside the homeobox, only two residues of the Lox5 peptide are susceptible to this method. With this in mind, I find slim evidence for an association between mesozoans and lophotrochozoans. I demonstrate that the lophotrochozoan genes Lox2 and Lox4 would provide many more reliable residues that are truly indicative of lophotrochozoan affinity. Finally, I point out the potential problems in using unpolarized signatures to address the question of the position of the acoel flatworms.
Molluscan engrailed expression, serial organization, and shell evolution
Authors: Jacobs David K. , Wray Charles G. , Wedeen Cathy J. , Kostriken Richard , DeSalle Rob , Staton Joseph L. , Gates Ruth D. , Lindberg David R.
Published: March 2003

SUMMARY Whether the serial features found in some molluscs are ancestral or derived is considered controversial. Here, in situ hybridization and antibody studies show iterated engrailed‐gene expression in transverse rows of ectodermal cells bounding plate field development and spicule formation in the chiton, Lepidochitona caverna, as well as in cells surrounding the valves and in the early development of the shell hinge in the clam, Transennella tantilla. Ectodermal expression of engrailed is associated with skeletogenesis across a range of bilaterian phyla, suggesting a single evolutionary origin of invertebrate skeletons. The shared ancestry of bilaterian‐invertebrate skeletons may help explain the sudden appearance of shelly fossils in the Cambrian. Our interpretation departs from the consideration of canonical metameres or segments as units of evolutionary analysis. In this interpretation, the shared ancestry of engrailed‐gene function in the terminal/posterior addition of serially repeated elements during development explains the iterative expression of engrailed genes in a range of metazoan body plans.
Comparative development of fiber in wild and cultivated cotton
Authors: Applequist Wendy L. , Cronn Richard , Wendel Jonathan F.
Published: March 2003

SUMMARY One of the most striking examples of plant hairs is the single‐celled epidermal seed trichome of cultivated cotton. The developmental morphology of these commercial “fibers” has been well‐characterized in Gossypium hirsutum, but little is known about the pattern and tempo of fiber development in wild Gossypium species, all of which have short, agronomically inferior fiber. To identify developmental differences that account for variation in fiber length, and to place these differences in a phylogenetic context, we conducted SEM studies of ovules at and near the time of flowering, and generated growth curves for cultivated and wild diploid and tetraploid species. Trichome initiation was found to be similar in all taxa, with few notable differences in trichome density or early growth. Developmental profiles of the fibers of most wild species are similar, with fiber elongation terminating at about two weeks post‐anthesis. In contrast, growth is extended to three weeks in the A‐ and F‐genome diploids. This prolonged elongation period is diagnosed as a key evolutionary event in the origin of long fiber. A second evolutionary innovation is that absolute growth rate is higher in species with long fibers. Domestication of species is associated with a further prolongation of elongation at both the diploid and allopolyploid levels, suggesting the effects of parallel artificial selection. Comparative analysis of fiber growth curves lends developmental support to previous quantitative genetic suggestions that genes for fiber “improvement” in tetraploid cotton were contributed by the agronomically inferior D‐genome diploid parent.
Geographic patterning of variation in segment number in geophilomorph centipedes: clines and speciation
Authors: Arthur Wallace , Kettle Chris
Published: March 2003

SUMMARY Since their origin as a metameric group, arthropods have diversified considerably in their number of segments. Present‐day geophilomorph centipedes provide a model system for investigating the evolutionary origins of this diversification, because they exhibit intraspecific variation in segment number. (This variation is, however, derived; it is not a plesiomorphic condition within the Chilopoda.) Previous studies have shown that there are significant differences in segment number between populations within several geophilomorph species. In one (arguably two) species, it has been demonstrated that there is a particular form of geographic patterning of the variation, namely a latitudinal cline, with the segment number decreasing with increasing distance north. Here, we provide additional data on four more species, all of which show evidence of a latitudinal cline in either one or both sexes. It is therefore becoming clear that this is a general phenomenon, applying widely (perhaps universally) across the Geophilomorpha, a group consisting of some 1000 known species. It may be that latitudinal clines are a frequent part of the speciation cycle in this group.
Hox gene duplication and deployment in the annelid leech Helobdella
Authors: Kourakis Matthew J. , Martindale Mark Q.
Published: March 2003

