Constant-volume hydrogel osmometer: a new device concept for miniature biosensors

A new type of biosensor is proposed that combines the recognition properties of "intelligent" hydrogels with the sensitivity and reliability of microfabricated pressure transducers. In the proposed device, analyte-induced changes in the osmotic swelling pressure of an environmentally responsive hydrogel are measured by confining it within a small implantable enclosure between a rigid semipermeable membrane and the diaphragm of a miniature pressure transducer. Proof-of-principle tests of this device were performed in vitro using pH-sensitive hydrogels, with osmotic deswelling data for the same hydrogels used as a benchmark for comparison. The swelling pressure of the hydrogel was accurately determined from osmotic deswelling measurements against reservoirs of known osmotic stress. Values of swelling pressure vs salt concentration measured with a preliminary version of the sensor agree well with osmotic deswelling results. Through modification of the hydrogel with various enzymes or pendant binding moieties, the sensor has the potential to detect a wide range of biological analytes with good specificity.     

Hemodynamic sensing using subcutaneous photoplethysmography

Pacemakers and implantable defibrillators presently operate without access to hemodynamic information. If available, such data would allow tailoring of delivered therapy according to perfusion status, optimization of device function, and enhancement of disease monitoring and management. A candidate method for hemodynamic sensing in these devices is photoplethysmography (PPG), which uses light to noninvasively detect changes in blood volume. The present study tested the hypotheses that PPG can function in a subcutaneous location, that the acute changes in blood volume it detects are directly proportional to changes in arterial pressure, and that optimum pacing intervals identified by it are concordant with those determined by arterial pressure. Aortic pressure and PPG were simultaneously recorded in 10 dogs under general anesthesia during changes in atrioventricular (AV) delay and bursts of rapid pacing to simulate tachyarrhythmias. Direct proportionality between transient changes in pressure and PPG waveforms was tested using regression analysis. Scatter plots had a linear appearance, with correlation coefficients of 0.95 (SD 0.03) and 0.72 (SD 0.24) for rapid-pacing and AV delay protocols, respectively. The data were well described by a directly proportional relationship. Optimum AV delays estimated from the induced changes in aortic pressure and PPG waveforms were concordant. This preliminary canine study demonstrates that PPG can function subcutaneously and that it may serve as a surrogate for acute changes in arterial pressure.     

A Fully Implantable Pacemaker for the Mouse: From Battery to Wireless Power

Animal models have become a popular platform for the investigation of the molecular and systemic mechanisms of pathological cardiovascular physiology. Chronic pacing studies with implantable pacemakers in large animals have led to useful models of heart failure and atrial fibrillation. Unfortunately, molecular and genetic studies in these large animal models are often prohibitively expensive or not available. Conversely, the mouse is an excellent species for studying molecular mechanisms of cardiovascular disease through genetic engineering. However, the large size of available pacemakers does not lend itself to chronic pacing in mice. Here, we present the design for a novel, fully implantable wireless-powered pacemaker for mice capable of long-term (>30 days) pacing. This design is compared to a traditional battery-powered pacemaker to demonstrate critical advantages achieved through wireless inductive power transfer and control. Battery-powered and wireless-powered pacemakers were fabricated from standard electronic components in our laboratory. Mice (n = 24) were implanted with endocardial, battery-powered devices (n = 14) and epicardial, wireless-powered devices (n = 10). Wireless-powered devices were associated with reduced implant mortality and more reliable device function compared to battery-powered devices. Eight of 14 (57.1%) mice implanted with battery-powered pacemakers died following device implantation compared to 1 of 10 (10%) mice implanted with wireless-powered pacemakers. Moreover, device function was achieved for 30 days with the wireless-powered device compared to 6 days with the battery-powered device. The wireless-powered pacemaker system presented herein will allow electrophysiology studies in numerous genetically engineered mouse models as well as rapid pacing-induced heart failure and atrial arrhythmia in mice.     

