Hydrogels As An Alternative To Reperfusion And Transplant.

“Cardiac failure is a critical condition that results in life-threatening consequences. Due to a limited number of organ donors, tissue engineering has emerged to generate functional tissue constructs and provide an alternative means to repair and regenerate damaged heart tissues.” 

Such is the sentiment from Ali Khademhosseini and a team from Massachusetts. In fact, they reported here, that in 2009 an average of 77 U.S. citizens underwent transplant each day, but 20 died as a result of a lack of organ availability. The aim, then, in the absence of treatment, is to repair the damaged organ in-situ so as to negate the need for transplant at all.

Enter hydrogels.

Hydrogels are already used in the regeneration of a variety of tissues, and combined with some of the brightest minds in the field significant advances are being made in regenerative medicine: in May this year a team in Toronto have successfully repaired brain tissue after stroke and partially reversed blindness. These versatile substances are also used in disposable nappies, silica gel and contact lenses, so there’s a high chance you’ve already been exposed to them without even knowing it!

These polymers exhibit many desirable characteristics in regenerative medicine. They are relatively easy to synthesise, they can act as solute transports/drug-delivery systems, exhibit elastic properties as well as preventing thrombosis. Their structure also enables them to create a “scaffolding” for cells.

This last point is crucial when combined with the hydrogel’s other properties, but I’ll return to that shortly.

First, consider what happens to cardiac tissue after an acute myocardial infarction: during infarct, the oxygen supply to myocardial cells is reduced or diminished, causing irreversible cell death and necrosis around the occluded artery/arteries. The scar tissue that takes the place of the once-functioning cardiac muscle has none of its contractility and the heart is far less efficient as it once was. Cardiac output, systolic and diastolic functions are affected and whilst medication, reperfusion techniques a bit of luck regarding preserved left ventricle function all provide a better prognosis, heart failure is a serious risk and figures regarding mortality rates aren’t great: MI, specifically STEMI brings with it a 30% mortality rate, 50% of this figure dying before hospital admittance and 10-15% being re-hospitalised one year after the index event.

So, where do hydrogels come into the picture?

In the case of extreme loss of cardiac function and the inability of conventional treatment to improve the given prognosis, hydrogels provide an environment in which it is possible to introduce stem cells, growth factor, gene injection or therapeutic medication in an ‘artificial’ environment that simultaneously provides mechanical support to the infarcted area and aids in the replacement of necrotic tissue. As well as being a relatively non-invasive procedure when it comes to the injection of the treatment, the hydrogels scaffold itself is naturally degraded by the body when the process is complete.

According to another team in Massachusetts, published here, trials have shown significant success since they began in small animals, but their application isn’t as straightforward in large primates. They commenced in humans in 2008 (in an extremely truncated form), but in order for hydrogels to be viable in widespread clinical treatment, much more research is required. An example of this is that not much is known about the exchange of signals that take part in the movement of stem cells to an injured myocardial tissue post-hydrogel treatment. Optimum degradation time is a further issue in humans.

Despite these, and other setbacks, there remains great promise in hydrogels to lower global mortality rates as a result of MI. In recent years, significant advances in research are making the possibility of myocardial repair in humans an almost visible reality.

Thanks!

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The Best Apps For Student Physiologists

(in my opinion and predominantly found on android)

EDIT: I have added a 5th app at the bottom of the page, “Read by QxMD”.

My bus journey to university can take anywhere from 1.5 to 2.25 hours, depending on how willing the driver is to break the speed limit, so I try my best to make good use of the time available.
It can be rather cumbersome to hold a textbook when the bus is full and the constant movement makes it rather difficult to follow the words on a page, so I downloaded a few apps to help pass the time as well as study and, as you can imagine, some of them have been better than others.
So that you don’t have to spend your wages/student loan unnecessarily, I’ve decided to share those few apps that have either interested me, or helped me during the PTP programme so far.

I’ve omitted any apps that are effectively digital print textbooks, as these are often promoted in both Google Play and the App Store, costing £20-30 and are nowhere near as difficult to find as a couple of these picks.
I’m also not suggesting that you get all of these apps, either; were it not for this post, I wouldn’t have them all. Everyone learns differently, so you’ll probably need one or two at most.

All of these prices are correct at the time of posting, but if any have changed, let me know and I’ll update them accordingly.

 

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1.) ECGsource, Cathsource, Echosource (ECGsource LLC)
 Google Play: £1.92, £2.54, £3.03
App Store:      £0.79, £2.29, £2.29

These three apps provide a great deal of content and are very reasonably priced, but ECGsource on it’s own is the app that will benefit Y1&2 PTP students the most. It contains information and analysis parameters for a very large number of pathologies, videos to help you understand key principles in ECG science and a tutorial on reading a normal ECG.
This app is a personal favourite of mine, not just for the number of arrhythmias it covers, but for the examples it gives in addition to these.
If you have an android device and you can only get one app, make it this one.