SUMMARY The segmented leeches are members of the phylum Annelida within the Lophotrochozoa. Here, we describe the isolation of a new Hox gene, Lox18, in the leech Helobdella triserialis. Phylogenetic analysis indicates that Lox18 is a Deformed (Dfd  ) ortholog. H. triserialis has at least two Dfd orthologs, Lox18 and the previously described Lox6 (Kourakis et al. 1997; Wong and Macagno 1998), indicating that these genes duplicated after the last common ancestor of annelids and arthropods. Although the temporal appearance of Lox18 message is similar to that of Lox6, the spatial pattern is different. Lox18 does not have a sharply defined anterior border of expression in the second neuromere of the subesophageal ganglion of the central nervous system (CNS) as does Lox6, but is expressed uniformly in a small subset of cells in the longitudinal connectives and lateral roots in every segment of the CNS along the entire anterior‐posterior (AP) axis. Even though Lox18 shares greater sequence similarity within the homeodomain and flanking regions to Drosophila Dfd than to the previously isolated Lox6, its expression pattern suggests that its function has diverged from the ancestral Hox function. Previous sampling has indicated that the last common ancestor of protostomes and deuterostomes had as many as 10 clustered Hox genes representing distinct paralogy groups (Irvine et al. 1997; de Rosa et al. 1999); leech Hox genes may have undergone subsequent and independent cluster or genome‐wide duplication. These results point to the need for total genome level understanding for key members of the Lophotrochozoa.
Sipunculan ParaHox genes
Authors: Ferrier D. E. K. , Holland P. W. H.
Published: March 2003

SUMMARY Our perspective on the origin and evolution of the Hox gene cluster changed with the discovery of the ParaHox gene cluster in amphioxus (Cephalochordata; Branchiostoma floridae) (Brooke et al. 1998). The ParaHox gene cluster contains three homeobox genes (Gsx, Xlox, Cdx) and is deduced to be a paralogue (evolutionary sister) of the Hox gene cluster. If this deduction is correct, animals with Hox genes should also possess ParaHox genes. Paradoxically, however, only deuterostome animals have thus far been shown to contain all three ParaHox genes. Here we report the cloning of all three ParaHox genes from each of two species within the phylum Sipuncula. This is the first demonstration of all three ParaHox genes in the genome of a protostome animal and confirms that the common ancestor of protostomes and deuterostomes possessed all three ParaHox genes. Furthermore, it implies that the ParaHox genes are of sufficient functional importance in both protostomes and deuterostomes that they have all been conserved in both of these bilaterian clades.
Limbs in whales and limblessness in other vertebrates: mechanisms of evolutionary and developmental transformation and loss
Authors: Bejder Lars , Hall Brian K.
Published: March 2003

