Hemodialyzed (HD) patients with end-stage renal disease (ESRD) exhibit lower fitness as a consequence of chronic uremic changes that trigger various structural, metabolic, and functional abnormalities in skeletal muscles. The aim of this randomized study was to compare the effect of rehabilitation (RHB) training on a bicycle ergometer and electromyostimulation (EMS) of leg extensors in HD patients with ESRD. Thirty-two HD patients (18 men/14 women; mean age 61.1 ± 8.8 years) were randomized into three groups: (i) exercise training (ET; n = 11) on bicycle ergometer 2 × 20 min; (ii) EMS (n = 11) where stimulation (10 Hz) of leg extensors was applied for 60 min; and (iii) controls (CON; n = 10) without exercise. Exercising was performed between the 2nd and the 3rd hour of HD, three times a week, 20 weeks in total. Ergometric test was performed in order to evaluate peak workload (W(peak)), 6-min corridor walking test (CWT) to evaluate the distance walked, and dynamometry of leg extensors to assess muscle power (F(max)). Urea clearance was monitored and expressed as standard parameters: spKt/V, spKt/V equilibrated (spKt/V-e), and the urea removal ratio (URR). Quality of life (QoL) was assessed by the questionnaire SF-36. A significant increase of F(max) (P = 0.040 in group ET; P = 0.032 in group EMS), of 6-min CWT (P < 0.001 in ET group; P = 0.042 in EMS group), and of W(peak) (P = 0.041 in ET group) was observed. In both exercising groups, significant increase of spKt/V, spKt/V-e, and URR was found as compared with initial values (P < 0.05). In both exercising groups, highly significant changes in summarized mental functions were found (P = 0.001); in summarized physical components, significant improvement was observed in the ET group (P = 0.006). Intradialytic RHB showed comparable positive effects on functional parameters, urea clearance, and QoL. Intradialytic EMS might represent wide therapeutic possibility in the near future.

This study has three purposes, as follows. The first is to develop a microscopic system to observe the microcirculation of animals implanted with an artificial heart. The second is to investigate the influence of flow pattern change from pulsatile to nonpulsatile on the microcirculation. The third is to study the effects of pulsatility in blood flow on endothelium-derived nitric oxide release in the microvasculature. When the flow pattern was changed from pulsatile to nonpulsatile, the velocity of erythrocytes in many capillaries dropped and remained at a low level, and the number of perfused capillaries decreased. After the flow pattern was returned to pulsatile, the velocity of erythrocytes recovered to the initial level. In many cases, the flow of nonperfused capillaries recovered to the initial level as well. Also, the pulsatile flow enhances the basal and flow-stimulated endothelium-derived nitric oxide release in microvessels.

A new system toI observe the microcirculation on the bulbar conjunctiva was developed using a digital high definition microscope to investigate the influence of the flow patterns on the microcirculation in a goat with a total artificial heart (TAH). The undulation pump TAH was implanted into the goat. When the whole body condition became stable, the flow pattern was modulated between the pulsatile and the nonpulsatile mode, and the changes in the microcirculation were observed. When the flow pattern was changed from pulsatile to nonpulsatile mode, the erythrocyte velocity in capillaries dropped from 526 Ϯ 83 to 132 Ϯ 41 m/s and remained at a low level. The number of perfused capillaries decreased as well. Then the nonpulsatile flow mode was maintained for 20 minutes. After the flow pattern was returned to the pulsatile mode again, the erythrocyte velocity recovered to the initial level (433 Ϯ 71 m/s). In many cases, the flow of the nonperfused capillaries in the nonpulsatile mode recovered to the initial level after the flow pattern was changed to the pulsatile mode again. The perfused capillary density in the nonpulsatile mode (19.7 Ϯ 4.1 number of capillaries/mm) was significantly lower than that in the pulsatile mode (34.7 Ϯ 6.3 number of capillaries/mm).It is thought that the basal and flow stimulated endothelium derived nitric oxide release in the microvessels decreased because of the disappearance of pulsatility and that the nitric oxide induced the constriction of arterioles after the flow pattern was changed to the nonpulsatile mode. At the same time, the baroceptors might sense the decrease in the arterial peak pressure or dp/dt, and the sympathetic nerve increases activities and induce the constriction of arterioles. Then, the erythrocyte velocity in capillaries would decrease. Because of the flow pattern further in the chronic phase, it is important to follow the change in the microcirculation. ASAIO Journal 2004; 50:321-327. mplantation of the total artificial heart (TAH) triggers complex responses in the recipient's organism. Therefore, an important question is whether the microcirculation (MC) of the animal with a TAH is kept normal . The physiologic relations of the cardiovascular system can be changed and can lead to significant alterations because of a TAH. 1-2 Artificial perfusion is a complex process, and, at this point, the interactions taking place on the level of central and peripheral regulations are not fully understood. There is also another long standing question of whether arterial pulsation is essential to maintain adequate blood flow and aerobic metabolism in key organs. Nonpulsatile circulation has been widely used in the clinical setting of cardiopulmonary bypass or circulation support. 3-5 Many studies have been performed in cardiopulmonary bypass or in left ventricular support. 6 -13 In some studies, the organ to which attention was directed was the brain. 14 -20 The undulation pump total artificial heart (UPTAH) is an implantable TAH that has been in development at the Univers...

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A driving diaphragm in the long-term working total artificial heart (TAH) is under serious mechanical stress, and the long steady contact with blood causes changes to the diaphragm's surface. These changes can be influenced either by local or systemic interventions. In our study, we tried to follow the development of changes to the diaphragm's surface comparing the samples of diaphragms of long (over 30 days) and short (under 30 days) surviving calves and the effect of some preventive measures as well. We could confirm the presence of two types of calcification: a dystrophic calcification affecting primarily formed thrombi and necrotic tissue, and a primary type of calcification that begins in the form of calcifying nuclei on the protein layer of the polyurethane surface that is later on extensively covered with a fibrin network and blood cells. The calcified deposits caused mechanical damage or were the source of microembolization to the vital organs. A clotting mechanism occurs at the same time as the calcifying process from the beginning, often forming a fibrin network in and over the calcified deposits. An attempt at prevention was made by systemic administration of colloidal iron solution, Ferrum Lek (ferri saccharate in a stable colloidal form), based on the concept of the so-called reversed calciphylaxis.

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Twelve total artificial heart (TAH) models have been developed at the Brno Research Center. Devices VII, VIII, and IX were constructed on the principle of asymmetry. Three main objectives had to be fulfilled by this construction. First, contact of the flap inflow valve with the diaphragm during the pumping cycle had to be avoided. Second, the evacuation regimen of the blood chamber needed to be improved. Third, the danger of thrombi formation due to the lesser incidence of the dead corners had to be decreased or eliminated. The type VII heart has a roof-shaped polyurethane valve in the outflow tract whereas the type VIII heart has a flap valve. The decrease of thrombi incidence around the outflow valve was thus secured, and the driving pressure was decreased as well. In the type IX heart, the small additional flap valve is attached to the outflow valve. In one Brno VII device, Imachi's jellyfish valve has been mounted. Altogether, 62 long-term experiments with survival times of 30-314 days have been performed. To this number, 4 comparative experiments using the Rostock artificial heart were added.