Screenshot_2015-10-05-21-09-05~22.) ECG Practical Demo (One 2 One Medicine LTD)
Google Play: Free
App Store:     N/A

This app isn’t nearly as easy to follow as ECGsource, but is still packed with content once you know what you’re doing. It also contains a rate/R-R correction tool, a set of digital calipers and an easy to use axis calculator for measurements on the go.
There is a paid version of this app available to purchase, but if you spend a couple of quid, you’ll get all the same information with better quality examples by getting ECGsource or QxMD. For the tools you get with the free version, however, you can check your answers on analysis assignments for free, making this worth a look.

I’m yet to find an app with all of these features on the App Store, but, if I’m honest, I started running out of money whilst wading through the plethora of terrible apps out there, so stopped looking.

Screenshot_2015-10-05-17-24-33~23.) 100 ECG Cases for Finals (One 2 One Medicine LTD)
Google Play: Free
App Store:     N/A

A quiz featuring (shockingly) 100 ECG Cases for you to analyse and be graded on.
Quizzes are grouped into categories such as Uncommon Arrhythmias, Supraventricular Arrhythmias, etc, so you can really fine-tune your skills in a particular area.
100 ECfF doesn’t offer any tutorials, so obviously it’s recommended that you have some knowledge from other sources before you have a go at it, but it’s made for USMLE finals, so it’s a handy thing to have as you progress.

It isn’t available on iOS, but ACLS Rhythm Quiz is the best option over on the App Store, costing £0.79

Screenshot_2015-10-05-20-42-30~24.) QxMD ECG Guide (QxMD)
Google Play: £3.19
App Store:     £0.79

Much the same as ECGsource, but seemingly optimised for iDevices, this app has everything a PTP student could need for ECG analysis and arrhythmia recognition. This great app also comes with a handy analysis tool that can you can use to check your answers when you’re practicing.

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5.) Read by QxMD (QxMD)

Google Play: Free

App Store:    Free

This app is a wonderful way to tailor your journal reading experience to suit your course needs. New updates and articles are available frequently and are all viewable and searchable within the app. I have personally found this tool to be invaluable when trying to further understand the nuances of pathologies within cardiac science.

Hopefully these will help you along your programme as much as they have me.

Thanks!

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The Times They Are A-Changing.

Hello again!

It seems that as soon as I mentioned just how quickly this profession is evolving, something has been raised that enables me to give you an idea of how much.

This blog is called The Student Physiologist. The career’s professionals are known as physiologists or physiological scientists, ergo, myself and my peers are subsequently coined physiology students.

This, however, will soon be a thing of the past, as by the time I qualify, these terms will no longer exist. In their place will be Healthcare Scientist.

It’s difficult to find any sort of identity in such a changing professional environment and this difficulty is bolstered when a physiological scientist tries to explain their role within the NHS. We are among the most patient-facing scientists in the clinical setting, yet we are arguably the least “seen”, in that no matter the description of who you are and what your job is, patients and other staff alike will invariably refer to you as “nurse” or “doctor”. Whilst doctors and consultants are prevalent in this career, it is difficult to convey to patients and staff, the differences between medic and scientist in both the hospital and these roles specifically.

This has highlighted to me, the need for a global identity and perhaps a way for we, as the people with that identity, to forge it for ourselves.

As the evolution moves ever forward, this blog may be named The Healthcare Scientist and I may be signing off with the same name.
We shall see.

Thank you.

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An Introduction.

Hello.

I have this last academic year, completed my first full year of Cardiac Physiology.
My course consisted of four modules, each focusing on broad, yet still specific areas of science and scientific practice.

The modules were as follows;

Biomedical Skills.
– Medical physics, algebra, calculus, etc.

Anatomy and Physiology.
– Exactly what it sounds like; anatomical systems, terminology, dissection, prosection, and a hell of a lot of pop quizzes.

Cellular biochemistry and Genetics.
– Microscopy, mrganic chemistry, pharmacology and, shockingly… Genetics.

Physiology and Patient Care.
– The physics, biology and methodology behind various medical tests and how to use and perform them, then interpret the results, patient psychology and care, and the pathology of cardiac and respiratory disease, etc.

I refrained from creating this blog until the start of my second year due to the irrelevant content of the first year as a whole. Whilst the first three modules listed were required by the curriculum, they were far from ‘physiology-centric’ and the final module was little more than a (very good) detailed introduction. This will change, however, from here on out.
I must stress that this is not a slight on the course structure or its content so far, as nearly everything that myself and my colleagues have been taught has been engaging and informative, I simply felt that to document such a broad range of topics on a Cardiac Physiology blog would quickly become something akin to an unwanted university lifestyle diary. I can assure you, that aside from study tips, this shall not be the case.

The next steps of my journey are the ones that will be of greatest interest to fellow students, physiologists and hopefully to the relevant governing bodies.

In the forthcoming posts, I shall document my feelings on the course structure, content, struggles I have encountered and where the career path seems to be going.
I intend to post once a week without fail, but will update with more frequency as points of interest present themselves.

To those just starting their journey, I will post some relevant information regarding the Physiology module from last year, but mainly to assist with what’s to come.

If you know anyone who is currently journeying down this pathway, or is thinking of doing so, point them in this direction. I aim to network, exchange ideas, discuss common issues and everything in between.

Thank you.

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