SUMMARY We address the developmental and evolutionary mechanisms underlying fore‐ and hindlimb development and progressive hindlimb reduction and skeletal loss in whales and evaluate whether the genetic, developmental, and evolutionary mechanisms thought to be responsible for limb loss in snakes “explain” loss of the hindlimbs in whales. Limb loss and concurrent morphological and physiological changes associated with the transition from land to water are discussed within the context of the current whale phylogeny. Emphasis is placed on fore‐ and hindlimb development, how the forelimbs transformed into flippers, and how the hindlimbs regressed, leaving either no elements or vestigial skeletal elements. Hindlimbs likely began to regress only after the ancestors of whales entered the aquatic environment: Hindlimb function was co‐opted by the undulatory vertical axial locomotion made possible by the newly evolved caudal flukes. Loss of the hindlimbs was associated with elongation of the body during the transition from land to water. Limblessness in most snakes is also associated with adoption of a new (burrowing) lifestyle and was driven by developmental changes associated with elongation of the body. Parallels between adaptation to burrowing or to the aquatic environment reflect structural and functional changes associated with the switch to axial locomotion. Because they are more fully studied and to determine whether hindlimb loss in lineages that are not closely related could result from similar genetically controlled developmental pathways, we discuss developmental (cellular and genetic) processes that may have driven limb loss in snakes and leg‐less lizards and compare these processes to the loss of hindlimbs in whales. In neither group does ontogenetic or phylogenetic limb reduction result from failure to initiate limb development. In both groups limb loss results from arrested development at the limb bud stage, as a result of inability to maintain necessary inductive tissue interactions and enhanced cell death over that seen in limbed tetrapods. An evolutionary change in Hox gene expression—as occurs in snakes—or in Hox gene regulation—as occurs in some limb‐less mutants—is unlikely to have initiated loss of the hindlimbs in cetaceans. Selective pressures acting on a wide range of developmental processes and adult traits other than the limbs are likely to have driven the loss of hindlimbs in whales.
Amphibian defenses against ultraviolet‐B radiation
Authors: Blaustein Andrew R. , Belden Lisa K.
Published: March 2003

SUMMARYAs part of an overall decline in biodiversity, amphibian populations throughout the world are disappearing. There are a number of potential causes for these declines, including those related to environmental changes such as increasing ultraviolet‐B (UV‐B) radiation due to stratospheric ozone depletion. UV‐B radiation can kill amphibian embryos or can cause sublethal effects that can harm amphibians in later life stages. However, amphibians have defenses against UV‐B damage that can limit damage or repair it after exposure to UV‐B radiation. These include behavioral, physiological, and molecular defenses. These defenses differ interspecifically, with some species more able to cope with exposure to UV‐B than others. Unfortunately, the defense mechanisms of many species may not be effective against increasing persistent levels of UV‐B radiation that have only been present for the past several decades due to human‐induced environmental damage. Moreover, we predict that persistent UV‐B–induced mortality and sublethal damage in species without adequate defenses could lead to changes in community structure. In this article we review the effects of UV‐B radiation on amphibians and the defenses they use to avoid solar radiation and make some predictions regarding community structure in light of interspecific differences in UV‐B tolerance.
Plasmapheresis in the Treatment of Posttransplant Cardiomyopathy
Authors: Dzemeshkevich  , Ragimov  , Mikhaylov  , Roitman  , Adrianov  , Ryikunov  , Abugov  , Sheremetyeva  , Alekseeva  , Vinnitsky
Published: March 2003

After heart transplantation a number of factors such as pre‐ and postoperative hypoxia of the myocardium, myocardial failure of the early postoperative period, acute rejection episodes, cytomegalovirus infection, and finally the progressive atherosclerosis of the coronary arteries lead to the development of transplanted heart failure. Severe alterations of the myocardial function at this end stage of the process correspond to incurable cardiomyopathy. The target of plasmapheresis in this case is to decrease the extent of the disturbances in the lipoprotein contents and blood rheology for the improvement of the coronary perfusion of the transplanted heart. Nine patients with 3–7 year survival periods after heart transplantations underwent plasmapheresis twice a year using the Haemonetics PCS‐plus machine. 2,100–2,700 ml of plasma was removed. Biochemical data, rheology and coagulation, and the concentration of Sandimmune (Sandoz Pharma Ltd., Basel, Switzerland) were controlled, and radionuclide scintigraphy of the myocardium, coronarographia, and transesophageal ultrasound investigations were completed for these patients. The result was the significant improvement of the coronary perfusion of the myocardium. The level of immunosuppression after the plasmapheresis procedures did not change and therefore did not demand any correction. Thus, we think that plasmapheresis can be an effective method of treatment of posttransplantation cardiomyopathy; the improvement of coronary perfusion decreases the extent of chronic ischemia. Further studies are necessary to answer the question as to whether it is possible to prolong the time before retransplantation with the help of plasmapheresis.
Centrifugal Pumping During Routine Open Heart Surgery Improves Clinical Outcome
Authors: Klein Michael , Dauben Hans‐Peter , Schulte Hagen D. , Gam Emmeran
Published: March 2003