Reduced baroreflex sensitivity and blunted endogenous nitric oxide synthesis precede the development of hypertension in TGR(mREN2)27 rats

Transgenic TGR(mREN2)27 (TGR) rats are an animal model of fulminant hypertension characterized by an inverse circadian blood pressure profile. The present study addressed the contribution of nitric oxide (NO) synthesis and baroreflex function to hypertension and the inverse blood pressure pattern. NO synthesis was measured at four different times of day indirectly by excretion of NO metabolites (NOx: NO^-₂ and NO^-₃) in the urine of 5- and 11-week-old TGR and Sprague-Dawley (SPRD) controls. Blood pressure, heart rate, and motor activity were recorded in age-matched rats of both strains using an implantable telemetry system. Beat-to-beat recording of blood pressure and pulse interval was performed hourly in 6-week-old animals over 24h. From these data, baroreflex sensitivity (BRS) was calculated by linear regression of spontaneous fluctuations of blood pressure and corresponding changes of pulse interval. Baroreflex sensitivity was lower in prehypertensive TGR rats than in SPRD rats, and the reduction was restricted to the daily resting period. In both strains, NOx excretion showed circadian rhythmicity, with peak values during the activity period at night. Interestingly, excretion of NOx was reduced during the resting period in 5-week-old TGR rats prior to the development of hypertension. Impairment of NO synthesis and baroreflex function precede the development of hypertension in TGR rats. The reduction of both parameters was restricted to the resting period and, therefore, could be involved in the development of the inverse circadian blood pressure profile of TGR rats. (Chronobiology International, 18(2), 215-226, 2001)     

可植入式心室辅助装置动物模型的建立

目的探讨建立可植入式心室辅助装置研究的实验动物模型。方法选取体质量120-180 kg小公牛7只,常规全麻后左侧第4肋间开胸,建立体外循环,体外循环辅助下诱颤后,植入自主研发的国产可植入式心室辅助装置（DIVAD,domestic-made implantable ventricular assist device）,DIVAD机械性能参数接近国际同类产品,泵尺寸29.5mm×72 mm,重量158 g,体外转速可达9000 r/min,流量可达8 L/min,整合流量计,并可通过体外控制器监测控制。DIVAD连接左室及降主动脉,转速3500-8000 r/min左右,行左室辅助。术后撤除体外循环,持续监测动物生命体征及DIVAD运转情况。肝素静滴维持ACT在正常值1.5-2倍之间。结果7只小牛术后全部复跳,均能成功撤离体外循环辅助,最长存活时间超过93 h,最短存活时间0.5 h,平均存活时间20.28 h。结论小牛可以作为DIVAD研究的合适动物模型,其围手术期处理有相应特点,小牛DIVAD实验模型的建立对于进一步研究改进DIVAD有重要作用。     

Tissue engineering of a bioartificial kidney

Tissue engineering is a rapidly growing field in biotechnology. The use and packaging of synthetic materials, biologic compounds, and cellular components of specific tissues can be envisioned to replace physiologic function of diseased organs. Long-term ex vivo therapy for kidney failure has been achieved, so that the kidney may be the first solid organ in which tissue engineering concepts can produce an implantable device for long-term in vivo replacement therapy. To replace the kidney's excretory function, an implantable bioartificial kidney requires both a device to replace blood ultrafiltration performed by renal glomeruli and a device to replace transport regulatory function of the renal tubule. The initial concepts for these devices are just beginning to be considered and developed. (c) 1994 John Wiley & Sons, Inc.     

Intrapulmonal dislocation of a totally implantable venous access device

BACKGROUND: Totally implantable venous access devices are widely used for infusion of chemotherapy or parenteral nutrition. Device associated complications include technical operative problems, infections, paravasal infusions and catheter or punction chamber dislocation. CASE PRESENTATION: We present the case of a 49-year-old patient with the rare complication of a intrapulmonal catheter dislocation of a totally implantable venous access system. Treosulfane for chemotherapy of metastatic breast cancer was infused via the catheter causing instant coughing and dyspnoea which lead to the diagnosis of catheter dislocation. The intrapulmonal part of the catheter was removed under thoracoscopic control without further complications. CONCLUSION: Intrapulmonal catheter dislocation is a rare complication of a totally implantable venous access device which can not be avoided by any prophylactic measures. Therefore, the infusion system should be tested before each use and each new symptom, even when not obviously related to the catheter should be carefully documented and evaluated by expert physicians to avoid severe catheter-associated complications.     

