Bionics 2

1. Bionics 2 Kevin Warwick Room 171

2. Body Parts • Nowadays it is speculated that a human could be replaced bit by bit/organ by organ • How true is this? • Excepting the brain and Neuroprosthetics, what about human organ replacement? • Artificial devices not transplants

3. Body Parts • Artificial Hearts • Artificial Lungs • Artificial Kidneys • Artificial Pancreas • Artificial Hips and Knees • Artificial bladder/cardia/penis • Not Prosthetic Arms and Legs • Not Neural stuff

4. Artificial organs • Life support to prevent imminent death while awaiting a transplant (e.g. artificial heart) • Dramatic improvement of the patient's ability for self care (e.g. artificial limb) • Improvement of the patient's ability to function socially (e.g. cochlear implant) • Cosmetic - after cancer, surgery or an accident.

5. Artificial Hearts • An artificial heart is a prosthetic device that is implanted into the body to replace the biological heart. • It is different from a heart bypass machine, which is an external device (a CardioPulmanory Bypass - CPB). • A CPB is only suitable for a few hours use, while artificial hearts have so far been used for periods of well over a year.

6. Artificial Hearts • Heart is basically a pump, but with a lot of subtleties. • Lower the need for transplants • Foreign-body rejection a problem • Right is Abiocor

7. Artificial Hearts • 1963 – first patented device (Uni Utah) • 1982 – first patient 61-year-old Barney Clark, survived for 112 days • 2001 – Abiocor, self-contained, approved for human use - the longest implantation so far is 602 days (20.4 months). • Main use is still for folk waiting for a transplant

8. CardioPulmonary Bypass (CPB) • Temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. Referred to as a Heart-Lung Machine • Oxygenator was first described by Robert Hooke in the 17th Century – removes carbon dioxide, injects oxygen to/from blood

9. Iron Lung • A large machine that enables a person to breathe when muscle control has been lost or is poor. • Person is in the centre of a steel drum. Head and neck external. Drum forms an air-tight compartment enclosing the person's body. Pumps periodically decrease & increase the air pressure. When the pressure falls below that within the lungs, the lungs expand and air from outside the chamber is sucked in via the nose to keep the lungs filled; when the pressure rises above that within the lungs, the reverse occurs, and air is expelled. In this manner, the iron lung mimics the normal action of breathing.

10. Iron Lung

11. Iron Lung • Not exactly portable • Is it Bionic? • No portable/replacement form available • External ventilators for asthma sufferers + oxygen tanks for divers etc – but are these Bionic? • What about other artificial organs?

12. Artificial Kidneys • A portable, self-contained artificial kidney has not yet been developed. • A dialysis machine is a critical life support device that completely replaces the duties of a kidney – like an Iron Lung, it is a separate machine. • Dialysis machine is used as a temporary measure, because of a disease or for a person waiting for a kidney transplant.

13. Dialysis Machine • Doesn’t treat the disease – merely a life support system • Via a membrane, restores levels of minerals such as sodium and chloride, and bicarbonates to expected levels in blood flow. • Removes potassium, acid and urea from the blood. (waste products) • Replicates effects of kidneys

14. Dialysis Machine

15. Pancreas • The pancreas is below the stomach and above the duodenum. It releases endocrine hormones (insulin, amylin and glucagon) into the portal vein, where it flows directly to the liver. • Diabetes is the inability of the beta cells of the pancreas to produce sufficient insulin.

16. Artificial Pancreas • Helps diabetics control their blood glucose level by providing the substitute endocrine functionality of a healthy pancreas. • The lack of insulin production is the motivation to develop a substitute. • Insulin replacement therapy is appreciated for its life-saving capability, but manually managing the blood sugar level with insulin alone is arduous and inadequate.