Carrying out a 1,000 patient prospective, randomized study comparing a roller pump and the BioMedicus centrifugal pump (CP), hematological parameters, blood loss, renal function, postoperative complications, and lethality data were evaluated. Using a validated preoperative risk stratification method (Cardiac RiskMaster), patients were divided into different risk categories for statistical analysis. This study verified an improved outcome with the use of a CP in routine cardiac surgery, demonstrated by blood handling, blood loss, renal function, and nephrological complication data. There was also a significant reduction in neurological complications. There was no significant difference in postoperative lethality, but high risk patients demonstrated outcomes comparable to those being defined for medium risk patients. Routine cardiac surgical patients as well as multimorbid patients benefit from the use of a CP. Preoperative risk stratification is a valid tool to demonstrate how the employment of new technologies can provide for an improved outcome without increasing overall costs at the same time.
A New Heparin‐Bonded Dense Membrane Lung Combined with Minimal Systemic Heparinization Prolonged Extracorporeal Lung Assist in Goats
Authors: Okamoto Taisuke , Tashiro Masafumi , Sakanashi Yuji , Tanimoto Hironari , Imaizumi Takashi , Sugita Michiko , Terasaki Hidenori
Published: March 2003

Heparin was covalently bonded to a new hollow‐fiber dense membrane artificial lung and extracorporeal circuit using a silane coupling agent and polyethyleneimine. This study investigated whether prolonged, venoarterial bypass extracorporeal lung assist (V‐A bypass ECLA) could be sustained in a goat by the combination of the new membrane lung and minimal systemic heparinization. We maintained ECLA with the hollow‐fiber lungs (surface area, 0.8 m2) and circuits by titrating the activated clotting time (ACT) to below 150 s with minimal systemic heparinization in 5 goats. The outcome was assessed from the function of the artificial lung via macro and microscopic examinations after the experiments and the incidence of systemic complications. The 5 goats were maintained on ECLA for 6 to 27 days. The bypass flow rate, blood gases at the return and drainage sites, platelet counts, and platelet aggregation activity were well maintained. Although the hemoglobin concentration, hematocrit, and plasma protein at the start of the ECLA were significantly lower than the pre‐ECLA values due to hemodilution, the values remained stable during ECLA. A cerebral infarction occurred in 1 goat. However, in the other 4 goats, no complications such as bleeding, thrombosis, or plasma leakage from the artificial lung were observed. Although several thrombi were observed in the stagnant area of the artificial lung, these local thrombi did not cause the function of the artificial lung to deteriorate. We found that this new type of highly biocompatible, dense membrane artificial lung, when combined with minimal systemic heparinization, prolonged ECLA without the deterioration of the artificial lung function and was suitable for prolonged ECLA.
Efficacy of a Bioreactor Filled with Porcine Hepatocytes Immobilized on Nonwoven Fabric for Ex Vivo Direct Hemoperfusion Treatment of Liver Failure in Pigs
Authors: Naruse Katsutoshi , Nagashima Ikuo , Sakai Yasuyuki , Harihara Yasushi , Jiang Gao Xiao , Suzuki Motoyuki , Muto Tetsuichiro , Makuuchi Masatoshi
Published: March 2003