Infrared body temperature measurement of mice as an early predictor of death in experimental fungal infections

Temperatures of mice were measured using an infrared high performance non-contact thermometer, after the device had been calibrated using implantable microchips containing temperature transponders. Mice were infected with three species of Candida (isolates) and the resultant disseminated infections monitored. Mouse temperatures could be reliably measured using the infrared device and this measurement caused little distress to the mice. We were further able to demonstrate that mice rarely recovered if their body temperature dropped below 33.3 degrees C (sensitivity 68%, specificity 97%). Adoption of a 33.3 degrees C endpoint in fungal sepsis experiments measured by infrared non-contact thermometer would significantly reduce the suffering in the terminal stages of this type of infection model.     

A muscle-powered energy delivery system and means for chronic in vivo testing.

Electrically stimulated skeletal muscle represents a potentially unlimited source of energy for the actuation of motor prostheses. Devices to harvest and deliver contractile power have proven mechanically feasible, but long-term efficacy has not been demonstrated. This report describes recent refinements in muscle energy converter (MEC) design and details the development of an implantable afterload chamber (IAC) designed to facilitate implant testing. The IAC comprises a fluid-filled bladder housed within a titanium cylinder that connects directly to the MEC. A vascular access port allows percutaneous measurement and adjustment of air pressure within the housing and provides a means both to monitor MEC function and to control hydraulic loading conditions. Data from in vitro tests show that IAC pressure mirrors changes in MEC-piston displacement over a wide range of actuation speeds and stroke lengths. Stroke lengths and actuation forces calculated from IAC pressure readings were typically found to be within 5% of measured values. This testing scheme may yield important information in regard to the ability to harness energy from in situ muscle over prolonged periods.     

Theoretical analysis of an implantable force transducer for tendon and ligament structures.

A mathematical model was developed for an implantable force transducer to be inserted within the midsubstance of a ligament or tendon. The model was generated by performing both equilibrium and strain-displacement analyses on a metallic, curved beam structure placed within a parallel-fibered tissue. The analysis permitted the transverse pressure acting between the device and fibers to be calculated along with peak device strain and sensitivity (ratio of strain output to axial tissue force). Transducer pressure and transducer strain were expressed in terms of nondimensionalized design factors. A parametric analysis of the key design factors was then performed. The transverse pressure was shown to vary little for large changes in these factors whereas device strain changed markedly. The analysis was verified by a bench test on an example device. Such a model permits a proposed design to be evaluated without having to conduct costly experiments.     

A novel model of solute transport in a hollow-fiber bioartificial pancreas based on a finite element method

Extravascular bioartificial pancreas based on hollow fiber seems to be a promising treatment of diabetes mellitus. However, solutes mass-transport limitations in such a device could explain its lack of success. To determine critical device parameters, we have developed a novel tridimensional model based on finite element method for glucose, insulin, and oxygen diffusion around an islet of Langerhans encapsulated in a hollow-fiber section. A glucose ramp stimulation was applied outside the fiber and diffused to the islet. Concomitantly, a stationary oxygen partial pressure was applied outside the fiber, and determined local oxygen partial pressure on the islet environment. An insulin secretion model stimulated by a glucose concentration ramp and corrected by the local oxygen partial pressure was also implemented. Insulin secretion by the islet was thus computed as a response to glucose signal. The model predictions notably showed that the fiber radius had to be small enough to favor a fast response for insulin secretion and to ensure a maximal oxygen partial pressure in the islet environment. Besides the effect of fiber radius, a better islet oxygenation could be achieved by adjustments on the islet density, i.e., on the fiber length dedicated to a single islet. These hints should allow the future proposal of an optimal design for an implantable bioartificial pancreas.     

Subcutaneous implantable infusion device for chronic intravenous pulsatile gonadotropin-releasing hormone treatment

Preliminary data indicate the potential utility of an implantable subcutaneous device that facilitates chronic intravenous infusion of pulsatile gonadotropin-releasing hormone (GnRH) for ovulation induction. GnRH distribution curves were congruent in control monkeys and those with implanted devices. Tissue tolerance was good in this brief trial. These findings suggest that use of this or a similar implantable device be considered for chronic GnRH administration in human pulse therapy.     

A novel, fully implantable, multichannel biotelemetry system for measurement of blood flow, pressure, ECG, and temperature.

