Application of Indirect Flow Rate Measurement Using Motor Driving Signals to a Centrifugal Blood Pump with an Integrated Motor

The method of measuring the flow rate of a centrifugal blood pump from the input electric power, which will be indispensable for the long-term use of such devices, was developed and was applied to the direct-driven centrifugal blood pump that has been developed by our research group. The accuracy was evaluated in a chronic animal experiment using an adult goat. The results demonstrated that this method carries the sufficient potential of the instantaneous monitoring method, but errors due to electromagnetic and mechanical losses were not determined always precisely. The detection of adverse phenomena such as the obstruction of the inlet cannula was also possible from the estimated value of the flow rate and its waveform pattern.     

植入式药泵行区域性灌注莪术油等治疗晚期大肠癌疗效观察

目的 :探讨治疗不能切除的晚期大肠癌的有效方法。方法 :将38例不能切除的晚期大肠癌患者分为两组。治疗组18例 ,采用莪术油等中药制剂经植入式药泵行区域性灌注治疗 ;对照组20例 ,采用相同药物经周围静脉给药治疗。结果 :在症状改善、住院时间、生活质量及生存期等方面比较 ,治疗组明显优于对照组(P<0.05或P<0.01)。结论 :通过植入式药泵进行区域性灌注莪术油等中药制剂治疗晚期大肠癌是一种有效的方法     

Development of Mechanical Circulatory Support Devices in China

Myocardial dysfunction leading to low cardiac output syndrome is a common clinical pathophysiological state. Currently, the use of mechanical circulatory support (MCS) is an essential aspect of the treatment of patients with cardiac failure. Several groups in China are engaged in the design and development of MCS devices. These devices can be classified as pulsatile, rotary, and total artificial heart (TAH). There are two types of pulsatile pump, which are driven by air (pneumatic). One of these pumps, the Luo‐Ye pump, has been used clinically for short‐term support since 1998. The other is a push‐plate left ventricular device, which has a variable rate mode. Various rotary devices are classified into axial and centrifugal pumps, depending on the impeller geometry. Most rotary pumps are based on the maglev principle, and some types have been used clinically. Others are still being studied in the laboratory or in animal experiments. Furthermore, certain types of total implantable pump, such as the UJS‐III axial pump and the UJS‐IV aortic valvo‐pump, have been developed. Only one type of TAH has been developed in China. The main constituents of this artificial heart are two axial pumps, two reservoir tanks mimicking the right and left atria, flow meters, two pressure gauges, and a resistance adaptor. Although the development of mechanical assist devices in China is still in a nascent stage, a number of different types of MCS devices are currently being studied.     

Kinetics of rate controlled rectally administered ranitidine to male volunteers

Ranitidine hydrochloride solution was given rectally to six healthy volunteers by means of an osmotic pump (Osmet^®) at a zero-order rate for 8 h. Quite constant steady-state drug concentrations were achieved in the range of 64–123 ng/ml plasma (meanC _ss: 100.6 ng/ml). The mean absorption time was 0.45 h (range 0–1.02 h), indicating that absorption was not always instantaneous. It is concluded that the Osmet^® system together with the rectal route offer the possibility for achieving steady-state concentrations of ranitidine, enabling the determination of pharmacodynamic effects. In addition, the rectal route can be considered as an alternative to oral and intravenous administration.     

DIAGNOSIS AND TREATMENT OF SMALL BOWEL DISEASES WITH A NEWLY DEVELOPED SINGLE BALLOON ENDOSCOPE

Background: Recent advances in capsule endoscopy (CE) and double balloon endoscopy (DBE) have enabled an endoscopic approach to small bowel diseases. However, CE is simply a diagnostic tool and DBE is fairly complicated to handle. Methods: We developed a single balloon endoscopy (SBE) in cooperation with Olympus Medical Systems. The single balloon enteroscope consists of an endoscope and a splinting tube. In this system, a balloon is attached to the splinting tube, but not to the scope itself. The single‐person insertion method was effective for SBE cases, but two persons were needed for DBE. The patients we examined had undergone upper and lower gastrointestinal endoscopy and were suspected of having small intestinal diseases. We examined a total of 30 cases (nine women, 21 men; range 19–78 years), and carried out a total of 48 examinations. Results: In fifteen cases, the cause of bleeding was diagnosed as either ulcer, angiodysplasia, Crohn's disease, inflammatory polyp, or metastatic cancer, but in eight cases, the cause was not identified. Four obstruction cases comprised ulcers, adhesion, and jejunal volvulus. For treatment, clippings were performed for bleeding in three patients, polypectomy for two, reversal of volvulus for one, and balloon dilation for ilial stenosis in one. The entire small intestine was observed in 71% of patients when the intention was to examine the whole bowel. No complications were encountered. Conclusions: The newly developed SBE is useful for diagnosis and treatment of small bowel diseases.     

Intrathecal Drug Delivery Device Infection and Meningitis due to Mycobacterium Fortuitum: A Case Report

Intrathecal drug delivery device infection with Mycobacterium fortuitum has not been reported previously. We report a case of an implanted baclofen pump infection and associated mycobacterium meningitis due to Mycobacterium fortuitum. The entire pump system was removed and the patient was treated successfully with a prolonged regimen of antibiotics.     

Effect of genipin on the biliary excretion of cholephilic compounds in rats.