We developed a new bioreactor for a bioartificial liver filled with porcine hepatocytes immobilized on polyester nonwoven fabric (NWF) and in our previous study showed that this NWF bioreactor has promising in vitro efficiency. In the present study, we investigated the efficacy of the NWF bioreactor in a direct hemoperfusion experiment conducted to treat pigs with liver failure. Porcine hepatocytes were isolated from the whole liver of a Sangen strain pig. They were immobilized in a 200 ml column containing NWF via perfusion in a closed circuit for 24 h to prepare a NWF bioreactor. The following day an operative liver failure model was produced by creating a portocaval shunt and ligating the entire hepatoduodenal ligament in the porta hepatis. Perfusion treatment was initiated 4 h after operative induction of liver failure and continued for about 1 h. The pigs which underwent perfusion treatment showed significant improvements in survival and blood data, including ammonia, total bile acid, glucose, and prothrombin time, attributed to significant improvements in the post‐ as compared to the pre‐bioreactor levels in the perfused blood of the treated pigs. These beneficial effects of the NWF bioreactor were based on its excellent composition which allows the accommodation of adequate numbers of hepatocytes and direct contact between hepatocytes and perfused blood.
Development of the Small Caliber Centrifugal Blood Pump
Authors: Miyazoe Yuki , Sawairi Toshio , Ito Kazuyuki , Yan Junzo
Published: March 2003

Regarding the development of a centrifugal blood pump to be connected directly with small diameter tubings for pediatric use while minimizing hemolysis, we have studied the inlet port side configurations of a pump using both a hemolysis test and computational fluid dynamics (CFD) analysis. We have conducted a hemolysis test on 2 models. The tapered shape inlet has proven to be lower in the index of hemolysis (IH) than the straight shape. CFD analyses utilizing expanded flow paths indicated that the flow velocity decreased as the fluid path became larger within the tapered nozzle. When entering the pump chamber, the flow rushed in at a greater velocity through the straight nozzle due to its small diameter. The straight shape showed an abrupt change in pressure around the entrance of the pump chamber while the tapered shape did not. The flow inlet angle of the straight model was observed to be larger than that of the tapered model because of its smaller turning radius.
Heparin‐Induced Hyperkalemia in Chronic Hemodialysis Patients: Comparison of Low Molecular Weight and Unfractionated Heparin
Authors: Hottelart C. , Achard J.M. , Moriniere Ph. , Zoghbi F. , Dieval J. , Fournier A.
Published: March 2003

Abstract: Aldosterone suppression and subsequent hyperkalemia are well described reversible side effects of prolonged treatment with heparin. This study was designed to examine whether the discontinuous use of heparin three times a week to prevent thrombosis formation during hemodialysis sessions could also induce hypoaldosteronism and might contribute to increased predialysis kalemia in hemodialysis patients. Two different heparinization regimens were prospectively compared in a crossover study of 11 chronic hemodialysis patients. During 2 consecutive weeks, the patients were dialyzed each week with either their usual doses of unfractionated heparin (UH) (6,160 IU ± 1,350 IU) or low molecular weight heparin (LMWH) (15 anti‐Xa activity [aXa] U/kg + 5 aXa U/kg/h). In all but 2 patients, the predialysis level of plasma K+ was higher with UH than with LMWH, and the mean value was higher (5.66 ± 0.83 versus 5.15 ± 0.68 mM, p = 0.01) while no differences in the predialysis plasma concentrations of creatinine, phosphate, urea, and bicarbonate were observed, excluding the potential role of differences in diet and dialysis efficacy in explaining the higher plasma K+ concentration with UH. The mean plasma aldosterone to plasma renin activity (pRA) ratio was higher with LMWH than with UH (149.54 ± 123.1 versus 111.91 ± 86.22 pg/ng/h, p < 0.05). Individual plasma aldosterone values were found to be correlated to pRAs both during the UH period and the LMWH period, and the slope of the positive linear relation between plasma aldosterone and pRA was lower during the UH treatment period (63 versus 105 pg/ng/h). Finally, a negative linear correlation was found between the differences in individual predialysis plasma K+ observed during the 2 protocols and the differences in the corresponding plasma aldosterone levels, suggesting a link between the higher kalemia and the lower aldosterone responsiveness to angiotensin with unfractionated heparin. Although it cannot be concluded whether or not LMWH inhibits aldosterone synthesis, should LMWH decrease aldosterone production, this side effect is 33% less marked than that of UH so that the predialysis plasma K+ levels are 10% lower. This property makes LMWH use preferable to that of UH in patients with elevated predialysis kalemia.
Arterial Baroreceptor Afferent Activity in Nonpulsatile Systemic Circulation
Authors: Shomura Yu , Tanaka Keizo , Takabayashi Shin , Hioki Iwao , Tenpaku Hironori , Maze Yasumi , Shimono Takatsugu , Shimpo Hideto , Yada Isao
Published: March 2003