17. Artificial Pancreas • Different approaches under consideration: • Medical equipment approach - using an insulin pump under closed-loop control using real-time data from a continuous blood glucose sensor. (nearly there) • The biotechnology approach - the development of a bio-artificial pancreas. When surgically implanted, the device will behave as the original pancreas and will be viable for years. (Speculation) • The gene therapy approach - the therapeutic infection of a diabetic person by a genetically engineered virus which causes a DNA change of intestinal cells to become insulin-producing cells. (Speculation)

18. Artificial Pancreas • The Insulin pump is used to automatically deliver basal insulin continuously, and bolus insulin at meal times by pressing the buttons. Before meals, a blood glucose value is entered into the pump to calculate the correction bolus to bring the blood glucose level back to the target value

19. Artificial Pancreas – present day • An insulin pump to infuse a rapid acting insulin is the first step in simulating the function of the pancreas. The pump can deliver small increments of insulin compared to an injection, and its controls match the insulin profile required for a given situation. The pump is controlled manually on command based on a snap shot of the recent blood glucose level and an estimate of the carbohydrate consumed. This approach is open-loop. Once a bolus has been calculated and delivered, the pump continues to deliver its basal rate insulin in the manner that has been programmed. • While insulin replacement is a life saving therapy, its practical use in controlling blood glucose levels sufficiently to avoid long term complications is not ideal. • It is a therapy!!!

20. Artificial Urinary Bladder • In 2006 the world's first lab-grown organ, a bladder, was transplanted into a human. The bladders are grown from a small sample of the patients' own bladder tissue, no risk of rejection. Traditionally, damaged bladders are stitched back together using other tissue from the stomach or intestine. • A CT scan of the patient is taken, to determine the shape of the bladder that must be created. A tissue sample is taken from the patient's bladder. These cells are grown (takes 4 weeks), and then layered onto a scaffold in the shape that the required bladder is to take. The transplant procedure then takes place. The entire bladder along with the scaffold is transplanted. The biodegradable scaffold degrades within the patient's body.

21. Artificial Cardia • Sounds like the heart – but no. • This relates to gastric repairs, specifically of the valves at either end of the stomach. • The cardia prevent the refulgence of stomach contents into the esophagus. • Artificial cardia consist of metallic and macromolecule materials • Simply used as replacements where disease has taken the originals. • Very few such operations even now have been carried out

22. Artificial Corpora Cavernosa • For erectile disfunction, both corpora cavernosa can be irreversibly surgically replaced with manually inflatable penile implants. This is a drastic therapeutic surgery meant only for men suffering from complete impotence that has resisted all other treatment approaches. • An implanted pump in the groin or scrotum can be manipulated by hand to fill the artificial cylinders, normally sized to be direct replacements for the natural corpus cavernosa, from an implanted reservoir in order to achieve an erection.

23. Artificial Hips • The most common reason for replacing the hip joint is because of damage to the hip by osteoarthritis. Other reasons include infection or a fractured hip, which commonly occurs in older women as a complication of osteoporosis or a fall. • The new joint is put in during a major operation known as a total hip replacement (THR). About 35,000 THRs are carried out each year in England and Wales on the NHS, and a considerable number more in private hospitals.

24. Artificial Hips • The joint consists of three parts: • A metal ball (titanium alloy) that replaces the top of the femur or leg bone. • Attached to this ball is a metal stem, which is inserted down into the centre space of the femur. The metal ball and stem are stuck to the bone using cement. • A spherical plastic cup is inserted separately in the bone of the pelvis. The metal ball of the artificial hip joint is then pushed into this cup, joining the leg and the pelvis. The ball can move around in the cup, so the joint can bend and move.

25. Artificial Knees • www.goldsteinortho.com/knee.htm • Illinois Bone and Joint Institute

26. Thoughts • Mechanical replacements – knees/hips • Organs still largely experimental or short term – mainly transplants not implants • Long way away from (artificially) rebuilding or building a human body • All therapeutic here – no enhancement • Here we have avoided the brain/nervous system – even more difficult

27. Final Thought • Still a long way from Bionic people