Annual Review of Biomedical Engineering Volume 1, 1999Martin L. Yarmush, Kenneth R. Diller, Mehmet Toner, Editors,1999, Annual Reviews, Palo Alto, California, ISBN: 0-8243-3501-5, viii + 709 pages, 30 colour plates, $67. This book is the first volume of an annual collection of review papers in biomedical engineering. The articles come from four main fields: bioelectrical engineering, bio-mechanical engineering, biochemical engineering, and biomedical imaging. These review articles extend our knowledge in clinical medicine, i.e. orthopaedics, respiratory treatment, transplantation, haematology and cardiovascular medicine, and broaden our know-how in rapidly growing and changing fields such as gene therapy, genome research and microscopic transport processes. The twenty four contributed chapters span impressively the field of biomedical engineering. In order to better understand and judge the book's contributions and value, it is essential to put it in perspective with other collections of a general nature, such as The Biomedical Engineering Handbook [1], or the Handbook of Medical Informatics [2]. These books give a more tutorial-like overview of the field whereas the intent of annual reviews lies in the provision of up-to-date reviews. The book serves its purpose. The book starts with a dedication in memoriam of Richard Skalak, a pioneer in bioengineering and biomechanics, by his son Thomas. In it he gives an overview of his father's live and work. The second paper by Laurencin et al. addresses orthopaedic applications of tissue engineering (bone, ligament, cartilage). Problems and limitations of existing therapies such as the insufficient supply of donor tissues, rejection and disease transfer are presented together with new approaches such as (a) using porous, degradable polymeric scaffolds which provide support while allowing the ingrowth of new tissue as the scaffold degrades, (b) extracting appropriate cells from a patient, culturing the cells in vitro and transplanting the cultured cells back into the patient, and (c) culturing the cells on a preformed 3D scaffold and then transplanting the cell-polymer construct into the patient. Kamm discusses in the third review topics related to the mechanical properties of the airways and their microstructural basis. Factors that influence airway constriction become increasingly interesting in diseases such as asthma. He presents experimental measurements and theoretical models of airway compliance and points at future directions of research. The fourth chapter by Schmid-Schönbein deals with the biomechanics of microcirculatory blood perfusion. As diseases manifest themselves early in microcirculation, the importance of biomechanical models describing not only how cell and tissue biology influences cytoplasmic mechanical properties and shape, but also how cells are influenced by fluid shear stress, becomes clear. Gert Schmid-Schönbein gives a very persuasive account of the subject and points to other reviews on microvascular haemodynamics and pulmonary microcirculation. The next report by Chaikof reviews the engineering and material considerations in islet cell transplantation. The activity in this field results from efforts to treat juvenile-onset diabetes with transplanted pancreatic islets. The whole process of islet cell transplantation requires that established biological constraints, biohybrid devices for cell delivery, available barrier materials and processing strategies directed at solute transport, barrier permeability, and host responses, interface. Elliot Chaikof finally presents an outlook on promising areas of investigation, i.e. adjunctive immunomodulation to achieve selective tolerance, generating immunoprivileged cells and sites. The contribution by Nielsen addresses bioreactors for haematopoietic cell cultures. The ex vivo expansion of haematopoietic cells has potential applications in bone marrow transplantation, immunotherapy, gene therapy and the production of blood products. Lars Nielsen addresses the optimisation of culture parameters and the design of bioreactors for large scale production. The paper by Heller gives a review and the current state of implanted electrochemical glucose sensors for diabetes management. The benefit of a close monitoring and maintaining of a normal glucose concentration was demonstrated by the Diabetes Complications and Control Trial (1993). Heller describes the three types of sensors that are currently engineered and their limitations. The chapter by Troyk presents the concept of an injectable micromodule implant. Philip Troyk examines the historical evolution of radio frequency identification tags and describes specific micromodules together with technological challenges. He stresses especially the use of mircomodule implants for functional-neuromuscular stimulation. The contribution by Howe and Matsuoka gives an overview of the use of robotics in surgery and discusses current research issues and promising new areas. Rakesh Jain explores in his article the transport of molecules, particles, and cells in solid tumors. The ultimate goal is a quantitative understanding of the various steps involved in the delivery of therapeutic agents. These steps are the understanding of angiogenesis and blood flow, metabolic microenvironment, transvascular transport, interstitial and lymphatic transport, cell transport, and systemic distribution and interspecies scale-up. Jain describes experimental and theoretical approaches, recent findings and some approaches of taking the concepts from bench to bedside. The review by Roth and Yarmush addresses three emerging technologies of nucleic acid biotechnology: (a) DNA microarrays for the molecular basis of disease, (b) antisense technology for the inhibition of undesired genetic functions, and (c) gene therapy for the introduction of genes into cells for a therapeutic effect. DNA microarrays ("chips") are arrays of nucleic acids on a