We directly measured aortic depressor nerve activity (ADNA) in rabbits to investigate changes in arterial baroreceptor afferent activity (ABAA) in response to nonpulsatile systemic circulation (NC) during total left heart bypass (TLHB). ADNA was measured before and 5, 20, 30, 40, 50, and 60 min after the start of TLHB while maintaining the mean aortic pressure (MAP) at preestablished values (n = 10). At 5 min, the ADNA was significantly increased compared to its baseline value. At 30 min, it was significantly decreased compared to its value at 5 min and thereafter remained the same. The ADNA was then measured before and 5 and 30 min after the start of TLHB under increased MAP (n = 10). The results showed that the percentage changes in ADNA during TLHB were significantly less than that observed when the MAP was increased before TLHB. We conclude that ABAA acutely adapts to NC 30 min after its initiation, but changes in ABAA are depressed under NC combined with increased MAP.
Pulsate Regimes of the Centrifugal Pump Operation for Assisted Circulation
Authors: Khaoustov Alexandre I. , Tolpekin Vladimir E. , Gasanov Edik J. , Korotkevich Petr N. , Khavrouniak Denis V.
Published: March 2003

This paper focuses on the evaluation of dynamic pumps as an element of the assist unit from the standpoint of its capacity to pass and change the left ventricle's pulsations. Analyses of the dynamic equations of the pipelines and pump have been performed. The pump intensification capacity of the disc and blade pumps was computed. Theoretically it was determined and experimentally confirmed that the pump intensification capacity was defined by the performance of the pump head. It was also determined that the existing pumps (e.g., The BioMedicus Biopump and the Moscow Aviation Institute, OK) pass and attenuate the left ventricle pressure pulsations.
Nonlinear Three‐Dimensional Finite Element Analysis of Newly Designed Cementless Total Hip Stems
Authors: Ando Masao , Imura Shinichi , Omori Hironori , Okumura Yasuhiro , Bo Akihiko , Baba Hisatoshi
Published: March 2003

We designed 2 new types of proximally coated stems (the FMS and FMS‐anatomic) based on the endosteal geometry of femora with congenital dislocation or dysplastic hip. The FMS was symmetric while the FMS‐anatomic was asymmetric. We compared the proximal fit and fill to the femoral canal, contact stress, relative motion, and load transfer to the femur of 5 stems (FMS, FMS‐anatomic, Omnifit, Omniflex, and individual stem) using three‐dimensional computer simulation and finite element analysis. The FMS and FMS‐anatomic showed a significantly greater fit and fill than conventional stems. The dispersion of the contact stresses and reduction of relative motions in the proximal area were the best in the FMS‐anatomic compared to other stems with the exception of the individual stem. In addition, the FMS‐anatomic stem transferred most of the load to the proximal femur. Our results suggest that the FMS‐anatomic should provide better biomechanical stability at least in the early postoperative period.
Arterial Anastomosis Using the Telescoping Method and an Elastomeric Adhesive
Authors: Urayama Hiroshi , Tsuchida Kei , Ohtake Hiroshi , Kawasuji Michio , Watanabe Yoh
Published: March 2003

We experimentally studied a new technique for anastomosis of small arteries which involves the telescoping method and a surgical adhesive with the objective of examining its clinical potential. This technique was applied to the unilateral femoral arteries of 27 mongrel dogs. After division of the artery, the distal artery was incised longitudinally, and the proximal end was invaginated into the opened artery. One stay suture and the elastomeric adhesive PUP201 were placed in the anastomotic site. The bursting and tensile strength and the patency were examined, and a histopathological study was performed at various intervals up to 1 year after the operation. The bursting strength exceeded 500 mm Hg. The patency rate of the anastomosed arteries was 100%. The mean percentage of stenosis to diameter of the proximal normal lumen was 20% one year after operation. The luminal surface of the anastomosed line was healed smoothly, and thrombi between the telescoped arteries were replaced by elastofibrotic union. In conclusion, small arterial anastomos is using the telescoping method and an elastomeric adhesiveis easy and safe and provides good patency.
Numerical Simulation of the Hemodynamic Response to Hemodialysis‐Induced Hypovolemia
Authors: Cavalcanti Silvio , Di Marco Luigi Yuri
Published: March 2003

