Med Cover Art for "EVA" Project

 A new study published in the journal Med suggests that some mammals possess the ability to use their rectums for respiration. In the study, Takanori Takebe and his team affiliated with Cincinnati Children's Hospital, Tokyo Medical and Dental University, and Yokohama City Univerity provide evidence of intestinal breathing in both rodents and pigs by delivering oxygen intrarectally through a liquid ventilation-based system termed EVA (enteral ventilation via anus).

The paper can be seen at Med(2021);2(6):633-784 .

 

 

Can mammals breathe through the bottom?

 

 During the COVID-19 pandemic, I have heard the machine named "ECMO" for few times in the news. Extracorporeal membrane oxygenation, or "ECMO" is a life support machine which provides cardiac and respiratory support to patients whose heart or longs lose function. A critical shortage of ECMO was a major problem in many countries. Many patients could have lived longer if there were sufficient ECMO or if there were alternative technologies provided.

  I now some animals, such as catfish can breathe through hindgut in some circumstances, but never imagined mammals do the same things until Dr. Takebe contacted me and explained his research. The study team injected oxygen-rich perfluorodecalin into mouse and pigs and supply oxygen enterally, then confirmed the improvement in oxygenation. This could be a vital discovery since this findings may pave the way for new ventilation strategies for humans.

 Dr. Takebe requested for the cover art submission and we talked about the ideas in email. This time, we agreed to make it straightforward -- a pig sinking in the liquid with bubbles. 

 

Two rough sketches for the cover art.  We decided to go for the left one since the study is about the bottoms.

 

 I quickly drew a pig using colored pencils, but wondered how to express transparent bubbles that surrounding the pig.

After some experiment, I used transparent films and drew bubbles by superposing the films on the drawn pig. It was time consuming to scan and adjust each bubble', but it was nice to control the position and the amount of bubbles. The background was created by watercolor paintings.

 

Pig, bubbles and dark blue background. Different papers and different media.

 

 It was fun to combine three media at the end. Lastly I added more bubbles digitally and put some reflected lights of the pig into digitally scanned bubbles. It was a learning process to understand how bubbles behave to the object in the water.

 

Two types were made for the cover submission. The left one was selected.

 

The official cover legend says: “On the Cover: Some non-mammalian aquatic organisms have evolved unique intestinal breathing mechanisms to survive extreme low-oxygen conditions. In this issue, Okabe et al. (pp. 773–783) provide evidence of intestinal breathing in both rodents and pigs by delivering oxygen intrarectally through a liquid ventilation-based system termed EVA (enteral ventilation via anus). During hypoxia induced-respiratory failure, EVA improved survival and systemic oxygen levels in preclinical models, thus opening up the possibility of recruiting the distal gut as breathing organ in critical care when mechanical ventilation is insufficient or in short supply. The cover art illustrates a pig swimming in oxygenated liquid, conceptually depicting the EVA technology. Artwork by Misaki Ouchida.”

 It was really nice to be involved in this unique study. I hope this technology would save more patients who are suffering from not only COVID-19 but also other respiratory related diseases in future.​