Aim: Genipin, a metabolite of geniposide, is reported to stimulate the insertion of multidrug resistance protein 2 (Mrp2) in the bile canalicular membrane, and to cause choleresis by increasing the biliary excretion of glutathione, which has been considered to be a substrate of Mrp2. In the present study, the effect of colchicine on the choleretic effect of genipin was investigated. The effect of genipin on the biliary excretion of the substrates of bile salt export pump and Mrp2 was also studied. Methods: After bile duct cannulation into rats, genipin was administered at the rate of 0.2 mumol/min/100 g, and the effect of colchicine pretreatment (0.2 mg/100 g) was examined. Metabolites of genipin in the bile were examined by a thin layer chromatography. Taurocholate (TC), sulfobromophthalein (BSP), and pravastatin were infused at the rate of 1.0, 0.2 and 0.3 mumol/min/100 g, respectively, and the effect of genipin co-administration was examined. Results: Genipin increased bile flow and the biliary glutathione excretion, and those increases were not inhibited by colchicine. The biliary excretion of genipin glucuronide was less than 10% of the genipin excreted into bile. The biliary excretion of TC, BSP, and pravastatin was unchanged by genipin co-administration. Conclusion: It was indicated that colchicine-sensitive vesicular transport has no role on the genipin-induced insertion of Mrp2 to the canalicular membrane. Choleresis of genipin is considered to be mainly due to the increased biliary glutathione excretion by genipin, not by the biliary excretion of glucuronide. TC had no effect on the biliary glutathione excretion.     

Comparison of a Steady Flow Pump to a Preload Responsive Pulsatile Pump in Left Atrial–to–Aorta Bypass in Canines

A unique preload responsive pulsatile pump was compared to a centrifugal pump in total cardiac support in 25-kg canines (n = 6, each group) in the left atrial-to-aorta mode during 5 h of ventricular fibrillation. With steady flow, there was immediate drop in output from 2.1 +/- 1.0 L/min to 1.4 +/- 0.3 L/min, followed by further reduction to 0.9 +/- 0.2 L/min during 5 h of ventricular fibrillation. With a pulsatile pump, there was no significant reduction from control of 2.4 +/- 0.6 L/min and no decline during 5 h of ventricular fibrillation. With steady flow, systemic vascular resistance (SVR) rose significantly from 1,762 dyne-s-cm-5 immediately on pump to 3,013 dyne-s-cm-5 at 5 h. With physiologic pulsatile flow, significant elevation of SVR did not occur. When stressed, due to diminished left atrial return, the centrifugal pump displayed line chatter and streaks of microbubbles, whereas the pulsatile pump did not. Crystalloid volume replacement with the centrifugal pump was 6.5 +/- 1.9 L, and with the preload responsive pulsatile pump, 5.6 +/- 1.3 L. It is concluded that in the left atrial-to-aorta mode during 5 h of ventricular fibrillation and with comparable volume replacement, total cardiac support of canines is associated with lower SVR with physiologic pulsatile flow and is not accompanied by line chatter and cavitation with this preload responsive pump.     

乳头括约肌小切开联合柱状球囊扩张术治疗巨大型胆总管结石的临床研究

目的  探讨乳头括约肌小切开联合柱状球囊扩张术治疗巨大型胆总管结石的效果和安全性。 方法  选取2012年1月-2015年12月于山东省东营市胜利油田中心医院收治的167例最大直径≥15 mm的胆总管结石患者，按照随机数表法分为EST组和sEST+EPBD组，比较两组取石成功率、术中X线透射时间、术后近、远期并发症，采用Logstic回归分析影响取石成功率和术后胰腺炎发生率的相关因素。结果  EST组和sEST+EPBD组取石成功率分别为91.5%和92.7%（P =0.076）；EST组X线透射时间长于sEST+EPBD组（P < 0.01）；术后两组近期并发症发生率分别16.9%和10.4%（P =0.221），EST组术后乳头出血发生率高于sEST+EPBD组（P =0.018）；EST和sEST+EPBD两组术后远期并发症分别出现12例（16.9%）和6例（6.25%），差异有统计学意义（P =0.028），两组术后急性胆管炎分别出现5例和1例（P =0.039）；Logstic回归分析提示，胆总管结石大小是影响取石成功率、内镜后胰腺炎发生的因素。结论  EST和sEST+EPBD方法治疗巨大型胆总管结石的取石成功率较高，两组术中X暴露时间、术后近远期并发症发生率有差异，应该权衡利弊综合考虑选择手术方案。

     

Continuous Intrathecal Baclofen Infusion Delivered by a Programmable Pump for the Treatment of Severe Spasticity Following Traumatic Brain Injury

The aim of this study was to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the chronic treatment of severe spasticity due to traumatic brain injury (TBI). Eight patients with severe spasticity following TBI, refractory to oral baclofen or who experienced intolerable side effects, were screened. The first five patients were enrolled in a research protocol that was approved by the Institutional Review Board for Human Research at Boston University Medical Center. The other three patients were evaluated after the FDA approved the therapy for spasticity of cerebral origin. Results showed that the mean Ashworth score for rigidity in the legs decreased from 4.4 preoperatively to 1.3 (p < 0.05) on ITB. In the arms, the Ashworth score decreased from 2.7 to 1.5 (p < 0.05). Reduction of spasticity resulted in improved levels of physical activity and locomotion and ease of care. Complications consisted of muscular hypotonia, areflexic bladder and urinary retention, erythema, and breakdown of the skin over the pump. Our results suggest that long‐term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spasticity arising from traumatic brain injury.