Abstract: To provide a framework for analyzing cardiovascular response to hemodialysis‐induced hypovolemia, we developed a computer model which simulates arterial pressure changes caused by loss of blood volume. The model includes arterial and venous systemic circulation, Starling's law and inotropic regulation of heart, arterial and cardiopulmonary baroreflex control of capacitance, and resistance vessels. The performance of this model was assessed by analyzing the hemodynamic responses recorded in 12 patients undergoing chronic hemodialysis, 6 classified as hypotension resistant (stable group) and 6 as hypotension prone (unstable group). Arterial pressure, heart rate, and blood volume were recorded during regular hemodialysis. Blood volume and heart rate were used as inputs to the simulator whereas the arterial pressure response obtained by simulation was fitted to the measured data by tuning simulator parameters relative to the capacitance and resistance controls. Although analyzed pressure responses exhibited a wide variety of time patterns, for each one it was possible to identify an optimal set of parameters allowing the recorded pressure data to be accurately reproduced by the model. Sensitivity analysis performed with the model indicated that pressure response strongly depends on the parameter Kv accounting for the capability to control vascular capacitance. According to these results, the parameter Kv in the stable group was 9 times that of the unstable group, thereby suggesting a possible cause of their different hemodynamic behavior.
Long‐Term In Vivo Left Ventricular Assist Device Study for 284 Days with Gyro PI Pump
Authors: Ohtsuka Goro , Nakata Kin‐ichi , Yoshikawa Masaharu , Takano Tamaki , Glueck Julia , Sankai Yoshiyuki , Takami Yoshiyuki , Mueller Juergen , Sueoka Akinori , Letsou George , Schima Heinrich , Schmallegger Helmut , Wolner Ernst , Koyanagi Hitoshi , Fujisawa Akira , Baldwin John C , Nosé Yukihiko
Published: March 2003

A totally implantable centrifugal artificial heart has been developed. The plastic prototype, the Gyro PI 601, passed 2 day hemodynamic tests as a functional total artificial heart (TAH), 2 week screening tests for anti‐thrombogenecity, and a 1 month system feasibility study. Based upon these results, a metallic prototype, the Gyro PI 700 series, was subjected to long‐term in vivo left ventricular assist device (LVAD) studies of over 1 month. The Gyro PI 700 series has the same inner dimension and same characteristics of the Gyro PI 601 such as an eccentric inlet port, a double pivot bearing system, and a magnet coupling system. The PI metallic pump is also driven with the Vienna DC brushless motor actuator like the PI 601. The pump‐actuator package was implanted in 3 calves in the preperitoneal space, bypassing from the left ventricular (LV) apex to the descending aorta. Case 1 achieved a 284 day survival. Case 2 was euthanized early at 72 postoperative days as a result of the functional obstruction of the inlet port due to the excessive growth of the calf. There was no blood clot inside the pumps of either case. Case 3 is on‐going (22 days on July 24, 1998). During these periods, all cases showed no physiological abnormalities. In conclusion, the PI 700 series pump has excellent results as a long‐term implantable LVAD.
Shaft/Shaft‐Seal Interface Characteristics of a Multiple Disk Centrifugal Blood Pump
Authors: Manning Keefe B. , Miller Gerald E.
Published: March 2003