Biotelemetry provides high-quality data in awake, free-ranging animals without the effects of anesthesia and surgery. Although many biological parameters can be measured using biotelemetry, simultaneous telemetric measurements of pressure and flow have not been available. The objective of this study was to evaluate simultaneous measurements of blood flow, pressure, ECG, and temperature in a fully implantable system. This novel system allows the measurement of up to four channels of blood flow, up to three channels of pressure, and a single channel each of ECG and temperature. The system includes a bidirectional radio-frequency link that allows the implant to send data and accept commands to perform various tasks. The system is controlled by a base station decoder/controller that decodes the data stream sent by the implant into analog signals. The system also converts the data into a digital data stream that can be sent via ethernet to a remote computer for storage and/or analysis. The system was chronically implanted in swine and alligators for up to 5 wk. Both bench and in vivo animal tests were performed to evaluate system performance. Results show that this biotelemetry system is capable of long-term accurate monitoring of simultaneous blood flow and pressure. The system allows, within the room, recordings, since the implant transmission range is between 6 and 10 m, and, with a relay, backpack transmission distance of up to 500 m can be achieved. This system will have significant utility in chronic models of cardiovascular physiology and pathology.     

Exercise-induced changes in cardiac gene expression and its relation to spatial maze performance

Cognitive performance is sensitive to both neural and non-neural changes induced by physical activity and inactivity. This study investigated whether access to physical activity outside a standard laboratory animal cage affected cognitive performance as measured by navigation of a spatial maze. It also examined gene expression in heart tissue for genes associated with cardiovascular function given recent reports of cognitive impairment associated with hyperlipidemia. Furthermore, we measured expression of neural-regulatory genes typically expressed in brain, but also found in cardiac tissue. Male Sprague-Dawley rats (n = 72) were separated into three groups having different access to physical activity: none outside a standard cage, twice-weekly physical activity, and every other day exercise on a running wheel. Compared with a sedentary group, spatial maze performance was enhanced in animals that had access to physical activity, either twice-weekly in a large box or every other day on a running wheel. Both the cardiovascular and neural-related genes expressed in the heart were distinguished by access to physical activity. Several genes that are associated with heart rate, cholesterol biosynthesis, blood pressure, and cell adhesion regulation, including GJA1, FDFT1, EDN1, and CD36, differed in animals based on access to physical activity. Neural-related genes expressed in cardiac tissue associated with neurite outgrowth, neuroplasticity, and neurogenesis including RTN4, HOMER2, ACTB, NCDN, KIF5B, and HMGB2, were expressed differently among the three groups. Significant shifts in ten cardiovascular and neural-related gene expressions in cardiac tissue were associated with physical activity and may have influenced learning and performance on a spatial maze.     

Patient-specific prediction of intrinsic mechanical loadings on sub-muscular pectoral pacemaker implants based on an inter-species transfer function

With the steady technological development enabling reduced device dimensions and new patient populations, detailed data on mechanical in vivo loads become increasingly important to ensure reliability of implantable medical devices. Based on an intra-species correlation of in-line and transverse force of the Pectoralis major established previously for the Chacma baboon (de Vaal et al., 2010a), a simplified physiological model and a mechanical equivalent model were developed for a sub-muscular pectoral device implant considering Pectoralis major, Pectoralis minor and rib cage. By assessing the morphometric and mechanical parameters of these musculo-skeletal structures and the associated model parameters, the intra-species correlation was shown to exhibit (a) robustness for a larger intra-species subject population and (b) linear scale variance allowing application for humans under consideration of the inter-species difference of the attachment angles of Pectoralis major. The transfer function provides a basis for the prediction of patient-specific maximum mechanical loadings on a sub-muscular pectoral cardiac pacemaker implant through non- or minimal invasive measurements on the patient.     

Telemetered epidural pressure.

An implantable transducer capable of telemetering epidural brain pressure during long periods of time is described. The transducer is constructed from conventionally available materials, and routine workshop techniques are used. The coplanarity principle has been applied while the described mounting clamp allows discrete positioning of the transducer relative to the brain. Basically, the transducer consists of a coil-capacitor circuit in which alterations of epidural pressure induce changes in capacity and, thus, the transducer's resonance frequency. An external electromagnetically coupled impedance-measuring device converts the resonance frequency to a pressure analogous voltage. In vitro tests showed that the transducer had good accuracy and reliability for a period of more than 1 month. An in vivo experiment with a cat showed that the measured epidural pressure was linearly related to ventricular fluid pressure.     