surface ("glass") for the purpose of large scale hybridisation. Oligonucleotides are generally synthesised directly on a glass slide. By sequentially masking selected portions of the array, all combinations of the nucleotide bases may be generated, thus overcoming computational complexity issues. Antisense molecules are oligonucleotides whose sequences are complementary to RNA transcribed from the target gene. These molecules block gene expression by interacting with its RNA transcript. Gene therapy refers to the transfer of a gene or genes to cells for a therapeutic effect. Transferred genes are expressed by the target cells, which should then produce some beneficial biological effect. Roth and Yarmush present these rapidly changing fields in a very condensed fashion. Maybe three reviews, one on each topic, would have served the purpose better. Nevertheless their article gives a good starting point to the fields, provides an extensive bibliography (171), and addresses issues such as "datamining", drug delivery strategies, and immune system resistance to vectors. The contribution by Wootton and Ku explores the fluid mechanics of vascular systems, diseases, and thrombosis. The distinguishing features of blood flow in the arteries are pulsatility and branches, which cause wall stresses to be cyclical and non-uniform. The chapter by Smith and Ideker deals with automatic implantable cardioverter-defibrillators. They give a review of the evolution of these devices and point to advances in circuits, leads, waveform detection, and the understanding of the mechanisms of fibrillation and defibrillation. Robert Roemer describes in his article the current status and the future requirements of software and equipment for the hyperthermia therapy of cancer. He addresses issues of customer needs, patient treatment planning systems, heating systems, feedback and data acquisition systems. The chapter by Robb gives an overview of 3D visualisation in biomedicine. With the availability of high-resolution tomographic scanners and imaging systems 3D visualisation becomes possible. Richard Robb gives an introduction to 3D image generation and display and reviews applications in virtual endoscopy, neurosurgery, prostate cancer, cardiac and coronary artery disease, radiation treatment planning, and microscopy imaging. The review by Voldman et al. describes microfabrication technology and its application to biology and medicine. Integrated circuit manufacturing technology is used here to create objects in the range of micrometers to millimetres. An overview is given of microfabrication technology and the applications of these objects within the domains of molecular biology (e.g. DNA microarrays) and biochemistry, cell biology, medical devices and biosensors. The contribution by Diamond addresses optimal strategies for blood clot dissolution. Blood clots form under hemodynamic conditions and can obstruct flow during angina, acute myocardial infarction, stroke, deep vein thrombosis, etc. Removal of these clots, through enzymatic and/or mechanical procedures, requires a consideration of the biochemistry and the structure of blood clots together with local transport phenomena (see the article by Wootton and Hu). Nitsche surveys selected aspects of intercellular and intracellular transport. By modelling such phenomena quantitatively it is possible to separate physical from chemical factors. Johannes Nitsche emphasises in his review a mechanistic understanding of the processes, experimental probes of cellular permeability, and linking biological phenomena occurring at different length scales. In the paper by Wiencek, strategies for protein crystal growth are reviewed. Wiencek focuses on aspects of protein crystallisation that are relevant to X-ray crystallography. Koffas et al. review basic concepts of metabolic engineering and give examples of applications in the production of primary and secondary metabolites, cell and tissue engineering, and biomedical engineering. Special attention is given to metabolic flux analysis, the determination of intracellular fluxes along with the analysis of factors affecting flux distributions. The contribution by York and Kim addresses the area of ultrasound processing. They present a review of established diagnostic ultrasound modes and new applications such as panoramic and three dimensional imaging. In their contribution Mun and Turner review the emergence and requirements of telemedicine, while the article by Budinger et al. addresses the imaging of small transgenic animals. The last paper by Jaklevic et al. discusses recent developments in the area of bioinstrumentation for genetic analysis. Overall, the edited book is very informative and presents a wide range of problems in biomedical engineering that are either solved, being solved or need to be solved, as well as a set of diverse applications reflecting the field. Of course, 24 chapters are not sufficient to cover every aspect of biomedical engineering, which means that advanced methods of biomedical signal analysis (e.g. wavelets) and pattern recognition (e.g. neural networks) are under-represented. The book is aimed at a rather unique audience. It addresses the mature researcher and scientist (who already has a substantial background in this area) and offers challenges to advance the field further. This is aided by extensive bibliographies at the end of each chapter and by an exceptional subject index (thirty pages, set in three columns). As the field of biomedical engineering is so extremely diverse and specialisation is a must, this book helps to bridge the gap across the disciplines. I personally enjoyed reading the papers and I strongly recommend the book to every professional involved in the field of biomedical engineering. [1] The Biomedical Engineering Handbook, Bronzino JD (Ed.), IEEE Press [2] Handbook of Medical Informatics, van Bemmel JH, Musen MA (Eds), Springer-Verlag Hans A. Kestler | ||