A multiple disk centrifugal pump (MDCP) is under investigation as a potential left ventricular assist device. As is the case with most shaft driven pumps, leakage problems around the shaft/shaft seal interface are of major interest. If leakage were to occur during or after implantation, potential events such as blood loss, clotting, blood damage, and/or infections might result in adverse effects for the patient. Because these effects could be quite disastrous, potential shaft and shaft seal materials have been investigated to determine the most appropriate course to limit these effects. Teflon and nylon shaft seals were analyzed as potential candidates along with a stainless steel shaft and a Melonite coated shaft. The materials and shafts were evaluated under various time durations (15, 30, 45, and 60 min), motor speeds (800, 1,000, 1,200, and 1, 400 rpm), and outer diameters (½ and ¾ inches). The motor speed and geometrical configurations were typical for the MDCP under normal physiologic conditions. An air and water study was conducted to analyze the inner diameter wear, the inner temperature values, and the outer temperature values. Statistical comparisons were computed for the shaft seal materials, the shafts, and the outer diameters along with the inner and outer temperatures. The conclusions made from the results indicate that both the tested shaft seal materials and shaft materials are not ideal candidates to be used for the MDCP. Teflon experienced a significant amount of wear in air and water studies. Nylon did experience little wear, but heat generation was an evident problem. A water study on nylon was not conducted because of its molecular structure.
Recovery from Lymphocytopenia Following Extracorporeal Circulation: Simple Indicator to Assess Surgical Stress
Authors: Tayama Eiki , Hayashida Nobuhiko , Oda Takeshi , Tomoeda Hiroshi , Akasu Kouji , Kosuga Tomokazu , Fukunaga Shyuji , Akashi Hidetoshi , Kawara Takemi , Aoyagi Shigeaki
Published: March 2003

This study investigated whether the lymphocyte count is a useful indicator to assess surgical damage following extracorporeal bypass. In Study 1, to investigate the correlation between extracorporeal circulating time (ECCT) and lymphocyte counts, 40 elective CABG patients were studied retrospectively. The lymphocyte recovery ratio (LRR), which represented the actual lymphocyte count divided by the preoperative lymphocyte count, was determined preoperatively, and on postoperative day (POD) 1, POD 3, and POD 5. In Study 2, the correlation between the interleukin‐8 (IL‐8) level and LRR was examined prospectively in elective CABG patients (n = 20). We measured the LRR and serum IL‐8 levels preoperatively and during extracorporeal circulation (ECC) at 5 min, at the end of ECC, and 1, 3, and 12 h following ECC termination. Study 1 showed that the LRR decreased until POD 1 and gradually increased thereafter. The LRR had a negative correlation with the ECCT. In Study 2, the IL‐8 level demonstrated a time course opposite to that of the LRR; it increased until 3 h after ECC termination and declined thereafter. There was a significant negative correlation between the LRR on POD 3 and the IL‐8 level at 3 h after ECC termination. In summary, long‐term ECC induced significant and prolonged lymphocytopenia. The LRR had a negative correlation with IL‐8. These results indicated that the LRR may represent the degree of surgical stress following ECC; therefore, the counting of lymphocytes can be a quite useful bedside monitor to assess surgical damage and prognosis.
A Sealless Centrifugal Blood Pump with Passive Magnetic and Hydrodynamic Bearings
Authors: Wampler Richard , Lancisi David , Indravudh Virote , Gauthier Raymond , Fine Robert
Published: March 2003

We are developing a permanently implantable ventricular assist system based on a sealless centrifugal blood pump. The impeller of the pump is supported by a passive radial magnetic bearing acting in synergy with hydrodynamic bearings. Torque is transmitted to the impeller by electromagnetic coupling via an integrated axial flux gap motor. Computer modeling has been used extensively to guide the hydraulic and electromagnetic design of the pump. As part of the development effort, a prototype system was built, which consisted of a radial magnetic bearing, an axial air gap motor, and a pivot bearing to constrain the axial motion. The following testing has been completed to validate the design. First, hydraulic tests have demonstrated sufficient hydraulic performance. Second, preliminary in vitro evaluation of hemolysis was low compared to that of a BioPump control. Third, a 6 h in vivo experiment was successfully completed.