Flexible polyimide probes with microelectrodes and embedded microfluidic channels for simultaneous drug delivery and multi-channel monitoring of bioelectric activity

The study of intracellular communication requires devices that can not only monitor the bioelectric activity, but also control and observe the biochemical environment at the cellular level. This paper reports on the development and characterisation of implantable polyimide microprobes that allow simultaneous, selective chemical delivery/probing and multi-channel recording/stimulation of bioelectric activity. The key component of the system is a flexible polyimide substrate with embedded microchannels that is batch-fabricated combining polyimide micromachining and a lamination technique. The devices provide platinum microelectrodes on both sides of the polyimide substrate with an active surface between 20 microm x 20 microm and 50 microm x 50 microm. The embedded microchannels permit highly localised drug delivery or probing at the tip of the device via channel outlets adjacent to the microelectrodes. The microelectrodes were characterised by electrical impedance spectroscopy and the microchannels were studied in microflow experiments. Two different fluid delivery schemes were explored in two different designs. The first device type consists of a simple combination of microchannels and microelectrodes on one substrate. Liquids are ejected at the tip of the device by pressure injection techniques. The second device was inspired by the so-called U-tube concept allowing for highly localised delivery of controlled amounts of liquids in the picoliters range. Thus, the influence of chemical compounds on the electrical activity of cells can be studied with high temporal and spatial resolution. The flexible, implantable devices can be used for studying the chemical and electrical information exchange and communication of cells in in vivo and in vitro experiments.     

Surface artery volume pulse wave measurement - verification of a new method

The aim of this paper is to prove the possible reproducibility of measurement with a new developed device for artery elasticity monitoring and determining the standard of major pulse wave parameters. As a measurement sensor, a conic probe with thin convex membrane was used. This technique allows setting an arbitrary pressure to a measured surface artery. We measured pulse waves on the radial arteries of 108 individuals. We expected similar features in arterial wall elasticity. We concentrated primarily on the amount of subcutaneous fat. For the measured waves we evaluated five following pulse wave parameters: relative crest time, elasticity index, dicrotic wave attenuation, dicrotic wave time and interwave distance. There were no significant differences in measured pulse wave parameters among the tested groups of subjects.     

Analysis of ultrafiltration and mass transfer in a bioartificial pancreas

A bioartificial pancreas is an implantable device which contains insulin secreting cells (Langerhans islets), separated from the circulating blood by a semi-permeable membrane to avoid rejection. This paper describes the operation of such a device and evaluates the respective contributions of diffusion and ultrafiltration to the glucose and insulin mass transfer. It is shown that the pressure drop along the blood channel produces across the first half of the channel an ultrafiltration flux toward the islet compartment followed in the second half by an equal flux in reverse direction from islets to blood. The mass transfer analysis is carried out for an optimal geometry in which a U-shaped blood channel surrounds closely a very thin islet compartment formed by a folded flat membrane. A complete model of insulin release by this device is developed and is compared with in vitro data obtained with rats islets. Satisfactory kinetics is achieved with a polyacrylonitrile membrane used in hemodialysis. But the model shows that the membrane hydraulic permeability should be increased by a factor of 10 to significantly improve the performance.     

Pre-ejection period controlled cardiac pacemaker

Numerous investigations have been performed in search for suitable parameters for physiologic adaptation of the pacing rate. In case of chronotropic incompetence corporeal as well as cardiac control parameters permit open or closed loop control of the pacing rate. Criteria to be considered are the patient's condition, the response time of the system, the proportionality to the oxygen uptake and the susceptibility to interference. A high specificity of the rate response is particularly important for the patient with a low cardiac reserve. The use of a parameter relating to the central hemodynamics, such as the systolic time intervals, particularly the pre-ejection period (PEP), as input signal for rate control is, therefore, of special interest. The concept presented of a PEP-controlled rate adaptive pacemaker is based on the linear proportionality between PEP and the cardiac cycle length. Changing with the sympathetic tone, the PEP permits adaptation of the pacing rate in response to physical as well as emotional stress. The right ventricular PEP parallels the left ventricular one and is measured between the electrode tip and the pacemaker housing. Clinical results obtained confirm the high sensitivity and specificity of this control parameter with respect to the metabolic demand. Technical details of an implantable multiprogrammable device are dealt with.